0001181431-13-049734.txt : 20130918
0001181431-13-049734.hdr.sgml : 20130918
20130918171046
ACCESSION NUMBER: 0001181431-13-049734
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130913
FILED AS OF DATE: 20130918
DATE AS OF CHANGE: 20130918
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: Gagliano Vincent J.
CENTRAL INDEX KEY: 0001570960
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 131104099
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
rrd390888.xml
FORM 4
X0306
4
2013-09-13
0
0001018979
AMERISAFE INC
AMSF
0001570960
Gagliano Vincent J.
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP - Chief Technology Officer
Common Stock, par value $0.01
2013-09-13
4
M
0
1780
18.70
A
28622
D
Common Stock, par value $0.01
2013-09-13
4
S
0
1780
33.00
D
26842
D
Employee Stock Option (right to buy)
18.70
2013-09-13
4
M
0
1780
0
D
2009-11-19
2019-11-19
Common Stock
1780
11400
D
/s/ Vincent J. Gagliano
2013-09-18