0001140361-17-002845.txt : 20170125 0001140361-17-002845.hdr.sgml : 20170125 20170125154336 ACCESSION NUMBER: 0001140361-17-002845 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161231 FILED AS OF DATE: 20170125 DATE AS OF CHANGE: 20170125 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: 1231 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: HOWELL HILTON H JR CENTRAL INDEX KEY: 0001213166 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 17546378 MAIL ADDRESS: STREET 1: 4370 PEACHTREE ROAD, N.E. CITY: ATLANTA STATE: GA ZIP: 30319 5 1 doc1.xml FORM 5 X0306 5 2016-12-31 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 465274 D Common Stock 227539 I By 401(k) Plan Common Stock 63100 I By Spouse Common Stock 168200 I Trust F/B/O Children Common Stock 190356 I Trust F/B/O Children Represents correction of holdings reported on May 5, 2016 and May 10, 2016, which inadvertently reported and included a grant of 10,000 shares of restricted stock. Based on most recent plan statement. Mr. Howell has an indirect interest in the following shares owned directly or indirectly by his spouse, Robin R. Howell: 22,925 shares owned directly; 2,175 shares owned in an IRA account and 38,000 shares held indirectly by her as custodian for their children. Mr. Howell disclaims beneficial ownership of all such shares. Shares held in a trust for the benefit of Mr. Howell's children and over which Mr. Howell's mother-in-law serves as trustee. Mr. Howell disclaims beneficial ownership of all such shares. Shares held in a trust for the benefit of Mr. Howell's children and over which Mr. Howell's mother-in-law serves as trustee. Mr. Howell disclaims beneficial ownership of all such shares. Hilton H. Howell, Jr. 2017-01-25