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