0001209191-15-005841.txt : 20150122 0001209191-15-005841.hdr.sgml : 20150122 20150122170404 ACCESSION NUMBER: 0001209191-15-005841 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150121 FILED AS OF DATE: 20150122 DATE AS OF CHANGE: 20150122 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: 15542584 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-01-21 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 2015-01-21 4 M 0 7500 7.50 A 139237 D Common stock, par value $0.01 2015-01-21 4 S 0 4265 41.20 D 134972 D Employee Stock Option (right to purchase) 7.50 2015-01-21 4 M 0 7500 0.00 D 2008-11-17 2015-11-17 Common Stock 7500 74000 D Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $40.63 and $41.50. 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. Kathryn H. Rowan attorney-in-fact for C. Allen Bradley, Jr. 2015-01-22