0001209191-21-035495.txt : 20210524 0001209191-21-035495.hdr.sgml : 20210524 20210524182447 ACCESSION NUMBER: 0001209191-21-035495 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210521 FILED AS OF DATE: 20210524 DATE AS OF CHANGE: 20210524 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McCray Andrew B. CENTRAL INDEX KEY: 0001777423 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 21956708 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 27 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 2021-05-21 0 0001018979 AMERISAFE INC AMSF 0001777423 McCray Andrew B. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CUO Common stock, par value $0.01 2021-05-21 4 S 0 611 65.03 D 7999 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 May 20, 2021. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $65.00 and $65.18. 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/Andrew B. McCray 2021-05-24