0001209191-21-017430.txt : 20210303 0001209191-21-017430.hdr.sgml : 20210303 20210303195454 ACCESSION NUMBER: 0001209191-21-017430 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210302 FILED AS OF DATE: 20210303 DATE AS OF CHANGE: 20210303 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: 21711796 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 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 2021-03-02 0 0001018979 AMERISAFE INC AMSF 0001667972 Shirley Kathryn Housh 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - CAO Common stock, par value $0.01 2021-03-02 4 S 0 1350 58.06 D 10089 D The shares were sold pursuant to the Reporting Person's 10b5-1 plan to pay required withholding taxes associated with shares of restricted stock that fully vested March 1, 2021 Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $57.76 and $58.48. 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 2021-03-03