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