AMERISAFE INC — Director's Dealing 2019

Feb 1, 2019

SEC Form 5 — Annual Statement of Changes in Beneficial Ownership

Issuer: AMERISAFE INC (AMSF)
CIK: 0001018979
Period of Report: 2017-12-31

Reporting Person: Fontenot Teri G. (Director)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2017-03-24	Common stock, par value $0.01	L	1.2	$66.55	Acquired	1095.96	Direct
2017-06-23	Common stock, par value $0.01	L	1.39	$57.55	Acquired	2019.35	Direct
2017-09-22	Common stock, par value $0.01	L	1.43	$56.00	Acquired	2020.78	Direct
2017-12-29	Common stock, par value $0.01	L	63.04	$61.00	Acquired	2083.82	Direct
2017-12-29	Common stock, par value $0.01	L	3.61	$60.95	Acquired	2087.43	Direct

Footnotes

F1: The 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.