0001140361-12-041877.txt : 20120928 0001140361-12-041877.hdr.sgml : 20120928 20120928145335 ACCESSION NUMBER: 0001140361-12-041877 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120723 FILED AS OF DATE: 20120928 DATE AS OF CHANGE: 20120928 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chorney Harris CENTRAL INDEX KEY: 0001454716 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 121116233 MAIL ADDRESS: STREET 1: P.O. BOX 37607 CITY: WEST HARTFORD STATE: CT ZIP: 06137 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 0001454716 Chorney Harris BOYLE BUILDING, 2ND FLOOR 31 QUEEN STREET HAMILTON D0 HM 11 BERMUDA 1 0 0 0 Common Stock 2012-07-23 2012-07-23 4 A 0 3053 18.01 A 15597 D Shares issued under the Director Compensation Policy. Per the policy, shares will be held in escrow until the 2013 Shareholders meeting. Harris K. Chorney 2012-09-28