Insider filing report for Changes in Beneficial Ownership
- Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
- Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
"Insiders might sell their shares for any number of reasons, but they buy them for only one: they think the price will rise"
- Peter Lynch
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- Peter Lynch
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CUSIP No. 03071H 10 0 Page 1 of 5 Pages
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
----------------------
SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULES 13d-1(b),(c), AND (d) AND AMENDMENTS THERETO FILED
PURSUANT TO RULE 13d-2(b)
(Amendment No. 1)
Amerisafe, Inc.
- --------------------------------------------------------------------------------
(Name of Issuer)
Common Stock, $.01 par value
- --------------------------------------------------------------------------------
(Title of Class of Securities)
03071H 10 0
- --------------------------------------------------------------------------------
(CUSIP Number)
December 31, 2006
- --------------------------------------------------------------------------------
Date of Event Which Requires Filing of this Statement
Check the appropriate box to designate the rule pursuant to which this Schedule
is Filed:
[ ] Rule 13d-1(b)
[ ] Rule 13d-1(c)
[X] Rule 13d-1(d)
CUSIP No. 03071H 10 0 Page 2 of 5 Pages
- --------------------------------------------------------------------------------
1) Name of Reporting Person Welsh, Carson,
I.R.S. Identification Anderson & Stowe
No. of Above Person VII, L.P.
(Entities Only)
- --------------------------------------------------------------------------------
2) Check the Appropriate Box (a) [ X ]
if a Member of a Group (b) [ ]
- --------------------------------------------------------------------------------
3) SEC Use Only
- --------------------------------------------------------------------------------
4) Citizenship or Place Delaware
of Organization
- --------------------------------------------------------------------------------
Number of 5) Sole Voting -0-
Shares Beneficially Power
Owned by Each
Reporting Person
With:
-----------------------------------------------
6) Shared Voting -0-
Power
-----------------------------------------------
7) Sole Dispositive -0-
Power
-----------------------------------------------
8) Shared Dis- -0-
positive Power
-----------------------------------------------
9) Aggregate Amount Beneficially -0-
Owned by Each Reporting Person
- --------------------------------------------------------------------------------
10) Check if the Aggregate
Amount in Row (9)
Excludes Certain Shares
- --------------------------------------------------------------------------------
11) Percent of Class -0-
Represented by
Amount in Row (9)
- --------------------------------------------------------------------------------
12) Type of Reporting PN
Person
CUSIP No. 03071H 10 0 Page 3 of 5 Pages
- --------------------------------------------------------------------------------
1) Name of Reporting Person WCAS Healthcare
I.R.S. Identification Partners, L.P.
No. of Above Person
(Entities Only)
- --------------------------------------------------------------------------------
2) Check the Appropriate Box (a) [ X ]
if a Member of a Group (b) [ ]
- --------------------------------------------------------------------------------
3) SEC Use Only
- --------------------------------------------------------------------------------
4) Citizenship or Place Delaware
of Organization
- --------------------------------------------------------------------------------
Number of 5) Sole Voting -0-
Shares Beneficially Power
Owned by Each
Reporting Person
With:
-----------------------------------------------
6) Shared Voting -0-
Power
-----------------------------------------------
7) Sole Dispositive -0-
Power
-----------------------------------------------
8) Shared Dis- -0-
positive Power
-----------------------------------------------
9) Aggregate Amount Beneficially -0-
Owned by Each Reporting Person
- --------------------------------------------------------------------------------
10) Check if the Aggregate
Amount in Row (9)
Excludes Certain Shares
- --------------------------------------------------------------------------------
11) Percent of Class -0-
Represented by
Amount in Row (9)
- --------------------------------------------------------------------------------
12) Type of Reporting PN
Person
CUSIP No. 03071H 10 0 Page 4 of 5 Pages
Amendment No. 1 to Schedule 13G (Final Amendment)
-------------------------------------------------
Reference is hereby made to the statement on Schedule 13G filed with
the Securities and Exchange Commission on January 24, 2006 (the "Schedule 13G").
Terms defined in the Schedule 13G are used herein as so defined.
The following items of the Schedule 13G are hereby amended and restated as
follows:
Item 4 - Ownership.
(a) Amount Beneficially Owned:
WCAS VII: -0-
WCAS HP: -0-
(b) Percent of Class:
WCAS VII: -0-
WCAS HP: -0-
(c) Number of shares as to which such persons have:
(i) sole power to vote or to direct the vote: -0-
(ii) shared power to vote or to direct the vote: -0-
(iii) sole power to dispose or to direct the disposition of: -0-
(iv) shared power to dispose or to direct the disposition of: -0-
Item 5 - Ownership Of Five Percent Or Less Of A Class.
If this statement is being filed to report the fact that as of the
date hereof the Reporting Persons have ceased to be the beneficial owners of
more than five percent of the Common Stock, check the following: [X]
CUSIP No. 03071H 10 0 Page 5 of 5 Pages
Signature:
After reasonable inquiry and to the best of their knowledge
and belief, the undersigned certify that the information set forth in this
statement is true, complete and correct.
WELSH, CARSON, ANDERSON & STOWE VII, L.P.
By: WCAS VII Partners, L.P., General Partner
By /s/ Jonathan M. Rather
---------------------------------------------
General Partner
WCAS HEALTHCARE PARTNERS, L.P.
By: WCAS HP Partners, General Partner
By /s/ Jonathan M. Rather
---------------------------------------------
Attorney-in-Fact
Date: February 7, 2007