-----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, WNRQtatWnfMoPui94pR1h826zISv5Up/YDh6sqHKhL1MuutH36EmJfVqna68y0qE 4UEleoaIV0vLpJG42n6FdA== 0000783603-09-000075.txt : 20090831 0000783603-09-000075.hdr.sgml : 20090831 20090831155829 ACCESSION NUMBER: 0000783603-09-000075 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090831 FILED AS OF DATE: 20090831 DATE AS OF CHANGE: 20090831 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: 091046101 MAIL ADDRESS: STREET 1: BRUEGGEN DAVID V STREET 2: 44 CHURCH ST CITY: P O BOX HM2064 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: 31 QUEENS STREET STREET 2: 2ND FLOOR CITY: HAMILTON STATE: D0 ZIP: HM 11 BUSINESS PHONE: 441-296-8560 MAIL ADDRESS: STREET 1: 31 QUEENS STREET STREET 2: 2ND FLOOR CITY: HAMILTON STATE: D0 ZIP: HM 11 FORMER COMPANY: FORMER CONFORMED NAME: AMERICAN SAFETY INSURANCE GROUP LTD DATE OF NAME CHANGE: 19971218 4 1 form4brueggen20090831_ex.xml X0303 4 2009-08-31 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244805 BRUEGGEN DAVID V BRUEGGEN DAVID V 44 CHURCH ST P O BOX HM2064 D0 99999 BERMUDA 1 0 0 0 Common Stock 2009-08-31 2009-08-31 4 A 0 2709 14.77 A 20317 D Common Stock 296648 I See footnote 1 Common Stock 2003 I See footnote #2 Owned by Anning-Johnson Company, successor company to Vertecs Corp. 2,003 shares owned by spouse. David V. Brueggen 2009-08-31 -----END PRIVACY-ENHANCED MESSAGE-----