0001181431-14-030084.txt : 20140825 0001181431-14-030084.hdr.sgml : 20140825 20140825173528 ACCESSION NUMBER: 0001181431-14-030084 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140822 FILED AS OF DATE: 20140825 DATE AS OF CHANGE: 20140825 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: BANTA GEOFFREY R CENTRAL INDEX KEY: 0001341774 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 141063354 MAIL ADDRESS: STREET 1: AMERISAFE INC STREET 2: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4 1 rrd415095.xml FORM 4 X0306 4 2014-08-22 0 0001018979 AMERISAFE INC AMSF 0001341774 BANTA GEOFFREY R 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP/Corporate Development Common Stock, par value $0.01 2014-08-22 4 M 0 208 8.50 A 1698 D Common Stock, par value $0.01 2014-08-22 4 S 0 208 37.30 D 1490 D Employee Stock Option (right to purchase) 8.50 2014-08-22 4 M 0 208 0 D 2008-11-17 2015-11-17 Common Stock 208 51542 D /s/ Kathryn H. Rowan attorney-in-fact for Geoffrey R. Banta 2014-08-25