-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, MCSS+H1nMgvEr29IqUyZ8+Um5pcb0fCKs3wrAmg9t3N0YFJPuqiPEEFtChRMWqSr zqNxv94l/AYFa/CAoaXq4Q== 0000783603-05-000027.txt : 20050131 0000783603-05-000027.hdr.sgml : 20050131 20050131160104 ACCESSION NUMBER: 0000783603-05-000027 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030130 FILED AS OF DATE: 20050131 DATE AS OF CHANGE: 20050131 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MATHIS STEVEN B CENTRAL INDEX KEY: 0001244809 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 05561887 BUSINESS ADDRESS: BUSINESS PHONE: 441 295 5688 MAIL ADDRESS: STREET 1: 44 CHURCH ST STREET 2: P O BOX HM2064 CITY: HAMILTON STATE: D0 ZIP: 99999 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERICAN SAFETY INSURANCE HOLDINGS LTD CENTRAL INDEX KEY: 0000783603 STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 44 CHURCH STREET CITY: HAMILTON STATE: D0 ZIP: HM HX BUSINESS PHONE: 4412968560 MAIL ADDRESS: STREET 1: 44 CHURCH STREET CITY: HAMILTON STATE: D0 ZIP: HM HX FORMER COMPANY: FORMER CONFORMED NAME: AMERICAN SAFETY INSURANCE GROUP LTD DATE OF NAME CHANGE: 19971218 4 1 form4_ex.xml X0202 4 2003-01-30 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244809 MATHIS STEVEN B 1801 URQUART COURT MARIETTA GA 30068 0 1 0 0 Chief Financial Officer Share Options (to buy) 6.75 2003-01-30 4 A 0 8000 6.75 A 2013-01-30 ASI 8000 37000 D Share Options (to buy) 8.57 2003-06-19 4 A 0 15000 8.57 A 2008-06-19 2013-06-19 ASI 15000 52000 D Share Options (to buy) 13.67 2004-01-22 4 A 0 9000 13.67 A 2014-01-22 ASI 9000 61000 D The Reporting Person was granted options to purchase Common Shares, which vest equally over three years beginning on the first anniversary of the date of grant. Steven B. Mathis 2004-01-31 -----END PRIVACY-ENHANCED MESSAGE-----