0001181431-13-049728.txt : 20130918 0001181431-13-049728.hdr.sgml : 20130918 20130918170649 ACCESSION NUMBER: 0001181431-13-049728 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130910 FILED AS OF DATE: 20130918 DATE AS OF CHANGE: 20130918 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 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: 131104073 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 rrd390868.xml FORM 4 X0306 4 2013-09-10 0 0001018979 AMERISAFE INC AMSF 0001570960 Gagliano Vincent J. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - Chief Technology Officer Common Stock, par value $0.01 2013-09-10 4 M 0 463 18.70 A 27305 D Common Stock, par value $0.01 2013-09-10 4 S 0 463 33.70 D 26842 D Employee Stock Option (right to buy) 18.70 2013-09-10 4 M 0 463 0 D 2009-11-19 2019-11-19 Common Stock 463 14737 D /s/ Vincent J. Gagliano 2013-09-18