0001140361-12-040174.txt : 20120912 0001140361-12-040174.hdr.sgml : 20120912 20120912161350 ACCESSION NUMBER: 0001140361-12-040174 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120723 FILED AS OF DATE: 20120912 DATE AS OF CHANGE: 20120912 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GROOT STEVEN L CENTRAL INDEX KEY: 0001201022 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 121087980 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 X0306 4 2012-07-23 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001201022 GROOT STEVEN L BOYLE BUILDING, 2ND FLOOR 31 QUEEN STREET HAMILTON D0 HM II BERMUDA 1 0 0 0 Common Stock 2012-07-23 2012-07-23 4 A 0 3053 18.01 A 43280 I Shares Owned by the Steven L. Groot Living Trust Shares issued under the Director Compensation Policy. Per the policy, shares will be held in escrow until the 2013 Shareholders meeting. Steven L. Groot 2012-09-12