SEC Form 4/A · accession 0001209191-15-082075
AMERISAFE INC · AMSF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Brendan Gau
Officer — Exec.VP & Chief Investment Of.
Period of report
Nov 2, 2015
Accepted (ET)
Nov 24, 2015 · 6:18 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 $0.01F1 | Nov 2, 2015 | M | 5,763 | $15.60 | A | 27,119 | D | |
| Common stock, par value $0.01F1,F2 | Nov 2, 2015 | S | 5,763 | $54.56 | D | 21,356 | D | |
| Common stock, par value $0.01F1 | Nov 3, 2015 | M | 2,910 | $15.60 | A | 24,266 | D | |
| Common stock, par value $0.01F1,F3 | Nov 3, 2015 | S | 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)F1,F4 | $15.60 | Nov 2, 2015 | M | 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)F1,F4 | $15.60 | Nov 3, 2015 | M | 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
- F1Amendment filed to 1) correct transaction codes and 2) include the correct acquisition price of securities in Table I.
- F2Represents 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.
- F3Represents 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.
- F4The stock options became exercisable in five equal installments beginning on August 7, 2010, which was the first anniversary of the grant date.