0001209191-21-034119.txt : 20210519
0001209191-21-034119.hdr.sgml : 20210519
20210519180707
ACCESSION NUMBER: 0001209191-21-034119
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210517
FILED AS OF DATE: 20210519
DATE AS OF CHANGE: 20210519
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: 21941619
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
2021-05-17
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
2021-05-17
4
A
0
2948
0.00
A
13037
D
Common stock, par value $0.01
2021-05-19
4
S
0
1474
64.41
D
11563
D
Shares issued for the 2018-2020 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 17, 2021 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 $64.02 and $65.00. 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
2021-05-19