0001209191-23-044407.txt : 20230803 0001209191-23-044407.hdr.sgml : 20230803 20230803161211 ACCESSION NUMBER: 0001209191-23-044407 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230801 FILED AS OF DATE: 20230803 DATE AS OF CHANGE: 20230803 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Wise Raymond F. Jr. CENTRAL INDEX KEY: 0001691779 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 231140109 MAIL ADDRESS: STREET 1: 10375 PROFESSIONAL CIRCLE CITY: RENO STATE: NV ZIP: 89521 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 X0508 4 2023-08-01 0 0001018979 AMERISAFE INC AMSF 0001691779 Wise Raymond F. Jr. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - CSO 0 Restricted Stock Unit 2023-08-01 4 A 0 14188 0.00 A Common stock 14188 14188 D Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock. The restricted stock units vest in four annual installments of 15%, 20%, 30%, 35% beginning August 1, 2024, the first anniversary of the grant date. /s/Kathryn H. Shirley, attorney-in-fact for Raymond F. Wise 2023-08-03