0001181431-14-030084.txt : 20140825
0001181431-14-030084.hdr.sgml : 20140825
20140825173528
ACCESSION NUMBER: 0001181431-14-030084
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140822
FILED AS OF DATE: 20140825
DATE AS OF CHANGE: 20140825
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: 141063354
MAIL ADDRESS:
STREET 1: AMERISAFE INC
STREET 2: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
rrd415095.xml
FORM 4
X0306
4
2014-08-22
0
0001018979
AMERISAFE INC
AMSF
0001341774
BANTA GEOFFREY R
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP/Corporate Development
Common Stock, par value $0.01
2014-08-22
4
M
0
208
8.50
A
1698
D
Common Stock, par value $0.01
2014-08-22
4
S
0
208
37.30
D
1490
D
Employee Stock Option (right to purchase)
8.50
2014-08-22
4
M
0
208
0
D
2008-11-17
2015-11-17
Common Stock
208
51542
D
/s/ Kathryn H. Rowan attorney-in-fact for Geoffrey R. Banta
2014-08-25