AMERISAFE INC — Director's Dealing 2005

Nov 23, 2005

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: AMERISAFE INC (AMSF)
CIK: 0001018979
Period of Report: 2005-11-23

Reporting Person: WELSH CARSON ANDERSON & STOWE VII LP ET AL (10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2005-11-23	Series A Preferred Stock	J	751602	—	Disposed	0	Direct
2005-11-23	Common Stock	J	7867975	—	Acquired	8068706	Direct

Footnotes

F1: Upon the closing of the Issuer's initial public offering, a portion of the Series A Preferred Stock was redeemed for cash (at a price of $101.03 per share) and the remainder was exchanged for Common Stock at a rate based on an initial public offering price of $9.00 per share of Common Stock.

F2: Includes shares issued as dividends accrued through 11/23/05.