0001140361-14-005533.txt : 20140210 0001140361-14-005533.hdr.sgml : 20140210 20140210142228 ACCESSION NUMBER: 0001140361-14-005533 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131231 FILED AS OF DATE: 20140210 DATE AS OF CHANGE: 20140210 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROBINSON J MACK CENTRAL INDEX KEY: 0001008889 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 14587871 MAIL ADDRESS: STREET 1: 4370 PEACHTREE RD CITY: ATLANTA STATE: GA ZIP: 30319 5 1 doc1.xml FORM 5 X0306 5 2013-12-31 0 0 0 0000008177 ATLANTIC AMERICAN CORP AAME 0001008889 ROBINSON J MACK 4370 PEACHTREE ROAD, N.E. ATLANTA GA 30319 0 0 1 0 Common Stock 544585 D Common Stock 300000 I By Delta Fire & Casualty Insurance Company Common Stock 1363809 I By Delta Life Insurance Company Common Stock 3756746 I By Gulf Capital Services Common Stock 2013-09-09 5 G 0 6720 0.00 D 9081074 I By Spouse Series D Preferred Stock Common Stock 1629073 65000 I By Delta Life Insurance Company Shares owned by an entity controlled by Mr. Robinson. Mr. Robinson disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. Shares owned by an entity in which Mr. Robinson holds a 24% interest. The remaining interests are held in equal amounts by trusts for the benefit of Mr. Robinson's two daughters, with Mr. Robinson's spouse as trustee. Mr. Robinson disclaims beneficial ownership of the remainder of the Company's Common Stock, representing the trusts' proportionate interests, held by Gulf Capital Services. Mr. Robinson has an indirect ownership interest in 9,081,074 shares of the Company's Common Stock owned directly or indirectly by his spouse, Harriett J. Robinson, as follows: 660,576 shares owned directly by her; 3,953,256 shares owned by a trust for the benefit of their daughter, Robin R. Howell, of which his spouse is trustee; 4,088,792 shares owned by a trust for the benefit of their daughter, Jill Robinson, of which his spouse is trustee; and 378,450 shares owned by a trust for the benefit of their grandchildren, of which his spouse is trustee. Mr. Robinson disclaims beneficial ownership of the shares owned directly or indirectly by his spouse. The Series D Preferred Stock is convertible into common stock at a per share price of $3.99, subject to certain anti-dilution provisions, provided that in no case may the conversion price be less than $2.59 per share without the prior approval of the Company's shareholders. Such shares are owned by Delta Life Insurance Company, an entity in which Mr. Robinson maintains a controlling interest. The Series D Preferred Stock was convertible into common stock upon issuance and has no expiration date. Harriett J. Robinson POA 2014-02-10