Annual Statement of Changes in Beneficial Ownership (5)
February 13 2023 - 03:45PM
Edgar (US Regulatory)
FORM 5
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response... 1.0 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
1. Name
and Address of Reporting Person * HOWELL HILTON H
JR |
2. Issuer Name and Ticker or Trading
SymbolATLANTIC AMERICAN CORP [AAME] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chairman, President & CEO |
(Last)
(First)
(Middle)
4370 PEACHTREE ROAD, N.E. |
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2022
|
(Street)
ATLANTA, GA 30319
(City)
(State)
(Zip)
|
4. If Amendment, Date Original
Filed(MM/DD/YYYY)
|
6. Individual or Joint/Group
Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership
(Instr. 4) |
Amount |
(A) or (D) |
Price |
Common Stock |
|
|
|
|
|
|
517272 |
D |
|
Common Stock |
|
|
|
|
|
|
309046 (1) |
I |
By 401(k) Plan |
Common Stock |
5/1/2022 |
|
J (2) |
30368 |
D(2) |
$0.00 |
34075 (3) |
I |
By Spouse |
Common Stock |
|
|
|
|
|
|
408765 (4) |
I |
Trust F/B/O Children |
Table II - Derivative Securities Acquired, Disposed of, or
Beneficially Owned (e.g., puts, calls, warrants, options,
convertible securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of Derivative Securities Beneficially
Owned at End of Issuer's Fiscal Year
(Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I)
(Instr. 4) |
11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
Reflects the reporting
person's interest in equivalent shares held by the unitized stock
fund in the Atlantic American Corporation 401(k) Plan. |
(2) |
Represents a disposition of
30,368 shares formerly held by Mr. Howell's spouse, Robin R.
Howell, as custodian for the benefit of their children. On the
transaction date, the shares were transferred to the individual
holdings of the adult children. |
(3) |
Mr. Howell has an indirect
interest in the following shares owned directly or indirectly by
his spouse, Robin R. Howell: 31,900 shares owned directly and 2,175
shares owned in an IRA account. Mr. Howell disclaims beneficial
ownership of all such shares. |
(4) |
Shares held in a trust for
the benefit of Mr. Howell's children and over which Mr. Howell's
mother-in-law serves as trustee. Mr. Howell disclaims beneficial
ownership of all such shares. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
HOWELL HILTON H JR
4370 PEACHTREE ROAD, N.E.
ATLANTA, GA 30319 |
X |
|
Chairman, President & CEO |
|
Signatures
|
/s/ Hilton H. Howell, Jr. |
|
2/13/2023 |
**Signature of Reporting
Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
If the form is filed by more than one
reporting person, see Instruction 4(b)(v). |
** |
Intentional misstatements or omissions
of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
Atlantic American (NASDAQ:AAME)
Historical Stock Chart
From Aug 2023 to Sep 2023
Atlantic American (NASDAQ:AAME)
Historical Stock Chart
From Sep 2022 to Sep 2023