0001209191-21-032144.txt : 20210512 0001209191-21-032144.hdr.sgml : 20210512 20210512173141 ACCESSION NUMBER: 0001209191-21-032144 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210511 FILED AS OF DATE: 20210512 DATE AS OF CHANGE: 20210512 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TRAYNOR SEAN CENTRAL INDEX KEY: 0001212999 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 21916362 MAIL ADDRESS: STREET 1: 320 PARK AVENUE STE 2500 CITY: NEW YORK STATE: NY ZIP: 10022 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 2021-05-11 0 0001018979 AMERISAFE INC AMSF 0001212999 TRAYNOR SEAN 599 LEXINGTON AVENUE 18TH FLOOR NEW YORK NY 10022 1 0 0 0 Common stock, par value $0.01 2021-05-11 4 P 0 8000 63.59 A 8925 D Represents the weighted average purchase price of the Issuer's common stock. The range of sales prices were between $63.42 and $63.60. 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 Sean M. Traynor 2021-05-12