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: 2016-12-31

Reporting Person: Fontenot Teri G. (Director)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2016-09-23	Common Stock, par value $0.01	L	1.18	$57.52	Acquired	1074.18	Direct
2016-12-29	Common stock, par value $0.01	L	20.58	$62.85	Acquired	1094.76	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 21.76 shares of Common Stock at a purchase price of $1361.40 during 2016. 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, 2017.