-----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, EeAG57K9wH11FmzjxLDjlqhWmzMJBTyd8UaxSo0snCdbKydWnvIlKOEJORqrQ63K BJXbe/Nkz0Vjuw9F+PXX4g== 0001140361-09-027666.txt : 20091130 0001140361-09-027666.hdr.sgml : 20091130 20091130151913 ACCESSION NUMBER: 0001140361-09-027666 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091130 FILED AS OF DATE: 20091130 DATE AS OF CHANGE: 20091130 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: 091211943 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 2009-11-30 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 2009-11-30 2009-11-30 4 P 0 3000 14.00 A 5790 D Common Stock 296648 I Shares owned by Anning Johnson Company Common Stock 2003 I Shares owned by spouse /s/ David V. Brueggen 2009-11-30 -----END PRIVACY-ENHANCED MESSAGE-----