0001567619-23-001134.txt : 20230123
0001567619-23-001134.hdr.sgml : 20230123
20230123161850
ACCESSION NUMBER: 0001567619-23-001134
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20221230
FILED AS OF DATE: 20230123
DATE AS OF CHANGE: 20230123
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROBINSON HARRIETT J
CENTRAL INDEX KEY: 0001196567
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-03722
FILM NUMBER: 23544687
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
4
1
doc1.xml
FORM 4
X0306
4
2022-12-30
0
0000008177
ATLANTIC AMERICAN CORP
AAME
0001196567
ROBINSON HARRIETT J
4370 PEACHTREE ROAD, N.E.
ATLANTA
GA
30319
0
0
1
1
Trustee under Rule 16a-8
Common Stock
2022-12-30
4
P
0
300000
3.00
A
1130259
D
Common Stock
2022-12-30
4
S
0
300000
3.00
D
0
I
By Delta Fire & Casualty Insurance Company
Common Stock
5120555
I
By Gulf Capital Services
Common Stock
3954281
I
As Trustee
Common Stock
4092767
I
As Trustee
Common Stock
408765
I
As Trustee
Common Stock
510956
I
As Trustee
Series D Preferred Stock
Common Stock
1378446
55000
I
By Delta Life Insurance Company
Represents change in nature of Reporting Person's ownership as a result of the transfer of shares by private sale to Harriett J. Robinson from her affiliate Delta Fire & Casualty Insurance Company.
Shares owned by Gulf Capital Services, an entity in which interests are held in equal amounts by trusts for the benefit of Mrs. Robinson's two daughters, and of which Mrs. Robinson 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 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.
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.
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 is not currently convertible into common stock .
/s/ Harriett J. Robinson
2023-01-23