NT 10-K 1 dnt10k.htm 12B-25 12b-25

(Check One):

    x  Form 10-K

    ¨  Form 20-F

    ¨  Form 11-K

    ¨  Form 10-Q

    ¨  Form N-SAR

    ¨  Form N-CSR

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 12b-25

 

NOTIFICATION OF LATE FILING

 

OMB APPROVAL


OMB Number: 3235-0058


Expires: March 31, 2006


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SEC FILE NUMBER

    1-14795


CUSIP NUMBER


 

    For Period Ended:     December 31, 2003    
    ¨  Transition Report on Form 10-K
    ¨  Transition Report on Form 20-F
    ¨  Transition Report on Form 11-K
    ¨  Transition Report on Form 10-Q
    ¨  Transition Report on Form N-SAR
    For the Transition Period Ended:     Not Applicable    

 

 

Read Instruction Before Preparing Form. Please Print or Type.

 

Nothing in this form shall be construed to imply that the Commission has verified any information contained herein.

 

 

If the notification relates to a portion of the filing checked above, identify the Item(s) to which the notification relates:     Not Applicable    

 


 

PART I — REGISTRANT INFORMATION

 

 

American Safety Insurance Holdings, Ltd.


Name of Registrant

 

American Safety Insurance Group, Ltd.


Former Name if Applicable

 

44 Church Street


Address of Principal Executive Office (Street and Number)

 

Hamilton, Bermuda HMHX


City, State and Zip Code



 

PART II — RULES 12b-25(b) AND (c)

 

If the subject report could not be filed without unreasonable effort or expense and the registrant seeks relief pursuant to Rule 12b-25(b), the following should be completed. (Check box if appropriate)

 

x

  (a)   The reasons described in reasonable detail in Part III of this form could not be eliminated without unreasonable effort or expense;

x

  (b)   The subject annual report, semi-annual report, transition report on Form 10-K, Form 20-F, 11-K or Form N-SAR, Form N-CSR or portion thereof, will be filed on or before the fifteenth calendar day following the prescribed due date; or the subject quarterly report of transition report on Form 10-Q, or portion thereof, will be filed on or before the fifth calendar day following the prescribed due date; and
    (c)   The accountant’s statement or other exhibit required by Rule 12b-25(c) has been attached if applicable.

 


 

PART III — NARRATIVE

 

 

State below in reasonable detail the reasons why Forms 10-K, 20-F, 11-K, 10-Q, N-SAR, N-CSR, or the transition report portion thereof, could not be filed within the prescribed time period.

 

The Registrant was unable to Edgarize its 2003 Annual Report on Form 10-K by the filing deadline. The 2003 Annual Report on Form 10-K was filed within hours of the filing deadline.


 

PART IV

 

OTHER INFORMATION

 

(1) Name and telephone number of person to contact in regard to this notification

 

    W. Brinkley Dickerson, Jr.    

(Name)

    

    (404)    

(Area Code)

  

    885-3822    

(Telephone Number)

 

(2) Have all other periodic reports required under Section 13 or 15(d) of the Securities Exchange Act of 1934 or Section 30 of the Investment Company Act of 1940 during the preceding 12 months or for such shorter period that the registrant was required to file such report(s) been filed? If the answer is no, identify report(s).

x Yes ¨ No

 

(3) Is it anticipated that any significant change in results of operations from the corresponding period for the last fiscal year will be reflected by the earnings statements to be included in the subject report or portion thereof?

¨ Yes x No

 

If so, attach an explanation of the anticipated change, both narratively and quantitatively, and, if appropriate, state the reasons why a reasonable estimate of the results cannot be made.

 


American Safety Insurance Holdings, Ltd.


(Name of registrant as specified in charter)

 

Has caused this notification to be signed on its behalf by the undersigned thereunto duly authorized:

 

Date: March 31, 2004       By:  

/s/ Steven B. Mathis


                Name:   Steven B. Mathis
                Title:   Chief Financial Officer