SEC Form 5 · accession 0001209191-19-006521
AMERISAFE INC · AMSF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Teri G. Fontenot
Director
Period of report
Dec 31, 2017
Accepted (ET)
Feb 1, 2019 · 5:13 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 | Mar 24, 2017 | L | 1 | $66.55 | A | 1,096 | D | |
| Common stock, par value $0.01F1 | Jun 23, 2017 | L | 1 | $57.55 | A | 2,019 | D | |
| Common stock, par value $0.01F1 | Sep 22, 2017 | L | 1 | $56.00 | A | 2,021 | D | |
| Common stock, par value $0.01F1 | Dec 29, 2017 | L | 63 | $61.00 | A | 2,084 | D | |
| Common stock, par value $0.01F1 | Dec 29, 2017 | L | 4 | $60.95 | A | 2,087 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The Reporting Person was appointed to the Board of Directors of the Company in January 2016. The Reporting Person placed the shares in a brokerage account with a pre-existing dividend reimbursement plan. Pursuant to this dividend reinvestment plan, the Reporting Person acquired a total of 70.67 shares of Common Stock at a purchase price of $4,304.86 during 2017. Reporting of the purchase of these shares was exempt under Rule 16a-6. However, these purchases should have been reported on a Form 5 on or before February 14, 2018.