0001181431-11-048791.txt : 20110912
0001181431-11-048791.hdr.sgml : 20110912
20110912124538
ACCESSION NUMBER: 0001181431-11-048791
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20110908
FILED AS OF DATE: 20110912
DATE AS OF CHANGE: 20110912
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kusumi Gary Y
CENTRAL INDEX KEY: 0001441875
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-50795
FILM NUMBER: 111085268
MAIL ADDRESS:
STREET 1: C/O AFFIRMATIVE INSURANCE HOLDINGS, INC.
STREET 2: 150 HARVESTER DRIVE, SUITE 300
CITY: BURR RIDGE
STATE: IL
ZIP: 60527
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: AFFIRMATIVE INSURANCE HOLDINGS INC
CENTRAL INDEX KEY: 0001282543
STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331]
IRS NUMBER: 752770432
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 4450 SOJOURN DRIVE
STREET 2: SUITE 500
CITY: ADDISON
STATE: TX
ZIP: 75001
BUSINESS PHONE: 972-728-6300
MAIL ADDRESS:
STREET 1: 4450 SOJOURN DRIVE
STREET 2: SUITE 500
CITY: ADDISON
STATE: TX
ZIP: 75001
4
1
rrd321759.xml
FORM 4
X0304
4
2011-09-08
0
0001282543
AFFIRMATIVE INSURANCE HOLDINGS INC
AFFM
0001441875
Kusumi Gary Y
150 HARVESTER DRIVE
SUITE 300
BURR RIDGE
IL
60527
1
1
0
0
Chairman & CEO
Common Stock, $0.01 par value
2011-09-08
4
P
0
400
1.72
A
15000
D
/s/ Gary Y. Kusumi
2011-09-12