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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Robinson Harriett J.
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(Last) (First) (Middle)
3500 Tuxedo Road, NW
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(Street)
Atlanta GA 30305-1068
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Atlantic American Corporation - AAME
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3. IRS or Social Security Number of Reporting Person (Voluntary)
###-##-####
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4. Statement for Month/Year
November 1999
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[ X ] Director [ X ] 10% Owner
[ ] Officer (give title below) [ X ] Other (specify below)
Trustee under Rule 16a-8
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7. Individual or Joint/Group Filing (Check applicable line)
[ X ] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 4,564 I 401(k)
Plan by
Spouse
(1***)
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Common Stock 11/22/99 P 16,000 A $2.80 256,585 D
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Common Stock N/A 6,720 D Joint w/
Grandson
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Common Stock 11/24/99 P 5,000 A $2.80 1,990,421 I 2***
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Common Stock N/A 3,381,202 I By Gulf
Capital
Svcs.
(3***)
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Common Stock N/A 3,893,256 I 4***
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Common Stock N/A 3,948,492 I 5***
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Page 1 of 2
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
of Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Employee Stock N/A Common 120,000 I By Spouse
Options(6) Stock
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Option to Buy N/A Common 8,000 D
(7) Stock
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Explanation of Responses:
*** Beneficial ownership of securities marked by *** expressly disclaimed.
(1) Information herein based on plan statement as of September 30, 1999.
(2) Includes 759,719 shared held directly by spouse; 936,702 shares held by
Delta Life Ins. Co.; and 294,000 shares held by Delta Fire & Casualty Ins.
Co.
(3) Spouse individually holds a 24% interest in partnership. The remaining
partnerships are held in equal shares by Trust for benefit of the reporting
person's daughters, with the reporting person as Trustee.
(4) By self as Trustee for Robin Robinson, securities directly held by Trust.
(5) By self as Trustee for Jill Robinson, securities directly held by Trust.
(6) Option to buy Common stock, granted at an option price $2.50 per share
under the Atlantic American Corporation 1992 Incentive Plan.
(7) Granted pursuant to the Company's 1996 Director Stock Option Plan at
option prices ranging from $3.00 to $4.4375.
/s/ 12/3/99
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**Signature of Reporting Person Date
** 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 provided is insufficient, see Instruction 6 for procedures.
Alternatively, this Form is permitted to be submitted to the Commission
in electronic format at the option of the reporting person pursuant to
rule 101(b)(4) of Regulation S-T.
Page 2 of 2
(122797DTI)