-----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, VaA8lL3V3RL4xa82ADjrg5O+m54Bkn0KvfBQEwHjdYLdlpH4Dbjk+ekzJetikuiD /pZzY/WuTJxjKnJXwf/hiA== 0001140361-09-023998.txt : 20091028 0001140361-09-023998.hdr.sgml : 20091028 20091028170523 ACCESSION NUMBER: 0001140361-09-023998 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: MUELLER THOMAS W CENTRAL INDEX KEY: 0001244812 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 091142331 MAIL ADDRESS: STREET 1: 44 CHURCH ST STREET 2: P O BOX HM2064 CITY: HAMILTON 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 0001244812 MUELLER THOMAS W 44 CHURCH STREET P.O. BOX HM 2064 HAMILTON D0 HM 11 BERMUDA 1 0 0 0 Common Stock 2009-07-27 4 A 0 2790 14.34 A 17576 D Common Stock 162745 I Held by the Mark C. Mueller Trust for which Thomas Mueller is the sole Trustee Common Stock 160000 I Held by the Thomas W. Mueller Trust Shares issued under the Director Compensation Policy. Per the policy shares will be held in escrow until the 2010 Shareholders meeting. /s/ Thomas W. Mueller 2009-10-28 -----END PRIVACY-ENHANCED MESSAGE-----