X0306 4 2016-05-10 0 0001018979 AMERISAFE INC AMSF 0001570960 Gagliano Vincent J. 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 EVP - Chief Risk Officer Common stock, par value $0.01 2016-05-10 4 M 0 1092 14.20 A 24597 D Common stock, par value $0.01 2016-05-10 4 S 0 1092 57.06 D 23505 D Common stock, par value $0.01 2016-05-11 4 M 0 2108 14.20 A 25613 D Common stock, par value $0.01 2016-05-11 4 S 0 2108 57.17 D 23505 D Employee Stock Option (right to purchase) 14.20 2016-05-10 4 M 0 600 0.00 D 2012-11-09 2019-11-09 Common stock 600 7600 D Employee Stock Option (right to purchase) 14.20 2016-05-10 4 M 0 492 0.00 D 2013-11-09 2019-11-09 Common stock 492 7108 D Employee Stock Option (right to purchase) 14.20 2016-05-10 4 M 0 2108 0.00 D 2013-11-09 2019-11-09 Common stock 2108 5000 D Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $57.00 and $57.20. The Reporting Person undertakes, upon request, to provide the SEC, the Issuer and any security holder of the Issuer, full information regarding the number of shares sold at each separate price. Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $57.00 and $57.24. The Reporting Person undertakes, upon request, to provide the SEC, the Issuer and any security holder of the Issuer, full information regarding the number of shares sold at each separate price. Represents stock options that become exercisable in five equal installments beginning on November 9, 2010, which was the first anniversary of the grant date. The options were exercised and sold pursuant to the Reporting Person's 10b5-1 plan. /s/ Vincent J. Gagliano 2016-05-12