0001209191-15-079155.txt : 20151110
0001209191-15-079155.hdr.sgml : 20151110
20151109173145
ACCESSION NUMBER: 0001209191-15-079155
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151105
FILED AS OF DATE: 20151109
DATE AS OF CHANGE: 20151109
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: Gau Brendan
CENTRAL INDEX KEY: 0001466489
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 151216869
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-11-05
0
0001018979
AMERISAFE INC
AMSF
0001466489
Gau Brendan
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
Exec.VP & Chief Investment Of.
Common Stock, par value $0.01
2015-11-05
4
A
0
14481
0.00
A
35837
D
Common Stock, par value $0.01
2015-11-05
4
D
0
14481
54.00
D
21356
D
Common Stock, par value $0.01
2015-11-06
4
A
0
10967
0.00
A
32323
D
Common Stock, par value $0.01
2015-11-06
4
D
0
10967
54.01
D
21356
D
Employee Stock Option (right to purchase)
15.60
2015-11-05
4
S
0
160
0.00
D
2010-08-07
2019-08-07
Common stock, par value $0.01 per share
160
60000
D
Employee Stock Option (right to purchase)
15.60
2015-11-05
4
S
0
14321
0.00
D
2011-08-07
2019-08-07
Common stock, par value $0.01 per share
14321
45679
D
Employee Stock Option (right to purchase)
15.60
2015-11-06
4
S
0
679
0.00
D
2011-08-07
2019-08-07
Common stock, par value $0.01 per share
679
45000
D
Employee Stock Option (right to purchase)
15.60
2015-11-06
4
S
0
10288
0.00
D
2012-08-07
2019-08-07
Common stock, par value $0.01 per share
10288
34712
D
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.07. 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.
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.03. 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/ Brendan Gau
2015-11-09