SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
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SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULE 13D-1(B), (C), AND (D) AND AMENDMENTS THERETO FILED
PURSUANT TO RULE 13D-2(B)
ASSURANCEAMERICA CORPORATION
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(NAME OF ISSUER)
COMMON STOCK, PAR VALUE $0.01
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(TITLE OF CLASS OF SECURITIES)
04621M102
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(CUSIP NUMBER)
AUGUST
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(DATE OF EVENT WHICH REQUIRES FILING OF THIS STATEMENT)
Check the appropriate box to designate the rule pursuant to which this
Schedule is filed:
| | Rule 13d-1(b)
|X| Rule 13d-1(c)
| | Rule 13d-1(d)
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* The remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities, and
for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall
not be deemed to be "filed" for the purpose of Section 18 of the Securities
Exchange Act of 1934 or otherwise subject to the liabilities of that section of
the Act but shall be subject to all other provisions of the Act (however, see
the NOTES).
(Continued on following pages)
(Page 1 of 10 Pages)
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CUSIP NO. 04621m102 13G Page 2 of 10 Pages
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________________________________________________________________________________
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Heritage Fund Advisors, LLC
________________________________________________________________________________
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [_]
(b) [_]
________________________________________________________________________________
3. SEC USE ONLY
________________________________________________________________________________
4. CITIZENSHIP OR PLACE OF ORGANIZATION
State of Georgia, United States of America
________________________________________________________________________________
NUMBER OF 5. SOLE VOTING POWER
SHARES N/A
_________________________________________________________________
BENEFICIALLY 6. SHARED VOTING POWER
OWNED BY 4,260,000 shares of Common Stock
_________________________________________________________________
EACH 7. SOLE DISPOSITIVE POWER
REPORTING N/A
_________________________________________________________________
PERSON 8. SHARED DISPOSITIVE POWER
WITH 4,260,000 shares of Common Stock
________________________________________________________________________________
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
4,260,000 shares of Common Stock
________________________________________________________________________________
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
[_]
________________________________________________________________________________
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
8.6% of the outstanding Common Stock
________________________________________________________________________________
12. TYPE OF REPORTING PERSON*
OO (Limited Liability Company)
________________________________________________________________________________
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CUSIP NO. 04621m102 13G Page 3 of 10 Pages
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________________________________________________________________________________
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Heritage Assurance Partners, L.P.
________________________________________________________________________________
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [_]
(b) [_]
________________________________________________________________________________
3. SEC USE ONLY
________________________________________________________________________________
4. CITIZENSHIP OR PLACE OF ORGANIZATION
State of Georgia, United States of America
________________________________________________________________________________
NUMBER OF 5. SOLE VOTING POWER
SHARES N/A
_________________________________________________________________
BENEFICIALLY 6. SHARED VOTING POWER
OWNED BY 4,260,000 shares of Common Stock
_________________________________________________________________
EACH 7. SOLE DISPOSITIVE POWER
REPORTING N/A
_________________________________________________________________
PERSON 8. SHARED DISPOSITIVE POWER
WITH 4,260,000 shares of Common Stock
________________________________________________________________________________
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
4,260,000 shares of Common Stock
________________________________________________________________________________
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
[_]
________________________________________________________________________________
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
8.6% of the outstanding Common Stock
________________________________________________________________________________
12. TYPE OF REPORTING PERSON*
PN (Limited Partnership)
________________________________________________________________________________
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CUSIP NO. 04621m102 13G Page 4 of 10 Pages
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________________________________________________________________________________
1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
John F. Ray
________________________________________________________________________________
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [_]
(b) [_]
________________________________________________________________________________
3. SEC USE ONLY
________________________________________________________________________________
4. CITIZENSHIP OR PLACE OF ORGANIZATION
State of Georgia, United States of America
________________________________________________________________________________
NUMBER OF 5. SOLE VOTING POWER
SHARES Beneficial ownership of all shares of Common Stock
disclaimed.
_________________________________________________________________
BENEFICIALLY 6. SHARED VOTING POWER
OWNED BY Beneficial ownership of all shares of Common Stock
disclaimed.
_________________________________________________________________
EACH 7. SOLE DISPOSITIVE POWER
REPORTING Beneficial ownership of all shares of Common Stock
disclaimed.
_________________________________________________________________
PERSON 8. SHARED DISPOSITIVE POWER
WITH Beneficial ownership of all shares of Common Stock
disclaimed.
________________________________________________________________________________
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
Beneficial ownership of all shares of Common Stock disclaimed.
________________________________________________________________________________
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
[_]
________________________________________________________________________________
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
N/A
________________________________________________________________________________
12. TYPE OF REPORTING PERSON*
IN
________________________________________________________________________________
Item 1. (a) NAME OF ISSUER:
AssuranceAmerica Corporation.
(b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
5500 Interstate North Pkwy., Suite 600, Atlanta,
Georgia 30328
Item 2. (a) NAME OF PERSON FILING:
Heritage Assurance Partners, L.P.
Heritage Fund Advisors, LLC
John F. Ray
(b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE:
For all persons filing:
3353 Peachtree Road, N.E., Suite 1040
Atlanta, GA 30326
(c) CITIZENSHIP:
For all persons filing:
State of Georgia, United States of America
(d) TITLE OF CLASS OF SECURITIES:
Common Stock, Par Value $0.01 Per Share
(e) CUSIP NUMBER:
04621m102
Item 3. IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(B), OR 13D-2(B)
OR (C), CHECK WHETHER THE PERSON FILING IS A:
(a) | | Broker or dealer registered under section 15 of the Act
(15 U.S.C. 78o).
(b) | | Bank as defined in section 3(a)(6) of the Act
(15 U.S.C. 78c).
(c) | | Insurance company as defined in section 3(a)(19)
of the Act (15 U.S.C. 78c).
(d) | | Investment company registered under section 8 of the
Investment Company Act of 1940 (15 U.S.C 80a-8).
(e) |X| An investment adviser in accordance with ss.240.13d-1
(b)(1)(ii)(E);
(Page 5 of 10 Pages)
(f) | | An employee benefit plan or endowment fund in
accordance with ss.240.13d-1(b)(1)(ii)(F);
(g) | | A parent holding company or control person in
accordance with ss. 240.13d-1(b)(1)(ii)(G);
(h) | | A savings associations as defined in Section 3(b) of
the Federal Deposit Insurance Act (12 U.S.C. 1813);
(i) | | A church plan that is excluded from the definition of
an investment company under section 3(c)(14) of the
Investment Company Act of 1940 (15 U.S.C. 80a-3);
(j) | | Group, in accordance with ss.240.13d-1(b)(1)(ii)(J).
Heritage Fund Advisors, LLC is an investment advisor in accordance with
ss.240.13d-1(b)(1)(ii)(E).
Item 4. OWNERSHIP.
Heritage Assurance Heritage Fund
Partners, L.P. Advisors, LLC John F. Ray
------------------ -------------- -----------
(a) Amount Beneficially
Owned: 4,260,000 4,260,000 Disclaimed
(b) Percent of Class: 8.6% 8.6% N/A
(c) Number of Shares to
Which Reporting Person
Has:
(i) Sole Voting Power: N/A N/A N/A
(ii)Shared Voting Power: 4,260,000 4,260,000 Disclaimed
(iii) Sole Dispositive Power: N/A N/A N/A
(iv)Shared Dispositive Power: 4,260,000 4,260,000 Disclaimed
The reported shares (4,260,000) represent the shares of Common Stock
into which the shares of unregistered Series A Convertible Preferred
Stock (426,000) are convertible into pursuant to a 10:1 conversion
ratio as set forth in the issuer's articles of incorporation.
The reported shares are owned directly by Heritage Assurance Partners,
L.P. ("HAP"), whose general partner is Heritage Fund Advisors, LLC, an
investment advisor (the "General Partner"). The General Partner could
be deemed to be an indirect beneficial owner of the reported shares,
and could be deemed to share such beneficial ownership with HAP.
(Page 6 of 10 Pages)
John F. Ray is the sole manager of the General Partner, and could be
deemed to be an indirect beneficial owner of the reported shares. He
could be deemed to share such indirect beneficial ownership with the
General Partner and HAP. Messr. Ray expressly disclaims beneficial
ownership of the reported shares, and the filing of this report shall
not be deemed to be an admission that he is a beneficial owner of the
reported shares for purposes of Section 13(d) of the Securities
Exchange Act of 1934 or for any other purpose.
Item 5. OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS.
If this statement is being filed to report the fact that as of the date
hereof the reporting person has ceased to be the beneficial owner of
more than five percent of the class of securities, check the following.
Item 6. OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON.
Heritage Capital Advisors, LLC is the sole member of the General
Partner, and has the right to receive or the power to direct the
receipt of dividends from, or the proceeds from the sale of, the
reported shares beneficially owned indirectly by the General Partner.
Item 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED
THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY OR CONTROL
PERSON.
Not applicable.
Item 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP.
Not applicable.
Item 9. NOTICE OF DISSOLUTION OF GROUP.
Not applicable.
Item 10. CERTIFICATION.
By signing below I certify that, to the best of my knowledge and
belief, the securities referred to above were not acquired and are not held for
the purpose of or with the effect of changing or influencing the control of the
issuer of the securities and were not acquired and are not held in connection
with or as a participant in any transaction having that purpose or effect.
(Page 7 of 10 Pages)
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief,
the undersigned certify that the information set forth in this Statement is
true, complete and correct.
Date: August 23, 2004
HERITAGE ASSURANCE PARTNERS, L.P.
By: Heritage Fund Advisors, LLC,
General Partner
By: /S/ J. WESLEY GRACE
---------------------------------
Name: J. Wesley Grace
Title: Treasurer
Date: August 23, 2004
HERITAGE FUND ADVISORS, LLC
By: /S/ J. WESLEY GRACE
---------------------------------
Name: J. Wesley Grace
Title: Treasurer
Date: August 23, 2004
/S/ JOHN F. RAY
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John F. Ray
(Page 8 of 10 Pages)
Exhibit Index
Exhibit 1 Joint Filing Agreement dated as of August 23, 2004, by and among
Heritage Assurance Partners, L.P.; Heritage Fund Advisors, LLC;
and John F. Ray.
(Page 9 of 10 Pages)
EXHIBIT I
JOINT FILING AGREEMENT and POWER OF ATTORNEY
Pursuant to Rule 13d-1(k), the undersigned hereby agree that the
attached Schedule 13G (including any amendments thereto) is filed on behalf of
each of them.
Each of the undersigned hereby makes, constitutes, and appoints J.
Wesley Grace and John F. Ray, and each of them acting alone, their true and
lawful attorney-in-fact, with full power of substitution and resubstitution, for
it in any and all capacities to execute and cause to be filed with the
Securities and Exchange Commission any and all amendments to this Schedule 13G,
together with exhibits to any such amendments and other documents in connection
therewith, and hereby ratifies and confirms all that said attorney-in-fact or
said attorney-in-fact's substitute or substitutes may do or cause to be done by
virtue hereof.
Date: August 23, 2004
HERITAGE ASSURANCE PARTNERS, L.P.
By: Heritage Fund Advisors, LLC, General
Partner
By: /S/ J. WESLEY GRACE
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Name: J. Wesley Grace
Title: Treasurer
Date: August 23, 2004
HERITAGE FUND ADVISORS, LLC
By: /S/ J. WESLEY GRACE
----------------------------------------
Name: J. Wesley Grace
Title: Treasurer
Date: August 23, 2004
/S/ JOHN F. RAY
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John F. Ray
(Page 10 of 10 Pages)