0001181431-13-060335.txt : 20131122 0001181431-13-060335.hdr.sgml : 20131122 20131122155950 ACCESSION NUMBER: 0001181431-13-060335 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131121 FILED AS OF DATE: 20131122 DATE AS OF CHANGE: 20131122 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: BRADLEY C ALLEN JR CENTRAL INDEX KEY: 0001341775 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 131238248 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 rrd396078.xml FORM 4 X0306 4 2013-11-21 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 $0.01 2013-11-21 4 M 0 7500 9 A 104437 D Common Stock, par value $0.01 2013-11-21 4 S 0 4378 41.27 D 100059 D Employee Stock Option (right to purchase) 9 2013-11-07 4 M 0 7500 0 D 2007-11-17 2015-11-17 Common Stock 7500 284000 D Transaction completed pursuant to 10b5-1 plan executed while officer was not in possession of material non-public information. Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $41.04 and $41.48. 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/ C. Allen Bradley, Jr. 2013-11-22