0001209191-15-052920.txt : 20150612 0001209191-15-052920.hdr.sgml : 20150612 20150612175839 ACCESSION NUMBER: 0001209191-15-052920 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150611 FILED AS OF DATE: 20150612 DATE AS OF CHANGE: 20150612 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: Frost G. Janelle CENTRAL INDEX KEY: 0001449515 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 15929601 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-06-11 0 0001018979 AMERISAFE INC AMSF 0001449515 Frost G. Janelle 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 President & CEO Common stock, par value $0.01 2015-06-11 4 M 0 15000 14.21 A 58990 D Common stock, par value $0.01 2015-06-11 4 S 0 11063 43.94 D 47927 D Employee Stock Option (right to purchase) 14.21 2015-06-11 4 M 0 15000 0.00 D 2013-11-10 2018-11-10 Common stock 15000 45000 D Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $43.76 and $44.10. 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/ G. Janelle Frost 2015-06-12