0001140361-12-006894.txt : 20120210
0001140361-12-006894.hdr.sgml : 20120210
20120210153231
ACCESSION NUMBER: 0001140361-12-006894
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111231
FILED AS OF DATE: 20120210
DATE AS OF CHANGE: 20120210
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HOWELL HILTON H JR
CENTRAL INDEX KEY: 0001213166
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-03722
FILM NUMBER: 12592534
MAIL ADDRESS:
STREET 1: 4370 PEACHTREE ROAD, N.E.
CITY: ATLANTA
STATE: GA
ZIP: 30319
ISSUER:
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: 0228
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
5
1
doc1.xml
FORM 5
X0304
5
2011-12-31
0
0
0
0000008177
ATLANTIC AMERICAN CORP
AAME
0001213166
HOWELL HILTON H JR
4370 PEACHTREE ROAD, N.E.
ATLANTA
GA
30319
1
1
0
0
Chairman, President & CEO
Common Stock
306954
D
Common Stock
157254
I
401(k) Plan
Common Stock
39025
I
By Spouse
Common Stock
2175
I
By Spouse IRA
Common Stock
6720
I
Joint - Harriett J. Robinson w/son
Option to Buy
Common Stock
100000
100000
D
Between December 31, 2010 and December 31, 2011, Mr. Howell acquired 24,793 shares of common stock in the Company's 401(k) plan, based on the most recent plan statement.
Mr. Howell has an indirect ownership interest in 39,025 shares of which 1,025 shares are held directly by his spouse; 6,000 shares are held F/B/O his daughter, Alston Elizabeth Howell, with his spouse as Custodian; 7,000 shares are held F/B/O his son, Hilton Hatchett Howell, III, with his spouse as Custodian; 12,500 shares are held F/B/O his daughter, Anna Louise Howell, with his spouse as Custodian; and 12,500 shares are held F/B/O his daughter, Julia Bailey Howell, with his spouse as Custodian. Mr Howell expressly disclaims beneficial ownership of all such securities.
Mr. Howell has an indirect ownership interest in 2,175 shares held directly by Mr. Howell's spouse in an IRA account. Mr. Howell expressly disclaims beneficial ownership of all such securities.
Mr. Howell has an indirect ownership interest in 6,720 shares owned jointly by his son with Harriett J. Robinson. Mr. Howell expressly disclaims beneficial ownership of all such securities.
Mr. Howell also holds presently exercisable stock options to acquire 100,000 shares of common stock granted pursuant to the Company's 2002 Incentive Plan at an exercise price of $1.59 per share. The expiration date of these stock options is May 6, 2013.
Hilton H. Howell, Jr.
2012-02-10