0001209191-17-016665.txt : 20170302
0001209191-17-016665.hdr.sgml : 20170302
20170302164009
ACCESSION NUMBER: 0001209191-17-016665
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170302
FILED AS OF DATE: 20170302
DATE AS OF CHANGE: 20170302
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: Shirley Kathryn Housh
CENTRAL INDEX KEY: 0001667972
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 17659458
MAIL ADDRESS:
STREET 1: 2301 HIGHWAY 190 WEST
CITY: DERIDDER
STATE: LA
ZIP: 70634
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-03-02
0
0001018979
AMERISAFE INC
AMSF
0001667972
Shirley Kathryn Housh
2301 HIGHWAY 190 WEST
DERIDDER
LA
70634
0
1
0
0
EVP, General Counsel
Common stock, par value $0.01
2017-03-02
4
S
0
480
65.05
D
12917
D
Represents restricted stock that fully vested on March 1, 2017. The shares were sold pursuant to the Reporting Person's 10b5-1 plan to cover taxes.
Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $65.00 and $65.08. 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
2017-03-02