-----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, T6isM5PRYctn43b8i8IZU4DXRGHAsML/awOVK4CUVDoe+Lg9SlefLlcA5m2ic0g0 fV/Ik80QrVHN+JMaNIkJKg== 0001209191-09-005295.txt : 20090129 0001209191-09-005295.hdr.sgml : 20090129 20090129151133 ACCESSION NUMBER: 0001209191-09-005295 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20081231 FILED AS OF DATE: 20090129 DATE AS OF CHANGE: 20090129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROBINSON HARRIETT J CENTRAL INDEX KEY: 0001196567 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 09554306 BUSINESS ADDRESS: STREET 1: 3500 TUXEDO ROAD NW CITY: ATLANTA STATE: GA ZIP: 30305 BUSINESS PHONE: 4042665532 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 5 1 doc5.xml FORM 5 SUBMISSION X0303 5 2008-12-31 0 0 0 0000008177 ATLANTIC AMERICAN CORP AAME 0001196567 ROBINSON HARRIETT J 4370 PEACHTREE ROAD, N.E. ATLANTA GA 30319-3054 1 0 1 1 Trustee under Rule 16a-8 Common Stock 627228 D Common Stock 6720 D Common Stock 18976 I 401(K) By Spouse Common Stock 3756646 I By Gulf Capital Services Common Stock 3953256 I Trustee as C/F Daughter Common Stock 4088792 I Trustee as C/F Daughter Common Stock 2561764 I By Spouse Series D Preferred Stock Cmn Stk 1754385 7000 I By Gulf Capital Services Mrs. Robinson also has a direct ownership of 6720 shares owned jointly with her grandson. Mrs. Robinson has an indirect ownership interest in 18976 shares in a 401(k) Plan based on the most recent plan statement, owned by Mr. Robinson and for which Mrs. Robinson expressly disclaims beneficial ownership. Mrs. Robinson also has an indirect ownership interest in 3756646 shares owned by Gulf Capital Services for which her spouse individually holds a 24% interest in the Partnership, with the remaining partnerships held in equal shares by Trust for the benefit of the reporting person's daughters, with the reporting person as Trustee. Mrs. Robinson also has an indirect ownership interest in 3953256 shares held by self as Trustee for daughter, Robin Robinson, securities held directly by Trust, for which Mrs. Robinson expressly disclaims beneficial ownership of such securities. Mrs. Robinson also has an indirect ownership interest in 4088792 shares held by self as Trustee for daughter, Jill Robinson, securities held directly by Trust, for which Mrs. Robinson expressly disclaims beneficial ownership of such securities. Mrs. Robinson also has an indirect ownership interest in 2561764 shares, of which 897955 shares are held by spouse; 1363809 shares are held by Delta Life Ins. Co.; and, 300000 shares are held by Delta Fire & Casualty Ins. Co., all of which Mrs. Robinson expressly disclaims any beneficial ownership of such securities. The Series D Preferred Stock is convertible into common stock at a pre 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. The Series D Preferred Stock was convertible into common stock upon issuance and has no expiration date. Janie L. Ryan POA 2009-01-29 -----END PRIVACY-ENHANCED MESSAGE-----