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