0001181431-13-044209.txt : 20130812
0001181431-13-044209.hdr.sgml : 20130812
20130812184347
ACCESSION NUMBER: 0001181431-13-044209
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130809
FILED AS OF DATE: 20130812
DATE AS OF CHANGE: 20130812
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
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: 131030927
MAIL ADDRESS:
STREET 1: AMERISAFE INC
STREET 2: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
rrd388069.xml
FORM 4
X0306
4
2013-08-09
0
0001018979
AMERISAFE INC
AMSF
0001341774
BANTA GEOFFREY R
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
President
Common Stock, par value $0.01
2013-08-09
4
M
0
3668
9
A
15158
D
Common Stock, par value $0.01
2013-08-09
4
S
0
3668
33.38
D
11490
D
Employee Stock Option (right to buy)
9
2013-08-09
4
M
0
3668
0
D
2008-11-17
2015-11-17
Stock, par value $0.01
3668
78250
D
Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $33.33 and $33.42. The Reporting Person undertakes, upon request, to provide the SEC, the Issuer and any security holder of the Issuer full informatoin regarding the number of shares sold at each separate price.
/s/ Kathryn H. Rowan, attorney-in-fact for Geoffrey R. Banta
2013-08-12