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: QUAELLY PAUL B (Director, 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	Indirect
2005-11-23	Series A Preferred Stock	J	481	—	Disposed	0	Direct
2005-11-23	Common Stock	J	7867975	—	Acquired	8068706	Indirect
2005-11-23	Common Stock	J	5028	—	Acquired	5155	Direct
2005-11-23	Common Stock	A	833	—	Acquired	5988	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.

F3: The Reporting Person is a general partner of the sole general partner of Welsh, Carson, Anderson & Stowe VII, L.P. Pursuant to Instruction 4(b)(iv) of Form 4, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficiailly owned by such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecunciary interest therein, and/or that are not actually distributed to him.