-----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, JA9Ona9K7431iw6RPAy+OUP8G+UP3A4LSoNQJJjcXywa8jqsg+Gt8bRYcJe8RqgI KnC2ZCzAlQy+t/ROwydBPg== 0001140361-09-023983.txt : 20091028 0001140361-09-023983.hdr.sgml : 20091028 20091028162257 ACCESSION NUMBER: 0001140361-09-023983 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090727 FILED AS OF DATE: 20091028 DATE AS OF CHANGE: 20091028 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: 091142004 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 doc1.xml FORM 4 X0303 4 2009-07-27 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244805 BRUEGGEN DAVID V 44 CHURCH STREET P.O. BOX 2064 HAMILTON D0 HM 11 BERMUDA 1 0 0 0 Common Stock 2009-07-27 4 A 0 2790 14.34 A 23107 D Common Stock 296648 I Owned by Anning-Johnson Company, successor to Vertecs Corp. Common Stock 2003 I Shares owned by spouse. Shares issued under the Director Compensation Policy. Per the policy, shares will be held in escrow until the 2010 Shareholders meeting. /s/ David V. Brueggen 2009-10-28 -----END PRIVACY-ENHANCED MESSAGE-----