SEC Form 4 · accession 0001209191-15-078485
AMERISAFE INC · AMSF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Brendan Gau
Officer — Exec.VP & Chief Investment Of.
Period of report
Nov 2, 2015
Accepted (ET)
Nov 4, 2015 · 5:09 pm EST
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 | Nov 2, 2015 | A | 5,763 | $0.00 | A | 27,119 | D | |
| Common stock, par value $0.01F1 | Nov 2, 2015 | D | 5,763 | $54.56 | D | 21,356 | D | |
| Common Stock, par value $0.01 | Nov 3, 2015 | A | 2,910 | $0.00 | A | 24,266 | D | |
| Common Stock, par value $0.01F2 | Nov 3, 2015 | D | 2,910 | $54.03 | D | 21,356 | 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) | $15.60 | Nov 2, 2015 | S | 5,763 | D | Aug 7, 2010 | Aug 7, 2019 | Common stock, par value $0.01 per share | 5,763 | 63,070 | D |
| Employee Stock Option (right to purchase) | $15.60 | Nov 3, 2015 | S | 2,910 | D | Aug 7, 2010 | Aug 7, 2019 | Common stock, par value $0.01 per share | 2,910 | 60,160 | D |
Explanation of responses
- F1Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.50 and $54.82. 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.
- F2Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.12. 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.