-----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, GtliDlPmX4oBl5GQYKGUEaHIO4cBzItJAIsSLNhCynpB6iibzqXH7xRHtGANasmM eKhhQA2HRAoxchQHTDA86w== 0000783603-05-000057.txt : 20050906 0000783603-05-000057.hdr.sgml : 20050905 20050906151458 ACCESSION NUMBER: 0000783603-05-000057 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050818 FILED AS OF DATE: 20050906 DATE AS OF CHANGE: 20050906 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRUEGGEN DAVID V CENTRAL INDEX KEY: 0001244805 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 051070180 MAIL ADDRESS: STREET 1: BRUEGGEN DAVID V STREET 2: 44 CHURCH ST CITY: P O BOX HM2064 STATE: D0 ZIP: 99999 4 1 brueggen_ex.xml X0202 4 2005-08-18 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244805 BRUEGGEN DAVID V 1959 ANSON DRIVE MELROSE PARK IL 60160 1 0 0 0 Common Shares 2005-08-18 2005-08-18 4 A 0 1042 15.76 A 291218 I See Footnote (1) Common Shares 2003 I See Footnote (2) Common Shares 1000 I See Footnote (3) By Vertecs Corporation. Owned by spouse. Owned jointly with spouse David V. Brueggen - By Power of Attorney 2005-09-06 -----END PRIVACY-ENHANCED MESSAGE-----