0001209191-23-031879.txt : 20230524 0001209191-23-031879.hdr.sgml : 20230524 20230524160944 ACCESSION NUMBER: 0001209191-23-031879 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230522 FILED AS OF DATE: 20230524 DATE AS OF CHANGE: 20230524 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McCray Andrew B. CENTRAL INDEX KEY: 0001777423 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 23954215 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 27 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 X0407 4 2023-05-22 0 0001018979 AMERISAFE INC AMSF 0001777423 McCray Andrew B. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP-CUO 0 Common stock, par value $0.01 2023-05-22 4 S 0 978 54.42 D 8382 D The shares were sold 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 $54.37 and $54.44. 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. Total number of shares adjusted due to immaterial miscalculation reported on May 23, 2022. /s/Andrew B. McCray 2023-05-24