0001209191-23-048372.txt : 20230906 0001209191-23-048372.hdr.sgml : 20230906 20230906161603 ACCESSION NUMBER: 0001209191-23-048372 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230901 FILED AS OF DATE: 20230906 DATE AS OF CHANGE: 20230906 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Omiridis Anastasios CENTRAL INDEX KEY: 0001789494 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 231239364 MAIL ADDRESS: STREET 1: 200 EAST RANDOLPH STREET STREET 2: SUITE 3300 CITY: CHICAGO STATE: IL ZIP: 60601 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 2023-09-01 0 0001018979 AMERISAFE INC AMSF 0001789494 Omiridis Anastasios 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO 0 Common stock 2023-09-01 4 M 0 7989 A 7989 D Common stock 2023-09-01 4 F 0 3144 52.34 D 4845 D Restricted Stock Units 2023-09-01 4 M 0 7989 0.00 D Common stock 7989 16333 D Restricted stock units convert into common stock on a one-for-one basis. On September 1, 2022, the reporting person was granted 22,826 restricted stock units, vesting in four annual installments of 35%, 15%, 20% and 30% beginning September 1, 2023, the first anniversary of the grant date. /s/Anastasios Omiridis 2023-09-06