-----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, TEX9be0xUxZwjY1ehFQ209dHNELKtMIqomKinYGV4wX+uzRoY0Gut2c7f7kyVITe D7TSX56Gmn1zzpG9FN8+DA== 0001209191-07-041817.txt : 20070710 0001209191-07-041817.hdr.sgml : 20070710 20070710142054 ACCESSION NUMBER: 0001209191-07-041817 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20070702 FILED AS OF DATE: 20070710 DATE AS OF CHANGE: 20070710 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: SAMPLE JOHN G JR CENTRAL INDEX KEY: 0001196481 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 07971696 BUSINESS ADDRESS: STREET 1: 4370 PEACHTREE ROAD N.E. CITY: ATLANTA STATE: GA ZIP: 30319 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2007-07-02 0 0000008177 ATLANTIC AMERICAN CORP AAME 0001196481 SAMPLE JOHN G JR 4370 PEACHTREE ROAD, N.E. ATLANTA GA 30319 0 1 0 0 Senior VP & CFO Common Stock 12927 I 401(k) Common Stock 2007-07-02 4 A 0 10000 A 10000 D Coomon Stock 2007-07-09 4 S 0 2500 3.97 D 7500 D Option to Buy Cmn Stk 50000 D Mr. Sample has an indirect ownership interest in 12927 shares held in a 401(k) Plan, based on the most recent plan statement. Represents a lapse of forfeiture provisions with respect to 10000 shares of common stock previously awarded pursuant to the Company's 1992 Incentive Plan. Mr. Sample also owns directly 10000 Deferred Shares granted under the Atlantic American Corporation 1992 Incentive Plan and 50000 options granted pursuant to the Company's 1992 Incentive Plan at an option price of $2.00. /s/ 2007-07-10 -----END PRIVACY-ENHANCED MESSAGE-----