SEC Form 4/A · accession 0001209191-15-082081
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 9, 2015
Accepted (ET)
Nov 24, 2015 · 6:23 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 9, 2015 | M | 435 | $15.60 | A | 21,791 | D | |
| Common stock, par value $0.01F1 | Nov 9, 2015 | S | 435 | $54.00 | 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,F2 | $15.60 | Nov 9, 2015 | M | 435 | D | Aug 7, 2012 | Aug 7, 2019 | Common stock, par value $0.01 per share | 435 | 34,277 | D |
Explanation of responses
- F1Amendment file to 1) correct transaction codes and 2) include the correct acquisition price of securities in Table I.
- F2The stock options became exercisable in five equal installments beginning on August 7, 2010, which was the first anniversary of the grant date.