0001567619-21-003967.txt : 20210216
0001567619-21-003967.hdr.sgml : 20210216
20210216153855
ACCESSION NUMBER: 0001567619-21-003967
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201231
FILED AS OF DATE: 20210216
DATE AS OF CHANGE: 20210216
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: 21637316
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
5
1
doc1.xml
FORM 5
X0306
5
2020-12-31
0
0
0
0000008177
ATLANTIC AMERICAN CORP
AAME
0001196567
ROBINSON HARRIETT J
4370 PEACHTREE ROAD, N.E.
ATLANTA
GA
30319
1
0
1
1
Trustee under Rule 16a-8
Common Stock
943229
D
Common Stock
300000
I
By Delta Fire & Casualty Insurance Company
Common Stock
1363809
I
By Delta Life Insurance Company
Common Stock
3756746
I
By Gulf Capital Services
Common Stock
358556
I
As Trustee
Common Stock
448195
I
As Trustee
Common Stock
2020-02-27
5
G
0
1025
0
A
3954281
I
As Trustee
Common Stock
4092767
I
As Trustee
Series D Preferred Stock
Common Stock
1378446
55000
I
By Delta Life Insurance Company
Shares owned by an entity controlled by Mrs. Robinson. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein.
Mrs. Robinson has an indirect interest in the shares owned by Gulf Capital Services, an entity in which she holds a 24% interest, with the remaining interests being held in equal amounts by trusts for the benefit of her two daughters, and of which she serves as trustee. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein, if any.
Mrs. Robinson serves as trustee of a trust for the benefit of her grandchildren. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein.
Mrs. Robinson serves as trustee of a trust for the benefit of her grandchildren. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein.
Mrs. Robinson serves as trustee of a trust for the benefit of her daughter, Robin R. Howell. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein.
Mrs. Robinson serves as trustee of a trust for the benefit of her daughter, Jill Robinson. Mrs. Robinson disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein.
The Series D Preferred Stock is convertible into common stock at a per 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. Such shares are owned by Delta Life Insurance Company and Mrs. Robinson disclaims beneficial ownership of such shares.
The Series D Preferred Stock was convertible into common stock upon issuance and has no expiration date.
Harriett J. Robinson
2021-02-16