0001181431-14-035994.txt : 20141110 0001181431-14-035994.hdr.sgml : 20141110 20141110163117 ACCESSION NUMBER: 0001181431-14-035994 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141107 FILED AS OF DATE: 20141110 DATE AS OF CHANGE: 20141110 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: LEACH CRAIG P CENTRAL INDEX KEY: 0001342814 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 141209095 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 rrd418682.xml FORM 4 X0306 4 2014-11-07 0 0001018979 AMERISAFE INC AMSF 0001342814 LEACH CRAIG P AMERISAFE, INC. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP, Sales and Marketing Common Stock, par value $.01 2014-11-07 4 M 0 7016 8.50 A 8031 D Common Stock, par value $.01 2014-11-07 4 S 0 7016 41.18 D 1015 D Employee Stock Option (right to buy) 8.50 2014-11-07 4 M 0 7016 0 D 2009-11-17 2015-11-17 Common Stock, par value $.01 7016 0 D Represents the weighted average selling price of the Issuer's common stock. The range of the sales prices were between $41.09 and $41.52. 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/ Craig P. Leach 2014-11-10