0001209191-17-036590.txt : 20170531 0001209191-17-036590.hdr.sgml : 20170531 20170531183710 ACCESSION NUMBER: 0001209191-17-036590 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170530 FILED AS OF DATE: 20170531 DATE AS OF CHANGE: 20170531 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: MORRIS JARED A CENTRAL INDEX KEY: 0001341776 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 17882744 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-05-30 0 0001018979 AMERISAFE INC AMSF 0001341776 MORRIS JARED A 2301 HIGHWAY 190 WEST DERIDDER LA 70634 1 0 0 0 Common stock, par value $0.01 2017-05-30 4 P 0 2500 50.82 A 60317 I Owned by Jared Morris 1997 Trust Common stock, par value $0.01 12390 D Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $50.03 and $51.55. 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 Jared A. Morris 2017-05-31