0001181431-13-016619.txt : 20130313
0001181431-13-016619.hdr.sgml : 20130313
20130313154625
ACCESSION NUMBER: 0001181431-13-016619
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130313
FILED AS OF DATE: 20130313
DATE AS OF CHANGE: 20130313
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BANTA GEOFFREY R
CENTRAL INDEX KEY: 0001341774
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 13687431
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
rrd374060.xml
FORM
X0306
4
2013-03-13
0
0001018979
AMERISAFE INC
AMSF
0001341774
BANTA GEOFFREY R
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
President and COO
Common Stock, par value $0.01
2013-03-13
4
M
0
6000
9
A
11500
D
Common Stock, par value $0.01
2013-03-13
4
S
0
3010
33.56
D
8490
D
Employee Stock Option (right to buy)
9
2013-03-13
4
M
0
6000
0
D
2008-11-17
2015-11-17
Stock, par value $0.01
6000
91750
D
Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $33.50 and $33.65. 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.
/s/ Geoffrey R. Banta
2013-03-13