0001181431-12-032634.txt : 20120525 0001181431-12-032634.hdr.sgml : 20120525 20120525110055 ACCESSION NUMBER: 0001181431-12-032634 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120524 FILED AS OF DATE: 20120525 DATE AS OF CHANGE: 20120525 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: 12869855 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 rrd346425.xml 2012MAY24BRADLEYFORM4 X0305 4 2012-05-24 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 2012-05-24 4 S 0 10000 26.91 D 36099 D Employee Stock Option (right to purchase) 9 2012-05-24 4 M 0 10000 0 D 2006-11-17 2015-11-17 Common Stock 10000 449000 D Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $26.76 and $27.05. 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 five equal, annual installments, commencing on the first anniversary of the grant date. C. Allen Bradley, Jr. 2012-05-25