-----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, HNRq3XhIDBuc3ZOoxqTvRBEjDjsBcUonTp/hjm30FPdVVQdDdRZiz3gPPymyCyHq Vf/rxP2pyWGn1XWVlPN1yQ== 0000783603-05-000072.txt : 20050916 0000783603-05-000072.hdr.sgml : 20050916 20050916153008 ACCESSION NUMBER: 0000783603-05-000072 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050916 FILED AS OF DATE: 20050916 DATE AS OF CHANGE: 20050916 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lackner Frank D CENTRAL INDEX KEY: 0001315632 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 051089023 BUSINESS ADDRESS: BUSINESS PHONE: 441-295-5688 MAIL ADDRESS: STREET 1: 44 CHURCH STREET STREET 2: P.O. BOX HM2064 CITY: HAMILTON STATE: D0 ZIP: HM HX 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 lackner0916_ex.xml X0202 4 2005-09-16 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001315632 Lackner Frank D 237 LAFAYETTE STREET APT. 9E NEW YORK NY 100212 1 0 0 0 Common Shares 2005-09-16 2005-09-16 4 P 0 2500 17.35 A 3542 D Frank Lackner By Power of Attorney 2005-09-16 -----END PRIVACY-ENHANCED MESSAGE-----