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