0001140361-13-024383.txt : 20130606 0001140361-13-024383.hdr.sgml : 20130606 20130606152908 ACCESSION NUMBER: 0001140361-13-024383 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130604 FILED AS OF DATE: 20130606 DATE AS OF CHANGE: 20130606 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCOLLO JOSEPH D CENTRAL INDEX KEY: 0001244815 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14795 FILM NUMBER: 13897212 MAIL ADDRESS: STREET 1: 44 CHURCH STREET STREET 2: P O BOX HM2064 CITY: HAMILTON STATE: D0 ZIP: 99999 FORMER NAME: FORMER CONFORMED NAME: SCOLLO JOSEPH D JR DATE OF NAME CHANGE: 20030620 4 1 doc1.xml FORM 4 X0306 4 2013-06-04 0 0000783603 AMERICAN SAFETY INSURANCE HOLDINGS LTD ASI 0001244815 SCOLLO JOSEPH D BOYLE BUILDING, 2ND FLOOR 31 QUEEN STREET HAMILTON D0 HM 11 BERMUDA 0 1 0 0 COO Common Stock 2013-06-04 4 M 0 50000 8.57 A 108592 D Common Stock 2013-06-04 4 F 0 14817 28.92 D 93775 D Stock Option - Right to Buy 8.57 2013-06-04 4 M 0 50000 8.57 D 2003-06-19 2013-06-19 Common Stock 50000 0 D Stock Option - Right to Buy 13.67 2004-01-21 2014-01-21 Common Stock 12000 12000 D Stock Option - Right to Buy 16.40 2006-03-15 2016-03-15 Common Stock 7500 7500 D Stock Option - Right to Buy 19.05 2007-03-15 2017-03-15 Common Stock 7500 7500 D Stock Option - Right to Buy 17.95 2008-03-04 2018-03-04 Common Stock 14446 14446 D Stock Option - Right to Buy 9.10 2009-03-11 2019-03-11 Common Stock 23712 23712 D Stock Option - Right to Buy 14.64 2010-03-05 2020-03-05 Common Stock 14857 14857 D Surrendered 14,817 shares @ $28.92 per share to pay exercise price of options @ $8.57 per share. Joseph D. Scollo, Jr. 2013-06-06