0001209191-23-036767.txt : 20230613
0001209191-23-036767.hdr.sgml : 20230613
20230613165029
ACCESSION NUMBER: 0001209191-23-036767
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230609
FILED AS OF DATE: 20230613
DATE AS OF CHANGE: 20230613
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GARCIA PHILIP A
CENTRAL INDEX KEY: 0001177114
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 231011907
MAIL ADDRESS:
STREET 1: 100 ERIE INSURANCE PL
CITY: ERIE
STATE: PA
ZIP: 16530
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: AMERISAFE INC
CENTRAL INDEX KEY: 0001018979
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 752069407
STATE OF INCORPORATION: TX
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
BUSINESS PHONE: 337-463-9052
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0407
4
2023-06-09
0
0001018979
AMERISAFE INC
AMSF
0001177114
GARCIA PHILIP A
5997 CYPRESS LANE
BONITA SPRINGS
FL
34134
1
0
0
0
0
Common stock, par value $0.01
2023-06-09
4
A
0
1408
0.00
A
21537
D
Subject to restrictions that will lapse at the time of the Issuer's 2024 annual meeting of shareholders.
/s/Kathryn H. Shirley attorney-in-fact for Philip A. Garcia
2023-06-13