-----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, JJ756Cs7mToxXGPOR3dOvtdzW7oRaUD6zdTVCrOJ6oQOGpkcEmOEBEIUx1meCNMR kPPxRsb+mD76Aut1b4qQIw== 0001140361-10-047313.txt : 20101129 0001140361-10-047313.hdr.sgml : 20101129 20101129153156 ACCESSION NUMBER: 0001140361-10-047313 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101124 FILED AS OF DATE: 20101129 DATE AS OF CHANGE: 20101129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cloutier Guy CENTRAL INDEX KEY: 0001486659 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 101218755 MAIL ADDRESS: STREET 1: 9E PINE HILL DRIVE CITY: PEMBROKE STATE: D0 ZIP: HM 08 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 2010-11-24 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001486659 Cloutier Guy 44 CHURCH STREET P.O. BOX HM2064 HAMILTON D0 HM 11 BERMUDA 0 1 0 0 Chief Actuary Common Stock 2010-11-24 2010-11-24 4 S 0 1825 19.70 D 56025 D Common Stock 2010-11-24 2010-11-24 4 S 0 300 19.71 D 55725 D Common Stock 2010-11-24 2010-11-24 4 S 0 300 19.72 D 55425 D Common Stock 2010-11-24 2010-11-24 4 S 0 95 19.73 D 55330 D Stock Option (Right To Buy) 19.55 2012-03-17 2017-03-17 Common Stock 5000 5000 D Stock Option (Right To Buy) 17.95 2009-03-01 2018-03-01 Common Stock 2500 7500 D Stock Option (Right To Buy) 9.10 2010-03-09 2019-03-09 Common Stock 11241 18741 D Stock Option (Right To Buy) 14.34 2011-03-05 2020-03-05 Common Stock 10941 29682 D Options awarded pursuant to the Company's 2007 Incentive Stock Option Plan. These options have a three-year vesting schedule, pursuant to which the shares underlying the options shall cliff vest on the 5th anniversary of the date of grant. The date shown is the date the first vested number of shares becomes/became exercisable. Options awarded pursuant to the Company's 2007 Incentive Stock Option Plan. These options have a three-year vesting schedule, pursuant to which the shares underlying the options shall vest in one-third increments commencing one year after the date of grant. The date shown is the date the first vested number of shares becomes/became exercisable. Options awarded pursuant to the Company's 2007 Incentive Stock Option Plan. These options have a three-year vesting schedule, pursuant to which the shares underlying the options shall vest in one-third increments commencing one year after the date of grant. The date shown is the date the first vested number of shares becomes/became exercisable. 5,621 options were exercised on 11/16/2010 of 16,862 originally issued. Guy Cloutier 2010-11-29 -----END PRIVACY-ENHANCED MESSAGE-----