0001140361-12-042590.txt : 20121003
0001140361-12-042590.hdr.sgml : 20121003
20121003114342
ACCESSION NUMBER: 0001140361-12-042590
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: MUELLER THOMAS W
CENTRAL INDEX KEY: 0001244812
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-14795
FILM NUMBER: 121125755
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
X0306
4
2012-07-23
0
0000783603
AMERICAN SAFETY INSURANCE HOLDINGS LTD
ASI
0001244812
MUELLER THOMAS W
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
24442
D
Common Stock
142745
I
As trustee of Mark C. Mueller Trust
Common Stock
140000
I
Shares held by Thomas W. Mueller Trust
Common Stock
81960
I
Shares held by Market Street Realty Trust
Shares issued under the Director Compensation Policy. Per the policy, shares will be held in escrow until the 2013 Shareholders meeting.
Thomas W. Mueller
2012-10-03