SEC Form 4 · accession 0001209191-15-052920
AMERISAFE INC · AMSF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
G. Janelle Frost
Officer — President & CEO
Period of report
Jun 11, 2015
Accepted (ET)
Jun 12, 2015 · 5:58 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001018979
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common stock, par value $0.01 | Jun 11, 2015 | M | 15,000 | $14.21 | A | 58,990 | D | |
| Common stock, par value $0.01F1 | Jun 11, 2015 | S | 11,063 | $43.94 | D | 47,927 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (right to purchase) | $14.21 | Jun 11, 2015 | M | 15,000 | D | Nov 10, 2013 | Nov 10, 2018 | Common stock | 15,000 | 45,000 | D |
Explanation of responses
- F1Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $43.76 and $44.10. 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.