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OMB APPROVAL
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OMB Number 3235-0104
Expires: September 30, 1998
Estimated average burden
hours per response ....... 0.5
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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
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1. Name and Address of Reporting Person*
RENAUD ROBERT A.
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(Last) (First) (Middle)
670 ESTATE CLUB DR.
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(Street)
ROSWELL GA 30075
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
02/26/01
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
ATLANTIC AMERICAN CORPORATION (AAME)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [ ] 10% Owner
[ X ] Officer (give title below) [ ] Other (specify below)
VICE PRESIDENT AND CFO
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6. If Amendment, Date of Original (Month/Year)
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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 Beneficially Owned
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3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr.5)
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* If the Form is filed by more than one Reporting Person, see Instruction
5(b)(v)
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Page 1 of 2
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned (e.g., puts,
calls, warrants, options, convertible securities)
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5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr.5) (Instr. 5)
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Employee Stock
Options *(1) 7/07/1997 7/07/2002 Common Stock 5,000 $3.03125 D
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Employee Stock
Options *(1) 7/07/1998 7/07/2002 Common Stock 2,500 $3.03125 D
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Employee Stock
Options *(1) 7/07/1999 7/07/2002 Common Stock 2,500 $3.03125 D
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Employee Stock
Options *(2) 10/31/1997 10/31/2002 Common Stock 3,000 $3.75 D
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Employee Stock
Options *(2) 10/31/1998 10/31/2002 Common Stock 1,500 $3.75 D
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Employee Stock
Options *(2) 10/31/1999 10/31/2002 Common Stock 1,500 $3.75 D
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Employee Stock
Options *(3) 10/27/1998 10/27/2003 Common Stock 3,000 $3.734 D
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Employee Stock
Options *(3) 10/27/1999 10/27/2003 Common Stock 1,500 $3.734 D
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Employee Stock
Options *(3) 10/27/2000 10/27/2003 Common Stock 1,500 $3.734 D
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Explanation of Responses:
*Options to buy granted pursuant to the Atlantic American Corporation
1992 Incentive Plan
(1) Options granted 7/07/1999
(2) Options granted 10/31/1997
(3) Options granted 5/5/1998
/s/ 01/29/01
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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 procedure.
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
(122795DTI)
