SEC Form 4/A · accession 0001209191-15-082078

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

Officer — Exec.VP & Chief Investment Of.

Period of report

Nov 5, 2015

Accepted (ET)

Nov 24, 2015 · 6:21 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
Common stock, par value $0.01^F1	Nov 5, 2015	M	14,481	$15.60	A	35,837	D
Common stock, par value $0.01^F1,F2	Nov 5, 2015	S	14,481	$54.00	D	21,356	D
Common stock, par value $0.01^F1	Nov 6, 2015	M	10,967	$15.60	A	32,323	D
Common stock, par value $0.01^F1,F3	Nov 6, 2015	S	10,967	$54.01	D	21,356	D

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 5, 2015	M	160	D	Aug 7, 2010	Aug 7, 2019	Common stock, par value $0.01 per share	160	60,000	D
Employee Stock Option (right to purchase)^F1,F4	$15.60	Nov 5, 2015	M	14,321	D	Aug 7, 2011	Aug 7, 2019	Common stock, par value $0.01 per share	14,321	45,679	D
Employee Stock Option (right to purchase)^F1,F4	$15.60	Nov 6, 2015	M	679	D	Aug 7, 2011	Aug 7, 2019	Common stock, par value $0.01 per share	679	45,000	D
Employee Stock Option (right to purchase)^F1,F4	$15.60	Nov 6, 2015	M	10,288	D	Aug 7, 2012	Aug 7, 2019	Employee Stock Option (right to purchase)	10,288	34,712	D

F1Amendment file 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 $54.00 and $54.07. 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 $54.03. 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.