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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Option to Purchase | $ 14.85 | 04/23/2002(12) | 04/23/2006 | Common Stock, $.01 par | 35,000 | 1 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ROBINSON J MACK 4370 PEACHTREE ROAD NE ATLANTA, GA 30319 |
X | X | Chairman |
FREDERICK J. ERICKSON attorney in fact for J. MACK ROBINSON | 02/07/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Directors fee paid pursuant to board of directors resolution. |
(2) | Stock compensation pursuant to board of directors resolution. |
(3) | Owned by spouse, Harriett J. Robinson. |
(4) | Owned by Harriett J. Robinson, Trustee U/A 8/25/84 FBO Jill E. Robinson. |
(5) | Owned by Harriett J. Robinson, Trustee U/A 8/25/84 FBO Robin M. Robinson. |
(6) | Owned by Delta Life Insurance Co., of which the reporting person is Chairman & President. |
(7) | Owned by Delta Fire & Casualty Insurance Co., of which the reporting person is Chairman & President. |
(8) | Owned by Bankers Fidelity Life Insurance Company, a wholly-owned subsidiary of Atlantic American Corporation, of which the reporting person is Chairman of the Board. |
(9) | Owned by Georgia Casualty & Surety Insurance Co., of which the reporting person is Chairman. |
(10) | Owned by Gulf Capital Services, Ltd., which is a family-owned limited partnership. |
(11) | The reporting person is a general partner of the Robinson-Prather Partnership, which beneficially owns these securities. |
(12) | Exercisable in 11,650 share increments on 4/23/02 and 4/23/03, and 11,700 share increment on 4/23/04. |