0001181431-14-031244.txt : 20140905
0001181431-14-031244.hdr.sgml : 20140905
20140905161930
ACCESSION NUMBER: 0001181431-14-031244
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140904
FILED AS OF DATE: 20140905
DATE AS OF CHANGE: 20140905
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: 141086186
MAIL ADDRESS:
STREET 1: AMERISAFE INC
STREET 2: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
rrd415786.xml
FORM 4
X0306
4
2014-09-04
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
2014-09-04
4
M
0
5000
8.50
A
6490
D
Common Stock, par value $0.01
2014-09-04
4
S
0
5000
38.16
D
1490
D
Employee Stock Option (right to purchase)
8.50
2014-09-04
4
M
0
5000
0
D
2008-11-17
2015-11-17
Common Stock
5000
41750
D
Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $38.02 and $38.25. 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
2014-09-05