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