1. Name and Address of Reporting Person * |
Â
Jain Ambuj |
|
2. Date of Event Requiring Statement (Month/Day/Year) 03/30/2012 |
3. Issuer Name and Ticker or Trading Symbol AMERICAN SAFETY INSURANCE HOLDINGS LTD [ASI]
|
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 |
|
5. If Amendment, Date Original Filed(Month/Day/Year)
|
HAMILTON, D0 HM 11 |
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
|
1,755
(1)
|
D
|
Â
|
Common Stock
|
3,791
(2)
|
D
|
Â
|
Common Stock
|
12,500
(3)
|
D
|
Â
|
Common Stock
|
2,459
(4)
|
D
|
Â
|
Common Stock
|
4,032
(5)
|
D
|
Â
|
Common Stock
|
25,000
(6)
|
D
|
Â
|
Common Stock
|
4,465
(7)
|
D
|
Â
|
|
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
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)
|
07/27/2009(8)
|
07/27/2014 |
Common Stock
|
10,000
|
$
13.77
|
D
|
Â
|
Stock Option (Right to Buy)
|
03/15/2009(9)
|
03/15/2016 |
Common Stock
|
4,000
|
$
16.4
|
D
|
Â
|
Stock Option (Right to Buy)
|
03/15/2010(9)
|
03/15/2017 |
Common Stock
|
4,000
|
$
19.05
|
D
|
Â
|
Stock Option (Right to Buy)
|
03/04/2011(9)
|
03/04/2018 |
Common Stock
|
4,000
|
$
17.95
|
D
|
Â
|
Stock Option (Right to Buy)
|
03/11/2012(10)
|
03/11/2019 |
Common Stock
|
10,342
|
$
9.1
|
D
|
Â
|
Stock Option (Right to Buy)
|
03/05/2013(9)
|
03/05/2020 |
Common Stock
|
6,565
|
$
14.64
|
D
|
Â
|
* |
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). |
(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. |