0001181431-11-054867.txt : 20111104 0001181431-11-054867.hdr.sgml : 20111104 20111104163713 ACCESSION NUMBER: 0001181431-11-054867 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111103 FILED AS OF DATE: 20111104 DATE AS OF CHANGE: 20111104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRADLEY C ALLEN JR CENTRAL INDEX KEY: 0001341775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 111181672 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 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 rrd325083.xml 2011NOV3BRADLEYFORM4 X0304 4 2011-11-03 0 0001018979 AMERISAFE INC AMSF 0001341775 BRADLEY C ALLEN JR 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 1 0 0 Chairman and CEO Common stock, par value $.01 2011-11-03 4 S 0 10000 23.56 D 36099 D Employee Stock Option (right to purchase) 9.00 2011-11-03 4 M 0 10000 0 D 2006-11-17 2015-11-17 Common Stock 10000 459000 D Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $23.50 and $23.85. The Reporting Person undertakes, upon request, to provide the SEC, the Issuer and any security holder of the Issuer full information regarding the number of shares sold at each separate price. These options were granted on 11-17-2005 and vested in 5 equal, annual installments, commencing on the first anniversary of the grant date. C. Allen Bradley, Jr. 2011-11-04