0001209191-15-082078.txt : 20151124 0001209191-15-082078.hdr.sgml : 20151124 20151124182116 ACCESSION NUMBER: 0001209191-15-082078 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151105 FILED AS OF DATE: 20151124 DATE AS OF CHANGE: 20151124 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: Gau Brendan CENTRAL INDEX KEY: 0001466489 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 151253898 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 4/A 1 doc4a.xml FORM 4/A SUBMISSION X0306 4/A 2015-11-05 2015-11-09 0 0001018979 AMERISAFE INC AMSF 0001466489 Gau Brendan 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 Exec.VP & Chief Investment Of. Common stock, par value $0.01 2015-11-05 4 M 0 14481 15.60 A 35837 D Common stock, par value $0.01 2015-11-05 4 S 0 14481 54.00 D 21356 D Common stock, par value $0.01 2015-11-06 4 M 0 10967 15.60 A 32323 D Common stock, par value $0.01 2015-11-06 4 S 0 10967 54.01 D 21356 D Employee Stock Option (right to purchase) 15.60 2015-11-05 4 M 0 160 0.00 D 2010-08-07 2019-08-07 Common stock, par value $0.01 per share 160 60000 D Employee Stock Option (right to purchase) 15.60 2015-11-05 4 M 0 14321 0.00 D 2011-08-07 2019-08-07 Common stock, par value $0.01 per share 14321 45679 D Employee Stock Option (right to purchase) 15.60 2015-11-06 4 M 0 679 0.00 D 2011-08-07 2019-08-07 Common stock, par value $0.01 per share 679 45000 D Employee Stock Option (right to purchase) 15.60 2015-11-06 4 M 0 10288 0.00 D 2012-08-07 2019-08-07 Employee Stock Option (right to purchase) 10288 34712 D Amendment file to 1) correct transaction codes and 2) include the correct acquisition price of securities in Table I. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.07. 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. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.03. 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. The stock options became exercisable in five equal installments beginning on August 7, 2010, which was the first anniversary of the grant date. /s/ Brendan Gau 2015-11-24