0001209191-16-139328.txt : 20160831 0001209191-16-139328.hdr.sgml : 20160831 20160831171011 ACCESSION NUMBER: 0001209191-16-139328 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160829 FILED AS OF DATE: 20160831 DATE AS OF CHANGE: 20160831 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: 161863883 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-08-29 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 2016-08-29 4 A 0 10000 0.00 A 60321 D Common stock, par value $0.01 2016-08-29 4 S 0 7568 59.19 D 52753 D Common stock, par value $0.01 2016-08-30 4 A 0 20000 0.00 A 72753 D Common stock, par value $0.01 2016-08-30 4 S 0 15432 59.01 D 57321 D Employee Stock Option (right to purchase) 11.21 2016-08-29 4 M 0 10000 0.00 D 2013-11-10 2018-11-10 Common Stock 10000 35000 D Employee Stock Option (right to purchase 11.21 2016-08-30 4 M 0 20000 0.00 D 2013-11-10 2018-11-10 Common Stock 20000 15000 D Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $59.02 and $59.30. 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 $58.61 and $59.24. 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. /s/G. Janelle Frost 2016-08-31