-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JBS9PGHCKXZ3n2K5kdS4XOSU4Sh4DpvtVEewJTOIYGhGu9um6X18QLjzH3n0jhJS BWY+47m8uLnqvyeSS/2Tzw== 0000008177-99-000026.txt : 19990713 0000008177-99-000026.hdr.sgml : 19990713 ACCESSION NUMBER: 0000008177-99-000026 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980508 FILED AS OF DATE: 19990712 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ATLANTIC AMERICAN CORP CENTRAL INDEX KEY: 0000008177 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 581027114 STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-03722 FILM NUMBER: 99662622 BUSINESS ADDRESS: STREET 1: 4370 PEACHTREE RD NE CITY: ATLANTA STATE: GA ZIP: 30319 BUSINESS PHONE: 4042665500 MAIL ADDRESS: STREET 1: 4370 PEACHTREE ROAD CITY: ATLANTA STATE: GA ZIP: 30319 COMPANY DATA: COMPANY CONFORMED NAME: ATLANTIC AMERICAN CORP CENTRAL INDEX KEY: 0000008177 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] OFFICER IRS NUMBER: 581027114 STATE OF INCORPORATION: GA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 4370 PEACHTREE RD NE CITY: ATLANTA STATE: GA ZIP: 30319 BUSINESS PHONE: 4042665500 MAIL ADDRESS: STREET 1: 4370 PEACHTREE ROAD CITY: ATLANTA STATE: GA ZIP: 30319 3 1 INITIAL STATE/BENEFICIAL OWNERSHIP OF SECURITIES ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0104 Expires: September 30, 1998 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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(f) of the Investment Company Act of 1940 ================================================================================ 1. Name and Address of Reporting Person* Fischer Harold K. - -------------------------------------------------------------------------------- (Last) (First) (Middle) P.O. Box 9728 - ------------------------------------------------------------------------------- (Street) Austin TX 78766-9728 - -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Date of Event Requiring Statement (Month/Day/Year) 07/01/99 ================================================================================ 3. IRS or Social Security Number of Reporting Person (Voluntary) ###-##-#### ================================================================================ 4. Issuer Name and Ticker or Trading Symbol ATLANTIC AMERICAN CORPORATION (AAME) ================================================================================ 5. Relationship of Reporting Person to Issuer (Check all applicable) [ X ] Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) VICE PRESIDENT AND TREASURER -------------------------------------------------------------------- ================================================================================ 6. If Amendment, Date of Original (Month/Year) ================================================================================ 7. 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 ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr.5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 1,329,320 shares D Joint/with spouse ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 1 of 2 FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy* 01/02/00 07/01/04 Common Stock 5,000 $4.0625 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------- ====================================================================================================================================
Explanation of Responses: * Granted pursuant to the Atlantic American Corporation 1996 Director Stock Option Plan. /s/ 7//99 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** 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 provided is insufficient. See Instruction 6 for procedure. Alternatively, this form is permitted to be submitted to the Commission in electronic format at the option of the reporting person pursuant to Rule 101(b)(4) of Regulation S-T. Page 2 of 2 (122795DTI) -----END PRIVACY-ENHANCED MESSAGE-----