Sec Form 4/A Filing - Gau Brendan @ AMERISAFE INC - 2015-11-05

Insider filing report for Changes in Beneficial Ownership
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FORM 4/A
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Gau Brendan
2. Issuer Name and Ticker or Trading Symbol
AMERISAFE INC [ AMSF]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Exec.VP & Chief Investment Of.
(Last) (First) (Middle)
2301 HIGHWAY 190 WEST
3. Date of Earliest Transaction (MM/DD/YY)
11/05/2015
(Street)
DERIDDER, LA70634
4. If Amendment, Date Original Filed (MM/DD/YY)
11/09/2015
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common stock, par value $0.01 ( 1 ) 11/05/2015 M 14,481 A $ 15.6 35,837 D
Common stock, par value $0.01 ( 1 ) 11/05/2015 S 14,481 D $ 54 ( 2 ) 21,356 D
Common stock, par value $0.01 ( 1 ) 11/06/2015 M 10,967 A $ 15.6 32,323 D
Common stock, par value $0.01 ( 1 ) 11/06/2015 S 10,967 D $ 54.01 ( 3 ) 21,356 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to purchase) ( 1 ) $ 15.6 11/05/2015 M 160 08/07/2010( 4 ) 08/07/2019 Common stock, par value $0.01 per share 160 $ 0 60,000 D
Employee Stock Option (right to purchase) ( 1 ) $ 15.6 11/05/2015 M 14,321 08/07/2011( 4 ) 08/07/2019 Common stock, par value $0.01 per share 14,321 $ 0 45,679 D
Employee Stock Option (right to purchase) ( 1 ) $ 15.6 11/06/2015 M 679 08/07/2011( 4 ) 08/07/2019 Common stock, par value $0.01 per share 679 $ 0 45,000 D
Employee Stock Option (right to purchase) ( 1 ) $ 15.6 11/06/2015 M 10,288 08/07/2012( 4 ) 08/07/2019 Employee Stock Option (right to purchase) 10,288 $ 0 34,712 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Gau Brendan
2301 HIGHWAY 190 WEST
DERIDDER, LA70634
Exec.VP & Chief Investment Of.
Signatures
/s/ Brendan Gau 11/24/2015
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Amendment file to 1) correct transaction codes and 2) include the correct acquisition price of securities in Table I.
( 2 )Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.07. 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.
( 3 )Represents the weighted average selling price of the Issuer's common stock. The range of sales prices were between $54.00 and $54.03. 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.
( 4 )The stock options became exercisable in five equal installments beginning on August 7, 2010, which was the first anniversary of the grant date.

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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