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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 J. Mack
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(Last) (First) (Middle)
4370 Peachtree Road, NE
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(Street)
Atlanta GA 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 or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
January 30, 2003
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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
[ X ] Officer (give title below) [ ] Other (specify below)
Chairman
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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 8,929 D 401(k)
Plan(1)
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Common Stock N/A 740,921 D
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Common Stock N/A 294,000 I By Delta
Fire &
Casualty
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Common Stock N/A 936,702 I By Delta
Life Ins.
Co.
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Common Stock 01/30/03 P 700 A $1.65 I
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Common Stock 02/03/03 P 1,000 A $1.499 8,413,780 I By
Spouse
2(***)
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Common Stock N/A 3,411,102 I Capital
Services
(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.
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 Cmn. Stk. 100,000 D 4
Option
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Option to Buy N/A Cmn. Stk 5,000 I By
Spouse
(5)
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Explanation of Responses:
*** Reporting Person expressly disclaims beneficial ownership of such
securities.
(1) Information herein based on plan statement as of December 31, 2001.
(2) Includes 426,812 shares held directly by spouse; 6,720 shares held by
spouse, jointly with grandson; 3,953,256 shares held directly by Trust for
daughter, Robin Robinson with spouse as Trustee; and 4,026,992 shares held
directly by Trust for daughter, Jill Robinson with spouse as Trustee.
(3) Reporting person 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's spouse as
Trustee. The reporting person disclaims beneficial ownership for 76% of
the securities held by Gulf Capital Services, representing the Trusts' pro-
portionate partnership interest.
(4) Options to buy Common Stock, granted at excersise price of
$3.374 per share under the Atlantic American Corporation 1992
Incentive Plan.
(5) Granted pursuant to the Company's 1996 Director Stock Option Plan at
option prices ranging from $1.90 to $4.4375.
/s/ 02/04/03
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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
(122797DTI)