0001140361-12-016011.txt : 20120315 0001140361-12-016011.hdr.sgml : 20120315 20120315172415 ACCESSION NUMBER: 0001140361-12-016011 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120315 FILED AS OF DATE: 20120315 DATE AS OF CHANGE: 20120315 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRUEGGEN DAVID V CENTRAL INDEX KEY: 0001244805 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 12695045 MAIL ADDRESS: STREET 1: BRUEGGEN DAVID V STREET 2: 44 CHURCH ST CITY: P O BOX HM2064 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 2012-03-15 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244805 BRUEGGEN DAVID V BOYLE BUILDING, 2ND FLOOR 31 QUEEN STREET HAMILTON D0 HM 11 BERMUDA 1 0 0 0 Common Stock 2012-03-15 4 P 0 3000 18.21 A 30549 D David V. Brueggen 2012-03-15