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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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 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
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1. Name and Address of Reporting Person*
Howell, Jr. Hilton H.
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(Last) (First) (Middle)
4370 Peachtree Road, NE
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(Street)
Atlanta Georgia 30319-3000
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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 Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
December, 2001
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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 [ ] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
President & CEO
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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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5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 18,986 I 401(k)Plan(1)
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Common Stock N/A 164,000 D
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Common Stock N/A 39,025 I By Spouse(2)
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Common Stock N/A 6,720 I 3***
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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.
(Over)
(Form 5-07/98)
FORM 5 (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
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Employee Stock
Option $1.25/sh 10/15/01 A(5) 50,000 10/15/01 10/15/11 Cmn. Stk. 50,000 D
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Employee Stock
Option $1.25/sh 10/15/01 A(5) 25,000 10/15/02 10/15/11 Cmn. Stk. 25,000 D
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Employee Stock
Option $1.25/sh 10/15/01 A(5) 25,000 10/15/03 10/15/11 Cmn. Stk. 25,000 300,000(4) D
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Explanation of Responses:
1 The information herein is based on a plan statement as of December 31, 2001.
2 Joint by Son with Harriett J. Robinson.
3 Includes 1,025 shares held directly by spouse; 6,000 shares held F/B/O
daughter, Alston Elizabeth Howell, with spouse as Custodian; 7,000 shares
held F/B/O son, Hilton Hatchett Howell, III, with spouse as Custodian;
12,500 shares held F/B/O daughter, Anna Louise Howell, with spouse as
Custodian; and 12,500 shares held F/B/O daughter, Julia Bailey Howell, with
spouse as Custodian.
4 Options granted pursuant to the Company's 1992 Incentive Plan at prices
ranging from $1.25 to $3.75.
5 Option to buy 100,000 shares Common Stock, exempt under Rule 16b-3, of which
50% were exercisable on 10/15/01; an additional 25% are excercisable 10/15/02;
and the remaining 25% are exercisable on 10/15/03. These options are granted
under the Atlantic American Corporation 1992 Incentive Plan.
02/12/02
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Hilton H. Howell, Jr. Date
**Signature of Reporting Person
** 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.
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