0001209191-20-032040.txt : 20200526 0001209191-20-032040.hdr.sgml : 20200526 20200526164318 ACCESSION NUMBER: 0001209191-20-032040 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200522 FILED AS OF DATE: 20200526 DATE AS OF CHANGE: 20200526 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fuller Neal Andrew CENTRAL INDEX KEY: 0001529755 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 20911246 MAIL ADDRESS: STREET 1: C/O SEABRIGHT HOLDINGS, INC. STREET 2: 1501 4TH AVENUE, SUITE 2600 CITY: SEATTLE STATE: WA ZIP: 98101 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-05-22 0 0001018979 AMERISAFE INC AMSF 0001529755 Fuller Neal Andrew 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CFO Common stock, par value $0.01 2020-05-22 4 A 0 4344 0.00 A 22697 D Common stock, par value $0.01 2020-05-26 4 S 0 2172 63.61 D 20525 D Shares issued for the 2017-2019 performance period under an award agreement between the reporting person and the Company pursuant to the Company's Equity and Incentive Compensation Plan. The awards were determined by the Compensation Committee of the Board of Directors of the Company on May 22, 2020 in accordance with the terms of the Plan and the related award agreement. The shares were sold pursuant to the Reporting Person's 10b5-1 plan primarily to pay required withholding taxes associated with the shares awarded under the related award agreement. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $63.00 and $64.22. 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 Neal A. Fuller 2020-05-26