0001209191-16-124772.txt : 20160601
0001209191-16-124772.hdr.sgml : 20160601
20160601183112
ACCESSION NUMBER: 0001209191-16-124772
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160601
FILED AS OF DATE: 20160601
DATE AS OF CHANGE: 20160601
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: Shirley Kathryn Housh
CENTRAL INDEX KEY: 0001667972
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 161690476
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-06-01
0
0001018979
AMERISAFE INC
AMSF
0001667972
Shirley Kathryn Housh
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP, General Counsel
Common stock, par value $0.01
2016-06-01
4
S
0
375
60.92
D
13397
D
The shares were sold pursuant to the Reporting Person's 10b5-1 plan in order to pay required withholding taxes associated with shares of restricted stock that vested.
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $60.89 and $60.93. 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/ Kathryn H. Shirley
2016-06-01