01/11/2014 08:40:42 Free Membership Login

- Initial Statement of Beneficial Ownership (3)

Date : 04/30/2012 @ 2:29PM
Source : Edgar (US Regulatory)
Stock : American Safety Insurance Holdings, Ltd. (ASI)
Quote : 30.25  0.0 (0.00%) @ 2:17AM
American Safety share price Chart

- Initial Statement of Beneficial Ownership (3)

FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL
OMB Number: 3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Jain Ambuj

2. Date of Event Requiring Statement (MM/DD/YYYY)
3/30/2012 

3. Issuer Name and Ticker or Trading Symbol

AMERICAN SAFETY INSURANCE HOLDINGS LTD [ASI]

(Last)        (First)        (Middle)

BOYLE BUILDING, 2ND FLOOR, 31 QUEEN STREET

4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                            _____ 10% Owner
___ X ___ Officer (give title below)          _____ Other (specify below)
Senior Vice President /

(Street)

HAMILTON, D0 HM 11       

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed (MM/DD/YYYY)

 

6. Individual or Joint/Group Filing (Check Applicable Line)

_ X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person


Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security
(Instr. 4)
2. Amount of Securities Beneficially Owned
(Instr. 4)
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
Common Stock   1755   (1) D    
Common Stock   3791   (2) D    
Common Stock   12500   (3) D    
Common Stock   2459   (4) D    
Common Stock   4032   (5) D    
Common Stock   25000   (6) D    
Common Stock   4465   (7) D    

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 4)
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy)   7/27/2009   (8) 7/27/2014   Common Stock   10000   $13.77   D    
Stock Option (Right to Buy)   3/15/2009   (9) 3/15/2016   Common Stock   4000   $16.40   D    
Stock Option (Right to Buy)   3/15/2010   (9) 3/15/2017   Common Stock   4000   $19.05   D    
Stock Option (Right to Buy)   3/4/2011   (9) 3/4/2018   Common Stock   4000   $17.95   D    
Stock Option (Right to Buy)   3/11/2012   (10) 3/11/2019   Common Stock   10342   $9.10   D    
Stock Option (Right to Buy)   3/5/2013   (9) 3/5/2020   Common Stock   6565   $14.64   D    

Explanation of Responses:
( 1)  Restricted Stock Award given on March 4, 2008, pursuant to the Company's 2007 Incentive Compensation Plan, which vests 25% on the first and second anniversary and 50% on the third anniversary of the grant date.
( 2)  Restricted Stock Award given on March 11, 2009, pursuant to the Company's 2007 Incentive Compensation Plan, which vests 25% on the first and second anniversary and 50% on the third anniversary of the grant date.
( 3)  Restricted Stock Awards given on March 5, 2010, pursuant to the Company's 2007 Incentive Compensation Plan. Shares cliff vest three years from grant date.
( 4)  Restricted Stock Award given on March 5, 2010, pursuant to the Company's 2007 Incentive Compensation Plan, which vests 25% on the first and second anniversary and 50% on the third anniversary of the grant date.
( 5)  Restricted Stock Award given on March 14, 2011, pursuant to the Company's 2007 Incentive Compensation Plan, which vests 25% on the first and second anniversary and 50% on the third anniversary of the grant date.
( 6)  Restricted Stock Awards given on July 29, 2011, pursuant to the Company's 2007 Incentive Compensation Plan. Shares cliff vest five years from grant date.
( 7)  Restricted Stock Award given on March 14, 2012, pursuant to the Company's 2007 Incentive Compensation Plan, which vests 25% on the first and second anniversary and 50% on the third anniversary of the grant date.
( 8)  Options awarded pursuant to the Company's 2007 Incentive Compensation Plan. These options cliff vested at the fifth anniversary of the grant date. The date shown is the date the first vested number of shares became exercisable.
( 9)  Options awarded pursuant to the Company's 2007 Incentive Compensation Plan. These options have a three year vesting schedule, pursuant to which the shares underlying the options shall vest in one-third increments commencing one year after the grant date. The date shown is the date the first vested number of shares became/becomes exercisable.
( 10)  Options awarded pursuant to the Company's 2007 Incentive Compensation Plan. These options cliff vested at the third anniversary of the grant date. The date shown is the date the first vested number of shares became exercisable.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
Jain Ambuj
BOYLE BUILDING, 2ND FLOOR
31 QUEEN STREET
HAMILTON, D0 HM 11


Senior Vice President

Signatures
Ambuj Jain 3/30/2012
** Signature of Reporting Person Date


Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

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