SEC Form 4 · accession 0001209191-19-016745
AMERISAFE INC · AMSF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Vincent J. Gagliano
Officer — EVP - Chief Risk Officer
Period of report
Mar 4, 2019
Accepted (ET)
Mar 5, 2019 · 5:29 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 | Mar 4, 2019 | M | 5,000 | $3.95 | A | 21,929 | D | |
| Common stock, par value $0.01F1,F2 | Mar 4, 2019 | S | 5,000 | $61.29 | D | 16,929 | D | |
| Common stock, par value $0.01F3,F2 | Mar 4, 2019 | S | 744 | $61.29 | D | 16,185 | 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 pruchase) | $3.95 | Mar 4, 2019 | M | 5,000 | D | Nov 9, 2013 | Nov 9, 2019 | Common stock | 5,000 | 0 | D |
Explanation of responses
- F1The shares were sold pursuant to the Reporting Person's 10b5-1 plan.
- F2Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $61.04 and $62.13. 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.
- F3The shares were sold pursuant to the Reporting Person's 10b5-1 plan for restricted stock that fully vested March 1, 2019.