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UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL Washington, DC 20549 OMB Number: Expires: STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden hours per [ ] Check box if no response: longer subject to Filed pursuant to Section 16(a) of the Securities Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the or Form 5 obligations Public Utility Holding Company Act of 1935 may continue. See or Section 30(f) of the Investment Company Instruction 1(b). Act of 1940 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). (Over)
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ | 1. Name and Address of Reporting Person* | 2. Issuer Name and Ticker or Trading Symbol |6. Relationship of Reporting Person(s)| | West, Mark C. | Atlantic American Corporation - AAME | to Issuer (Check all applicable) | |--------------------------------------------|----------------------------------------------| | | (Last) (First) (Middle) | 3. IRS Identification | 4. Statement For | [X] Director [ ] 10% Owner | | | Number of Reporting | Month/Year | [ ] Officer (give [ ] Other (Specify| | | Person, if an entity | | title below) | | 1100 Circle 75 Parkway, Suite 760 | (Voluntary) | September, 2002 | below) | | | | | | |--------------------------------------------| |--------------------|--------------------------------------| | (Street) | | 5. If Amendment, |7. Individual or Joint/Group Filing | | | | Date of Original| (check Applicable Line) | | | | (Month/Year) | [X] Form Filed by One | | Atlanta, GA 30339-3097 | | | Reporting Person | |--------------------------------------------|----------------------------------------------| [ ] Form filed by More Than | | (City) (State) (Zip) | | One Reporting Person | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED | |----------------------------------------------------------------------------------------------------------------------------------| |1. Title of Security |2. Transaction |3. Transac- |4. Securities Acquired (A) | 5. Amount of Se- |6. Owner- |7. Nature | | (Instr. 3) | Date | tion Code | or Disposed of (D) | curities Benefi-| ship | of In- | | | (Month/Day/ | (Instr. 8) | | cially Owned at | Form: | direct | | | Year) | | | end of Issuer's | Direct | Benefi-| | | | | (Instr. 3, 4 and 5) | Fiscal Year | (D) or | cial | | | |--------------|---------------------------| (Instr. 3 and 4)| Indirect | Owner- | | | | Code | V | Amount | (A) or| Price| | (I) | ship | | | | | | | (D) | | | (Instr. 4)| (Instr.| | | | | | | | | | | 4) | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | Common Stock | N/A | | | | | | 66,142 | I | 1*** | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | Common Stock | N/A | | | | | | 5,000 | I | 2*** | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | Common Stock | N/A | | | | | | 127,500 | I | 3 | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | Common Stock | 09/06/02 | P | | 400 | A |$1.80 | | D | | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | Common Stock | 09/09/02 | P | | 200 | A |$1.80 | 3,327 | D | | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | | | | | | | | | | | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | | | | | | | | | | | |---------------------|-------------------|-------|------|------------|-------|------|--------------------|-------------|----------| | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ |1. Title of Derivative | 2. Conver- |3. Trans- |4. Trans- |5. Number of | 6. Date Exer- |7. Title and Amount |8. Price | | Security | sion or | action | action | Derivative | cisable and | of Underlying | of | | (Instr. 3) | Exercise | Date | Code | Securities | Expiration | Securities | Deriv- | | | Price of | (Month/| (Instr.| Acquired (A) | Date | (Instr. 3 and 4) | ative | | | Deriv- | Day/ | 8) | or Disposed | (Month/Day/ | | Secur- | | | ative | Year) | | of (D) | Year) | | ity | | | Security | | | (Instr. 3, | | | (Instr. 5)| | | | | | 4, and 5) |-----------------|--------------------| | | | | | | | Date |Expira- | | Amount or| | | | | |----------|----------------| Exer- |tion | Title | Number of| | | | | | Code| V | (A) | (D) | cisable|Date | | Shares | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | Option to Buy(4) | $2.68 | 05/07/02 | A | | 1,000 | |11/07/02|05/07/07|Cmn Stk.| 1,000 | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | | | | | | | | | | | | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | | | | | | | | | | | | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | | | | | | | | | | | | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | | | | | | | | | | | | | |-----------------------|--------------|----------|-----|----|-------|--------|--------|--------|--------|-----------|-------------| | | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------ | 9. Number of | 10. Ownership | 11. Name of | | Derivative | Form of | Indirect | | Securities | Derivative | Beneficial | | Beneficially | Security: | Ownership | | Owned at End | Direct (D) | (Instr. 4) | | of Year | or Indirect (I) | | | (Instr. 4) | (Instr. 4) | | | | | | |---------------------|-------------------------------|----------------------| | 5,000 | D | | |---------------------|-------------------------------|----------------------| | | | | |---------------------|-------------------------------|----------------------| | | | | |---------------------|-------------------------------|----------------------| | | | | |---------------------|-------------------------------|----------------------| | | | | |---------------------|-------------------------------|----------------------| | | | | - ------------------------------------------------------------------------------ Explanation of Responses: ***Reporting Person expressly disclaims beneficial ownership of such securities. /s/ Mark C. West 09/10/02 1 Shares owned by The West Foundation, Inc., for which Mr. West is an officer, -------------------------------- -------- and disclaims any beneficial ownership of the foundation. Mark C. West Date 2 Shares owned by the George West Mental Health Foundation, for which Mr. West Page 2 is the President. 3 Shares contributed to Atlantis Capital LLP, for which Mr. West is the President of the General Partner (Genoa Realty Services, Inc.) 4 Granted pursuant to the Company's 1996 Director Stock Option Plan at option prices ranging from $1.90 to $4.4375. ** 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. (Print or Type Responses) Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.