PARTICIPANT FEE DISCLOSURE STATEMENT Amerisafe, Inc. 401(k) Plan ("Plan") November 30, 2015 This Disclosure Statement is provided by your employer to explain the costs associated with participating in the Plan. It is for informational purposes and is intended to help you make informed decisions about your investments. Unless specifically noted below, all information in this statement is provided as of the above date. The document includes these sections: 1. General Plan Information 2. Plan Administrative s 3. Individual s 4. Comparative Chart of Plan Investment Options ( Comparative Chart ) Highlights This disclosure is provided for informational purposes. You should read this document carefully, but are not required to take any other specific action. This document explains the costs and fees that you may be charged for participating in your employer s retirement plan. This document may be helpful when making decisions about your plan investments. Special Note: No fees will be charged to you if you have no account balance in the plan. If you are an Eligible Employee* and not participating, you can enroll at: www.portal.adp.com or by calling the Participant Call Center. *Your plan may have certain age and length of service requirements that you must meet in order to participate. you received this notice, you may have become eligible and may already be participating in the plan. If you would like to confirm your eligibility under the plan, you may log on to the Participant Website or contact a Participant Call Center Representative. Page 1 of 9
1. General Plan Information Giving investment instructions 1 To direct or change your Plan investments, you must either: i. make your investment elections on the Participant Website www.portal.adp.com, or ii. speak with a Participant Call Center Representative at 1-888-822-9238. You may direct the investment of all funds held in your Plan account. Limitations on instructions. Your financial transactions that you request prior to 4:00 p.m. ET or the close of the NYSE, if earlier, on a business day are effective that day. Any financial transactions you request after that time will be treated as received, and will be processed, the next business day. Designated investment options. Your Plan has a menu of investment options into which you can direct the investment of your plan funds. Generally, Plan investments are selected to provide a wide range of different asset classes (like stocks and bonds) as well as investment styles and managers. it is important to understand how these investment choices fit into your sonal investment strategy, your company has provided extensive information on these investment choices through ADP s Participant Website and the Participant Call Center. Please see the Comparative Chart section below for the names of, and information about, these designated investment options. Voting and other rights. The Plan Sponsor will exercise any voting or other rights associated with ownership of shares or units of the designated investment options held in your plan account. 1 Your plan has employed ADP Retirement Services as your plan s record kee. ADP Retirement Services provides a comprehensive Participant Website to help you join the plan, initiate transactions or get more information. The participant website and toll free number are generally available 24 hours a day, 7 days a week except during iods of scheduled maintenance. In addition, the Participant Call Center Representatives are knowledgeable in your Plan s provisions, oations and investment choices. Whether you are already in the Plan and need help with a question or you wish to enroll and begin contributing, the Participant Call Center Representative can help Monday through Friday during normal business hours. Page 2 of 9
Designated investment manager. Guided Choice is a designated investment manager for the assets managed in accordance with the managed accounts product offered by Guided Choice. 2. Plan Administrative s. Plan administrative services, such as legal, consulting, audit, accounting, trustee and recordkeeping services may be required to administer the plan. The cost for these services may be paid by your employer or from the Plan, or both. s that are not paid by the employer may be deducted from your account. The actual fees deducted from your account, if any, will be reflected on your quarterly account statement and on the Participant Website at www.portal.adp.com. Your employer is currently invoiced for record keeping and trustee fees and additional disclosure will be provided to you if fees will be taken from participants accounts. Please see the online glossary on the Participant Website www.portal.adp.com for a definition of capita allocation and an example of how a capita allocation applies, or contact the Participant Call Center. Additional disclosure will be provided to participants if other Plan administrative fees will be charged to participant accounts. 3. Individual s. The Plan will apply the following charges directly to your account, if applicable: Transaction/Service Fee Final Distribution Withdrawal Loan Initiation Qualified Domestic Relations Order(QDRO) Review and Determination GuidedChoice Managed Accounts Buy/Sell Investments $50.00 distribution for all distributions in a year $50.00 withdrawal for all withdrawals in a year $125.00 processing fee Loan set-up $525.00 QDRO review and Determination 0.20% investment management fee charged by Guided Choice. 0.15% administrative services fee charged by ADP. This is an annual fee charged to your account monthly. Buying or selling some investments may result in individual account charges specific to those investments, such as redemption fees. See the Comparative Chart below for details. Page 3 of 9
4. Comparative Chart Investment Options November 30, 2015 The Comparative Chart section includes important information to help you compare the investment options in your retirement plan, including formance information, fees and expenses. Additional investment information such as the investments; objectives, strategies and portfolio turnover rate can be found at ADP s Participant website www.portal.adp.com on the Investment Performance and Information page. You may also contact the ADP Participant Call Center at 1-888-822-9238, ADP Retirement Services, 71 Hanover Road, MS 3333, Florham Park, NJ, 07932 to request additional investment information or a pa copy of the information available on the web site. Variable Performance Investment Comparative Chart 2 The Comparative Chart below includes formance of investment options that do not have a fixed or stated rate of return. It shows: Average Annual total Return 3 - Investment option formance over time as compared to an appropriate benchmark 4 for the same time iod, Oating s -The actual cost to you for investing in a fund is the amount. The impact of that expense is already included in the displayed. Shareholder type Charges and are investment related fees not reflected in Oating s, and fund specific investment restrictions. Past formance is no guarantee of future results. Your investment in these options could lose money. Current formance may be lower or higher than the formance data quoted. The most recent formance and information about risks is available at www.portal.adp.com on the Investment Performance and Information page. 2 Please note that this chart presents certain information about investments in the Plan. The information may differ in content (for example, the time iods over which formance is calculated) or in format from other material provided to you in written communications, on the Participant Website or in other websites or publications. 3 is a measure of the average return of an investment over some historical iod, such as 5 or 10 years. These returns are reported after adjusting for the fund s oating expenses, or, but do not include any sales charges or brokerage commissions incurred in managing the fund. 4 In order to evaluate an investment fund s formance, it is sometimes helpful to compare that fund s returns for the same iod against the return of the market from which the fund is choosing its investments. Certain independent companies publish Benchmarks, such as the Standard & Poor s 500, which are meant to approximate the return of all of the investments in that market. Each fund compares its returns against the Benchmark they feel most appropriately represents the market in which they are investing that fund s assets. Page 4 of 9
Oating s Vanguard Prime Money Market Fund - Investor Class/ Money Market - Taxable 0.02% 0.03% 1.43% 5.28% 0.16% $1.60 0.16% $1.60 Benchmark BofAML USD LIBOR 3 Mon CM 0.25% 0.31% 1.84% N/A N/A N/A N/A N/A T. Rowe Price U.S. Treasury Intermediate Fund/ Intermediate Government 3.98% 2.41% 4.72% 5.88% 0.51% $5.10 0.51% $5.10 Benchmark BarCap US Government TR USD 2.27% 2.31% 4.06% 6.17% N/A N/A N/A N/A Vanguard Total Bond Market Index Fund - Admiral Class/ Intermediate-Term Bond 2.75% 2.98% 4.60% 4.49% 0.07% $0.70 0.07% $0.70 Benchmark BarCap US Agg Bond TR USD 1.56% 2.98% 4.46% 4.65% N/A N/A N/A N/A American Century Inflation-Adjusted Bond Fund - Institutional Class/ Inflation-Protected Bond -1.66% 2.06% 3.78% 4.36% 0.27% $2.70 0.27% $2.70 Benchmark BarCap US Treasury US TIPS TR USD -2.73% 2.79% 4.06% 4.66% N/A N/A N/A N/A Vanguard Target Retirement Income Fund - Investor Class/ Target-Date 0.18% 5.17% 4.96% 5.15% 0.16% $1.60 0.16% $1.60 Moderate Income -2.25% 6.04% 5.18% 5.83% N/A N/A N/A N/A Vanguard Target Retirement 2010 Fund - Investor Class/ Target-Date 0.06% 6.24% N/A 5.31% 0.16% $1.60 0.16% $1.60 Moderate 2010-2.61% 7.28% 5.77% 5.59% N/A N/A N/A N/A of the fund within 365 days. Once you 365 days. Page 5 of 9
Oating s Vanguard Target Retirement 2015 Fund - Investor Class/ Target-Date -0.66% 7.04% 5.30% 5.90% 0.16% $1.60 0.16% $1.60 Moderate 2015-2.85% 7.97% 5.99% 7.08% N/A N/A N/A N/A Vanguard Target Retirement 2020 Fund - Investor Class/ Target-Date -1.13% 7.66% N/A 5.59% 0.16% $1.60 0.16% $1.60 Moderate 2020-3.16% 8.84% 6.18% 5.73% N/A N/A N/A N/A Vanguard Target Retirement 2025 Fund - Investor Class/ Target-Date -1.60% 8.16% 5.41% 6.17% 0.17% $1.70 0.17% $1.70 Moderate 2025-3.58% 9.80% 6.36% 7.66% N/A N/A N/A N/A Vanguard Target Retirement 2030 Fund - Investor Class/ Target-Date -2.16% 8.61% N/A 5.56% 0.17% $1.70 0.17% $1.70 Moderate 2030-4.12% 10.59% 6.49% 5.76% N/A N/A N/A N/A Vanguard Target Retirement 2035 Fund - Investor Class/ Target-Date -2.75% 9.06% 5.56% 6.60% 0.18% $1.80 0.18% $1.80 Moderate 2035-4.70% 11.02% 6.59% 7.90% N/A N/A N/A N/A Vanguard Target Retirement 2040 Fund - Investor Class/ Target-Date -3.43% 9.18% N/A 5.64% 0.18% $1.80 0.18% $1.80 Moderate 2040-5.19% 11.10% 6.63% 5.74% N/A N/A N/A N/A Vanguard Target Retirement 2045 Fund - Investor Class/ Target-Date -3.49% 9.19% 5.73% 6.92% 0.18% $1.80 0.18% $1.80 Moderate 2045-5.56% 10.98% 6.61% 7.95% N/A N/A N/A N/A Page 6 of 9
Oating s Vanguard Target Retirement 2050 Fund - Investor Class/ Target-Date -3.46% 9.18% N/A 5.69% 0.18% $1.80 0.18% $1.80 Moderate 2050-5.86% 10.81% 6.59% 5.64% N/A N/A N/A N/A Vanguard Target Retirement 2055 Fund - Investor Class/ Target-Date -3.58% 9.24% N/A 10.04% 0.18% $1.80 0.18% $1.80 Moderate 2055-6.14% 10.62% 6.53% 9.01% N/A N/A N/A N/A Fidelity Puritan Fund/ Risk Based -0.32% 9.73% 6.53% 10.95% 0.56% $5.60 0.56% $5.60 Benchmark Morningstar Moderately Aggr Target Risk -4.68% 10.01% 6.24% N/A N/A N/A N/A N/A Principal Equity Income Fund - Institutional Class/ Large Value -3.85% 10.94% 6.28% 8.12% 0.52% $5.20 0.52% $5.20 Benchmark Russell 1000 Value TR USD -3.48% 14.68% 6.18% 6.02% N/A N/A N/A N/A SSgA S&P 500 Index Securities Lending Series Fund - Class VI/ Large Blend -0.76% 13.21% 6.72% 7.67% 0.13% $1.30 0.13% $1.30 Benchmark S&P 500 TR 0.48% 15.87% 7.15% 7.76% N/A N/A N/A N/A Fidelity Blue Chip Growth Fund/ Large Growth 4.30% 15.64% 8.91% 11.10% 0.89% $8.90 0.89% $8.90 Benchmark Russell 1000 Growth TR USD 4.26% 17.40% 8.41% 9.72% N/A N/A N/A N/A of the fund within 30 days. Once you 85 days. of the fund within 30 days. Once you 30 days. of the fund within 30 days. Once you 85 days. Page 7 of 9
Oating s Fidelity Contrafund/ Large Growth 3.27% 13.34% 8.45% 12.32% 0.64% $6.40 0.64% $6.40 Benchmark Russell 1000 Growth TR USD 4.26% 17.40% 8.41% N/A N/A N/A N/A N/A JPMorgan Mid Cap Value Fund - Institutional Class/ Mid-Cap Blend 2.03% 14.63% 8.50% 12.71% 0.75% $7.50 0.94% $9.40 Benchmark Russell Mid Cap Value TR USD -2.54% 15.96% 7.93% 9.00% N/A N/A N/A N/A SSgA S&P MidCap Index Non Lending Series Fund - Class F/ Mid-Cap Blend 1.18% 12.69% 8.07% 9.47% 0.21% $2.10 0.21% $2.10 Benchmark Russell Mid Cap TR USD 0.02% 16.56% 8.40% 9.63% N/A N/A N/A N/A Wells Fargo Common Stock Fund - Institutional Class/ Mid-Cap Blend -1.38% 11.45% N/A 11.92% 0.86% $8.60 0.92% $9.20 Benchmark Russell Mid Cap TR USD 0.02% 16.56% 8.40% 14.16% N/A N/A N/A N/A Vanguard Small Cap Index Fund - Admiral Class/ Small Blend -0.15% 12.99% 7.75% 8.34% 0.09% $0.90 0.09% $0.90 Benchmark Russell 2000 TR USD 0.03% 15.55% 7.12% 7.20% N/A N/A N/A N/A Vanguard Total International Stock Index Fund - Admiral Class/ Foreign Large Blend -10.72% N/A N/A 2.23% 0.14% $1.40 0.14% $1.40 Benchmark MSCI AC World Ex USA NR USD -12.35% 4.76% 4.04% 1.89% N/A N/A N/A N/A of the fund within 30 days. Once you 85 days. of the fund within 60 days. Once you 90 days. Page 8 of 9
Oating s Oppenheimer International Growth Fund - Class Y/ Foreign Large Growth -2.88% 6.87% 6.44% 6.52% 0.89% $8.90 0.89% $8.90 Benchmark MSCI ACWI Ex USA Growth NR USD - Foreign Large Growth -8.66% 5.63% 4.54% 3.79% N/A N/A N/A N/A PIMCO Real Estate Real Return Strategy Fund - Institutional Class/ Real Estate 12.13% 14.88% 9.39% 12.93% 0.74% $7.40 0.80% $8.00 Benchmark S&P United States REIT TR USD -0.01% 12.24% 6.48% 9.63% N/A N/A N/A N/A The is the fund s "Total ()" reduced for any investment management fee waivers that are currently in effect. The is the fund's total expense ratio which is defined as the total cost of investing and administering assets, including management fees, 12b-1 fee (if applicable) in a mutual fund or other collective fund expressed as a centage of total assets. The Per $1,000 Oating s listed in the table above is the total annual oating expenses of the investment for a one-year iod expressed as a dollar amount for a $1,000 investment, assuming no returns and based on the stated centage. Fees and expenses are only one of several factors that you should consider when making investment decisions. The cumulative effect of fees and expenses may substantially reduce the growth of your retirement account. For more information about fees and expenses, visit the Department of Labor s web site at http://www.dol.gov/ebsa/publications/401k_employee.html. For a glossary of investment terms, log in to your account at www.portal.adp.com, select Investments, then go to the Investment Performance and Information page and click on the "Glossary of Investment Terms" link. Page 9 of 9