0001209191-18-032368.txt : 20180522
0001209191-18-032368.hdr.sgml : 20180522
20180522173346
ACCESSION NUMBER: 0001209191-18-032368
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180518
FILED AS OF DATE: 20180522
DATE AS OF CHANGE: 20180522
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: 18853371
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
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
2018-05-18
0
0001018979
AMERISAFE INC
AMSF
0001449515
Frost G. Janelle
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
1
1
0
0
President & CEO
Common Stock, par value $0.01
2018-05-18
4
A
0
1510
0.00
A
61911
D
Common Stock, par value $0.01
2018-05-22
4
S
0
685
60.10
D
61226
D
Shares issued for the 2015-2017 performance period under an award agreement between the Reporting Person and the Company pursuant to the Company's Equity and Incentive Compensation Plan. The awards were determined by the Compensation Committee of the Board of Directors of the Company on May 18, 2018 in accordance with the terms of the Plan and the related award agreement.
The shares were sold pursuant to the Reporting Person's 10b5-1 plan to pay required withholding taxes associated with shares of stock associated with the 2015-2017 performance period under an award agreement between the Reporting Person and the Company pursuant to the Company's Equity and Incentive Compensation Plan.
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $60.05 and $60.10. 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, attorney-in-fact for G. Janelle Frost
2018-05-22