-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Rzm3A+mpmvpL5vduBKzKS0fGJLp9rOgVs5IxdixwFGCZiXKbHyzeSdOrmvflyuHF VObtNTtQ1TNRxIkZgJDqgg== 0001209191-05-048771.txt : 20050926 0001209191-05-048771.hdr.sgml : 20050926 20050926150251 ACCESSION NUMBER: 0001209191-05-048771 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050922 FILED AS OF DATE: 20050926 DATE AS OF CHANGE: 20050926 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: ROBINSON J MACK CENTRAL INDEX KEY: 0001008889 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 051102726 BUSINESS ADDRESS: BUSINESS PHONE: 4042312111 MAIL ADDRESS: STREET 1: 4370 PEACHTREE RD CITY: ATLANTA STATE: GA ZIP: 30319 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2005-09-22 0 0000008177 ATLANTIC AMERICAN CORP AAME 0001008889 ROBINSON J MACK 4370 PEACHTREE ROAD, N.E. ATLANTA GA 30319-3054 1 1 1 0 Chairman Common Stock 777420 D Common Stock 15540 I 401(k) Plan Common Stock 300000 I By Delta Fire & Casualty Ins. Co. Common Stock 946702 I By Delta Life Ins. Co. Common Stock 2005-09-22 4 A 0 9700 2.697 A 3442804 I By Gulf Capital Services Common Stock 8571371 I By Spouse Option to Buy Cmn Stk 2000 I By Spouse Mr. Robinson also has an indirect ownership interest in 15540 shares held in a 401(k) Plan based on the most recent plan statement. Mr. Robinson also has an indirect ownership interest in 3442804 shares owned by Gulf Capital Services, for which Mr. Robinson holds a 24% interest in the Partnership. The remaining partnerships are held in equal shares by Trust for benefit of Mr. Robinson's daughters, with Mr. Robinson's spouse as Trustee. Mr. Robinson disclaims beneficial ownership for 76% of the securities held by Gulf Capital Services, representing the Trusts' proportionate partnership interest. Mr. Robinson also has an indirect ownership interest in options to acquire 2000 shares of common stock granted under the Company's 1996 Non-Employee Director Stock Option Plan at exercise prices ranging from $1.90 to $2.68 held by his wife. Janie L. Ryan, POA 2005-09-26 -----END PRIVACY-ENHANCED MESSAGE-----