0001181431-13-056933.txt : 20131105 0001181431-13-056933.hdr.sgml : 20131105 20131105172151 ACCESSION NUMBER: 0001181431-13-056933 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131104 FILED AS OF DATE: 20131105 DATE AS OF CHANGE: 20131105 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: Frost G. Janelle CENTRAL INDEX KEY: 0001449515 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 131193682 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 rrd394233.xml FORM 4 X0306 4 2013-11-04 0 0001018979 AMERISAFE INC AMSF 0001449515 Frost G. Janelle 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 President & COO Common Stock, par value $0.01 2013-11-04 4 M 0 9000 9 A 12850 D Common Stock, par value $0.01 2013-11-04 4 S 0 5176 39.44 D 7674 D Common Stock, par value $0.01 2013-11-04 4 A 0 25000 0 A 32674 D Employee Stock Option (right to purchase) 9 2013-11-04 4 M 0 9000 0 D 2005-11-17 2015-11-17 Common Stock 9000 10000 D Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $39.40 and $39.56. 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 et each separate price. Restricted shares which vest ratably over seven years beginning November 4, 2014. /s/ G. Janelle Frost 2013-11-05