Filing Details

Accession Number:
0001181431-11-030043
Form Type:
4
Zero Holdings:
No
Publication Time:
2011-05-16 16:50:42
Reporting Period:
2011-05-13
Filing Date:
2011-05-16
Accepted Time:
2011-05-16 16:50:42
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1018979 Amerisafe Inc AMSF Fire, Marine & Casualty Insurance (6331) 752069407
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1341774 R Geoffrey Banta 2301 Highway 190 West
Deridder LA 70634
President & Coo No Yes No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock, Par Value $.01 Disposition 2011-05-13 4,818 $22.57 0 No 4 S Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 S Direct
Reported Derivative Holdings
Sec. Name Sec. Type Price Date Expiration Date Amount Remaning Holdings Nature of Ownership
Common Stock, Par Value $.01 Option (right to purchase) $9.00 2010-11-17 2015-11-17 118,750 118,750 Direct
Expiration Date Amount Remaning Holdings Nature of Ownership
2015-11-17 118,750 118,750 Direct
Footnotes
  1. This price is a weighted average. Sales were made at various prices ranging from $22.51 to $22.61.
  2. Since the date of his last report Mr. Banta transferred 4,817 shares of common stock, par value $.01, and 118,750 options to purchase common stock, par value $.01, at a strike price of $9.00 to his ex-spouse pursuant to a domestic relations order. He does not report any of the shares or options so transferred to his ex-spouse as being beneficially held.