0001209191-16-119675.txt : 20160512
0001209191-16-119675.hdr.sgml : 20160512
20160512182204
ACCESSION NUMBER: 0001209191-16-119675
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160510
FILED AS OF DATE: 20160512
DATE AS OF CHANGE: 20160512
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: Gagliano Vincent J.
CENTRAL INDEX KEY: 0001570960
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 161645292
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-05-10
0
0001018979
AMERISAFE INC
AMSF
0001570960
Gagliano Vincent J.
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP - Chief Risk Officer
Common stock, par value $0.01
2016-05-10
4
M
0
1092
14.20
A
24597
D
Common stock, par value $0.01
2016-05-10
4
S
0
1092
57.06
D
23505
D
Common stock, par value $0.01
2016-05-11
4
M
0
2108
14.20
A
25613
D
Common stock, par value $0.01
2016-05-11
4
S
0
2108
57.17
D
23505
D
Employee Stock Option (right to purchase)
14.20
2016-05-10
4
M
0
600
0.00
D
2012-11-09
2019-11-09
Common stock
600
7600
D
Employee Stock Option (right to purchase)
14.20
2016-05-10
4
M
0
492
0.00
D
2013-11-09
2019-11-09
Common stock
492
7108
D
Employee Stock Option (right to purchase)
14.20
2016-05-10
4
M
0
2108
0.00
D
2013-11-09
2019-11-09
Common stock
2108
5000
D
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $57.00 and $57.20. 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 $57.00 and $57.24. 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 stock options that become exercisable in five equal installments beginning on November 9, 2010, which was the first anniversary of the grant date. The options were exercised and sold pursuant to the Reporting Person's 10b5-1 plan.
/s/ Vincent J. Gagliano
2016-05-12