0001140361-12-042587.txt : 20121003
0001140361-12-042587.hdr.sgml : 20121003
20121003113821
ACCESSION NUMBER: 0001140361-12-042587
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120723
FILED AS OF DATE: 20121003
DATE AS OF CHANGE: 20121003
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: 121125743
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
X0306
4
2012-07-23
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
2012-07-23
2012-07-23
4
A
0
3053
18.01
A
53919
D
Common Stock
2003
I
Shares owned by spouse.
Shares issued under the Director Compensation Policy. Per the policy, shares will be held in escrow until the 2013 Shareholders meeting.
David V. Brueggen
2012-10-03