-----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, JLpAYHH2bDEMERONxNixJ87LuGSr4chlt5K8Dej68ElyhlKEc+MhQBs+VMgBZVEH P5BtGzq8l5ckf6SW15EPnA== 0001209191-09-048527.txt : 20091014 0001209191-09-048527.hdr.sgml : 20091014 20091014111301 ACCESSION NUMBER: 0001209191-09-048527 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091013 FILED AS OF DATE: 20091014 DATE AS OF CHANGE: 20091014 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: 091118511 MAIL ADDRESS: STREET 1: 4370 PEACHTREE RD CITY: ATLANTA STATE: GA ZIP: 30319 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 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2009-10-13 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 2009-10-13 4 P 0 7080 1.25 A 923035 D Common Stock 18976 I 401(k) Plan Common Stock 300000 I By Delta Fire & Casualty Ins. Co. Common Stock 1363809 I By Delta Life Ins. Co. Common Stock 3756646 I By Gulf Capital Services Common Stock 8704736 I By Spouse Mr. Robinson also has an indirect ownership interest in 18976 shares held in a 401(k) Plan based on the most recent plan statement. Mr. Robinson also has an indirect ownership interest in 3756646 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 8704736 shares, of which 655968 are owned directly by his spouse; 6720 shares held by spouse, jointly with grandson; 3953256 shares held directly by Trust for daughter, Robin Robinson, with spouse as Trustee; and, 4088792 shares held directly by Trust for daughter, Jill Robinson, with spouse as Trustee, all of which Mr. Robinson expressly disclaims beneficial ownership of such securities. John G. Sample, Jr. 2009-10-14 -----END PRIVACY-ENHANCED MESSAGE-----