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