0001140361-11-055873.txt : 20111202 0001140361-11-055873.hdr.sgml : 20111202 20111202162258 ACCESSION NUMBER: 0001140361-11-055873 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111201 FILED AS OF DATE: 20111202 DATE AS OF CHANGE: 20111202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CRIM STEPHEN R CENTRAL INDEX KEY: 0001244806 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 111240669 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 0001244806 CRIM STEPHEN R 100 GALLERIA PARKWAY SE SUITE 700 ATLANTA GA 30339 1 1 0 0 CEO Common Stock 2011-12-01 4 M 0 20000 8.85 A 207094 D Common Stock 2011-12-01 4 F 0 8187 21.62 D 198907 D Option to Purchase Common Stock 8.85 2011-12-01 4 M 0 20000 8.85 D 2005-01-18 2012-01-18 Common Stock 20000 210671 D Paid by surrender of 8,187 shares of Common Stock held by the Reporting Person for more than 1 year at $21.62 per share. Stephen R. Crim 2011-12-02