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