-----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, WzeIpp0OQWtZ9PEkZjiZYnw0LphUKezVmOZvMtpJMRIqJhZZz7cFEqV6pdPDyCCg wM4TBY4f2Wg2D7AWbO4FCw== 0001140361-09-023107.txt : 20091013 0001140361-09-023107.hdr.sgml : 20091012 20091013143945 ACCESSION NUMBER: 0001140361-09-023107 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090930 FILED AS OF DATE: 20091013 DATE AS OF CHANGE: 20091013 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ervin Laura Lynne CENTRAL INDEX KEY: 0001461540 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 091116471 MAIL ADDRESS: STREET 1: 188 COVERED BRIDGE TRAIL SW CITY: SMYRNA STATE: GA ZIP: 30082 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/A 1 doc1.xml FORM 4/A X0303 4/A 2009-09-30 2009-10-09 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001461540 Ervin Laura Lynne 100 GALLERIA PARKWAY SE SUITE 700 ATLANTA GA 30339 0 1 0 0 Interim CFO Common Stock 2009-09-30 2009-09-30 4 A 0 2813 15.80 A 2972 D Common Stock 2009-09-30 2009-09-30 4 F 0 913 15.80 D 2059 D Stock Option (Right To Buy) 19.68 2009-09-30 2009-09-30 4 A 0 3000 19.68 A 2009-09-30 2009-12-30 Common Stock 3000 4000 D Stock Option (Right To Buy) 17.95 2009-09-30 2009-09-30 4 A 0 1000 17.95 A 2009-09-30 2009-12-30 Common Stock 1000 4000 D Shares issued as part of the Company's 2008 Long-Term Incentive Plan. Scheduled vesting was accelerated as part of the 09-18-2009 Separation Agreement. 913 shares surrendered @ $15.80 per share for withholdings on 2813 shares vested (1900 net shares). Vesting for options was accelerated as part of the 09-18-2009 Separation Agreement. /s/ Laura L. Ervin 2009-10-09 -----END PRIVACY-ENHANCED MESSAGE-----