0001567619-22-007970.txt : 20220404
0001567619-22-007970.hdr.sgml : 20220404
20220404170757
ACCESSION NUMBER: 0001567619-22-007970
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220331
FILED AS OF DATE: 20220404
DATE AS OF CHANGE: 20220404
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: 22803582
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
2022-03-31
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
830259
D
Common Stock
300000
I
By Delta Fire & Casualty Insurance Company
Common Stock
2022-03-31
4
S
0
1363809
4.00
D
0
I
By Delta Life Insurance Company
Common Stock
2022-03-31
4
P
0
1363809
4.00
A
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 shares sold by Delta Life Insurance Company in a private sale to Gulf Capital Services, Ltd.
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
2022-04-04