0001209191-17-053355.txt : 20170919
0001209191-17-053355.hdr.sgml : 20170919
20170919181009
ACCESSION NUMBER: 0001209191-17-053355
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170918
FILED AS OF DATE: 20170919
DATE AS OF CHANGE: 20170919
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: 171092907
MAIL ADDRESS:
STREET 1: C/O SEABRIGHT HOLDINGS, INC.
STREET 2: 1501 4TH AVENUE, SUITE 2600
CITY: SEATTLE
STATE: WA
ZIP: 98101
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-09-18
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
2017-09-18
4
S
0
1850
56.94
D
23210
D
The shares were sold pursuant to the Reporting Person's 10b5-1 plan to pay required withholding taxes associated with shares of restricted stock that fully vested September 15, 2017.
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $56.20 and $58.20. 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.
/s/Neal A. Fuller
2017-09-19