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