-----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, G3w+LYG0zfqnpaaI9itcsZiFd05aWCjBMEDCrE7XlkgwT93tFeAkHsamzCeKb1FF LT0Rg/u5SmE7yH77U7yjJg== 0000783603-05-000114.txt : 20051202 0000783603-05-000114.hdr.sgml : 20051202 20051202094850 ACCESSION NUMBER: 0000783603-05-000114 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051114 FILED AS OF DATE: 20051202 DATE AS OF CHANGE: 20051202 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: William Clarence Tepe CENTRAL INDEX KEY: 0001345760 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 051239112 BUSINESS ADDRESS: STREET 1: 1845 THE EXCHANGE CITY: ATLANTA STATE: 2Q ZIP: 30102 BUSINESS PHONE: 770-485-4373 MAIL ADDRESS: STREET 1: 1845 THE EXCHANGE CITY: ATLANTA STATE: 2Q ZIP: 30102 4 1 tepe_ex.xml X0202 4 2005-11-14 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001345760 William Clarence Tepe 1845 THE EXCHANGE ATLANTA GA 30102 0 1 0 0 Chief Financial Officer Common Shares (to buy) 2005-11-14 2005-11-14 4 A 0 25000 16.18 A 25000 D The Reporting Person was granted options to purchase Common Shares, which vest all at once at November 14, 2010. William C. Tepe 2005-12-02 -----END PRIVACY-ENHANCED MESSAGE-----