0001209191-19-016745.txt : 20190305 0001209191-19-016745.hdr.sgml : 20190305 20190305172933 ACCESSION NUMBER: 0001209191-19-016745 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190304 FILED AS OF DATE: 20190305 DATE AS OF CHANGE: 20190305 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Gagliano Vincent J. CENTRAL INDEX KEY: 0001570960 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 19659763 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 2019-03-04 0 0001018979 AMERISAFE INC AMSF 0001570960 Gagliano Vincent J. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - Chief Risk Officer Common stock, par value $0.01 2019-03-04 4 M 0 5000 3.95 A 21929 D Common stock, par value $0.01 2019-03-04 4 S 0 5000 61.29 D 16929 D Common stock, par value $0.01 2019-03-04 4 S 0 744 61.29 D 16185 D Employee Stock Option (right to pruchase) 3.95 2019-03-04 4 M 0 5000 0.00 D 2013-11-09 2019-11-09 Common stock 5000 0 D The shares were sold pursuant to the Reporting Person's 10b5-1 plan. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $61.04 and $62.13. 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. The shares were sold pursuant to the Reporting Person's 10b5-1 plan for restricted stock that fully vested March 1, 2019. /s/Kathryn H. Shirley attorney-in-fact for Vincent J. Gagliano 2019-03-05