0001181431-14-030263.txt : 20140827
0001181431-14-030263.hdr.sgml : 20140827
20140827153249
ACCESSION NUMBER: 0001181431-14-030263
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140825
FILED AS OF DATE: 20140827
DATE AS OF CHANGE: 20140827
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: 141068276
MAIL ADDRESS:
STREET 1: AMERISAFE INC
STREET 2: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
rrd415133.xml
FORM 4
X0306
4
2014-08-25
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
2014-08-25
4
M
0
200
8.50
A
1690
D
Common Stock, par value $0.01
2014-08-25
4
S
0
200
37.00
D
1490
D
Common Stock, par value $0.01
2014-08-26
4
M
0
4592
8.50
A
6082
D
Common Stock, par value $0.01
2014-08-26
4
S
0
4592
37.10
D
1490
D
Employee Stock Option (right to purchase)
8.50
2014-08-25
4
M
0
200
0
D
2008-11-17
2015-11-17
Common Stock
200
51342
D
Employee Stock Option (right to purchase)
8.50
2014-08-26
4
M
0
4592
0
D
2008-11-17
2015-11-17
Common Stock
4592
46750
D
Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $37.00 and $37.22. 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
2014-08-27