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