0001209191-16-142037.txt : 20160919 0001209191-16-142037.hdr.sgml : 20160919 20160919171919 ACCESSION NUMBER: 0001209191-16-142037 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160916 FILED AS OF DATE: 20160919 DATE AS OF CHANGE: 20160919 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: Fuller Neal Andrew CENTRAL INDEX KEY: 0001529755 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 161892460 MAIL ADDRESS: STREET 1: C/O SEABRIGHT HOLDINGS, INC. STREET 2: 1501 4TH AVENUE, SUITE 2600 CITY: SEATTLE STATE: WA ZIP: 98101 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-09-16 0 0001018979 AMERISAFE INC AMSF 0001529755 Fuller Neal Andrew 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO Common stock, par value $0.01 2016-09-16 4 S 0 1200 57.30 D 25060 D Represents restricted shares that fully vested on September 15, 2016. The shares were sold pursuant to the Reporting Person's 10b5-1 plan to cover taxes. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $57.21 and $57.34. 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/ Neal A. Fuller 2016-09-19