-----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, VOO/36wLKeDk8vv6HGcECBnrrRz7MhzYk8A+fDUB9aruRls67Wbdn2Ah3FyE/Qng /DL/32dAoW9RfHZbnWR9ZA== 0001209191-11-009167.txt : 20110214 0001209191-11-009167.hdr.sgml : 20110214 20110214135832 ACCESSION NUMBER: 0001209191-11-009167 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101231 FILED AS OF DATE: 20110214 DATE AS OF CHANGE: 20110214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SAMPLE JOHN G JR CENTRAL INDEX KEY: 0001196481 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03722 FILM NUMBER: 11605548 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 2010-12-31 0 0 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 6676 I 401(K) Plan Common Stock 7500 D Option to Buy Cmn Stk 50000 D Between December 31, 2009 and December 31, 2010, Mr. Sample disposed of 156 shares of common stock in the Company's 401(k) plan, based on the most recent plan statement. Mr. Sample owns 50000 presently exercisable options granted pursuant to the Company's 1992 Incentive Plan at an option price of $2.00. John G. Sample, Jr. 2011-02-14 -----END PRIVACY-ENHANCED MESSAGE-----