0001140361-11-055634.txt : 20111201 0001140361-11-055634.hdr.sgml : 20111201 20111201165153 ACCESSION NUMBER: 0001140361-11-055634 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111201 FILED AS OF DATE: 20111201 DATE AS OF CHANGE: 20111201 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: 111237774 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 X0304 4 2011-12-01 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244812 MUELLER THOMAS W 1300 W. MAIN PO BOX 2258 LOUISVILLE KY 40203 1 0 0 0 Common Stock 2011-12-01 4 S 0 20000 21.82 D 140000 I Shares held by Thomas W. Mueller Trust in which the Reporting Person has a pecuniary interest. Thomas W. Mueller 2011-12-01