-----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, LelGm5fxd2F4TMR/6vPLecRiw2Tns1u8b7bHvsBq17VVVSJprKdvrklBMeNlfA+F PTrbmwoS1nelewD1k0/WwA== 0000783603-05-000076.txt : 20050926 0000783603-05-000076.hdr.sgml : 20050926 20050926110418 ACCESSION NUMBER: 0000783603-05-000076 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050922 FILED AS OF DATE: 20050926 DATE AS OF CHANGE: 20050926 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: MATHIS STEVEN B CENTRAL INDEX KEY: 0001244809 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 051102196 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 4 1 mathis_ex.xml X0202 4 2005-09-22 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD C3CC@CCC 0001244809 MATHIS STEVEN B 1801 URQUART COURT MARIETTA GA 30068 0 1 0 0 Chief Financial Officer Share Options (to buy) 16.72 2005-09-22 2005-09-22 4 A 0 5000 16.72 A 2005-09-22 2015-09-22 ASI 5000 66000 D The Reporting Person was granted options to purchase Common Shares, which vest equally over three years beginging on the first anniversary of the date of grant. Steven B. Mathis 2005-09-26 -----END PRIVACY-ENHANCED MESSAGE-----