0001209191-19-049883.txt : 20190917 0001209191-19-049883.hdr.sgml : 20190917 20190917173108 ACCESSION NUMBER: 0001209191-19-049883 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190916 FILED AS OF DATE: 20190917 DATE AS OF CHANGE: 20190917 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: 191097849 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 2019-09-16 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 2019-09-16 4 S 0 2872 66.30 D 18353 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, 2019. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $66.15 and $66.69. 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 Neal Fuller 2019-09-17