UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Schedule 13D
Under the Securities Exchange Act of 1934
(Amendment No. 2)
AssuranceAmerica Corporation
(Name of Issuer)
Common Stock, par value $0.01 per share
(Title of Class of Securities)
04621M 1 02
(CUSIP Number)
Lawrence Stumbaugh
AssuranceAmerica Corporation
RiverEdge One
5500 Interstate North Parkway
Suite 600
Atlanta, Georgia 30328
(770) 933-8911
(Name, Address and Telephone Number of Person
Authorized to Receive Notices and Communications)
December 23, 2003
(Date of Event which Requires Filing of this Statement)
If the filing person has previously filed a statement on Schedule 13G to report
the acquisition that is the subject of this Schedule 13D, and is filing this
schedule because of ss.ss.240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the
following box. |_|
Note: Schedules filed in paper format shall include a signed original and five
copies of the schedule, including all exhibits. See ss.240.13d-7 for other
parties to whom copies are to be sent.
The information required on 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 ("Act") 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).
CUSIP No. 0462M 1 02 13D Page 2 of 7 Pages
--------------------------------------------------------------------------------
1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON
Sercap Holdings, LLC**
--------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) |_|
(b) |_|
--------------------------------------------------------------------------------
3 SEC USE ONLY
--------------------------------------------------------------------------------
4 SOURCE OF FUNDS*
N/A
--------------------------------------------------------------------------------
5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED
PURSUANT TO ITEMS 2(d) OR 2(e) |_|
--------------------------------------------------------------------------------
6 CITIZENSHIP OR PLACE OF ORGANIZATION
United States of America
--------------------------------------------------------------------------------
7 SOLE VOTING POWER
0
-----------------------------------------------------------------
NUMBER OF 8 SHARED VOTING POWER
SHARES
BENEFICIALLY 0
OWNED BY -----------------------------------------------------------------
EACH 9 SOLE DISPOSITIVE POWER
REPORTING
PERSON 0
WITH -----------------------------------------------------------------
10 SHARED DISPOSITIVE POWER
0
--------------------------------------------------------------------------------
11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
0
--------------------------------------------------------------------------------
12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* |_|
--------------------------------------------------------------------------------
13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
0%
--------------------------------------------------------------------------------
14 TYPE OF REPORTING PERSON*
OO (Limited Liability Company)
--------------------------------------------------------------------------------
*SEE INSTRUCTIONS BEFORE FILLING OUT!
**Sercap Holdings, LLC was dissolved in accordance with Georgia law on October
31, 2003.
CUSIP No. 0462M 1 02 13D Page 3 of 7 Pages
--------------------------------------------------------------------------------
1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON
Guy W. Millner
--------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) |_|
(b) |_|
--------------------------------------------------------------------------------
3 SEC USE ONLY
--------------------------------------------------------------------------------
4 SOURCE OF FUNDS*
OO (Conversion of Stock)
--------------------------------------------------------------------------------
5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED
PURSUANT TO ITEMS 2(d) OR 2(e) |_|
--------------------------------------------------------------------------------
6 CITIZENSHIP OR PLACE OF ORGANIZATION
United States of America
--------------------------------------------------------------------------------
7 SOLE VOTING POWER
36,255,653
-----------------------------------------------------------------
NUMBER OF 8 SHARED VOTING POWER
SHARES
BENEFICIALLY 0
OWNED BY -----------------------------------------------------------------
EACH 9 SOLE DISPOSITIVE POWER
REPORTING
PERSON 36,255,653
WITH -----------------------------------------------------------------
10 SHARED DISPOSITIVE POWER
0
--------------------------------------------------------------------------------
11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
36,255,653
--------------------------------------------------------------------------------
12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* |_|
--------------------------------------------------------------------------------
13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
80.3%
--------------------------------------------------------------------------------
14 TYPE OF REPORTING PERSON*
IN
--------------------------------------------------------------------------------
*SEE INSTRUCTIONS BEFORE FILLING OUT!
CUSIP No. 0462M 1 02 13D Page 4 of 7 Pages
--------------------------------------------------------------------------------
1 NAME OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON
Lawrence Stumbaugh
--------------------------------------------------------------------------------
2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) |_|
(b) |_|
--------------------------------------------------------------------------------
3 SEC USE ONLY
--------------------------------------------------------------------------------
4 SOURCE OF FUNDS*
OO (Conversion of Stock)
--------------------------------------------------------------------------------
5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED
PURSUANT TO ITEMS 2(d) OR 2(e) |_|
--------------------------------------------------------------------------------
6 CITIZENSHIP OR PLACE OF ORGANIZATION
United States of America
--------------------------------------------------------------------------------
7 SOLE VOTING POWER
5,084,347
-----------------------------------------------------------------
NUMBER OF 8 SHARED VOTING POWER
SHARES
BENEFICIALLY 5,000
OWNED BY -----------------------------------------------------------------
EACH 9 SOLE DISPOSITIVE POWER
REPORTING
PERSON 5,084,347
WITH -----------------------------------------------------------------
10 SHARED DISPOSITIVE POWER
5,000
--------------------------------------------------------------------------------
11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
5,089,347
--------------------------------------------------------------------------------
12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* |_|
--------------------------------------------------------------------------------
13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
11.3%
--------------------------------------------------------------------------------
14 TYPE OF REPORTING PERSON*
IN
--------------------------------------------------------------------------------
*SEE INSTRUCTIONS BEFORE FILLING OUT!
CUSIP No. 0462M 1 02 13D Page 5 of 7 Pages
This Amendment No. 2 hereby amends and supplements that certain Statement
on Schedule 13D filed on April 11, 2003, by Sercap Holdings, LLC, Guy W. Millner
and Lawrence Stumbaugh (as amended by Amendment No. 1 thereto filed on November
5, 2003, the "Schedule 13D") relating to the common stock, par value $0.01 per
share, of AssuranceAmerica Corporation, a Nevada corporation, as follows:
Item 1. Security and Issuer
No change.
Item 2. Identity and Background
Item 2 of the Schedule 13D is hereby amended and restated to read in its
entirety as follows:
"This statement is being filed jointly by Guy W. Millner and Lawrence
Stumbaugh (each individually, a "Reporting Person" and, collectively, the
"Reporting Persons").
Guy W. Millner is a citizen of the United States of America, and his
business address is RiverEdge One, 5500 Interstate North Parkway, Suite 600,
Atlanta, Georgia 30328. Mr. Millner's present occupation is Chairman of the
Board of Directors of the Issuer.
Lawrence Stumbaugh is a citizen of the United States of America, and his
business address is RiverEdge One, 5500 Interstate North Parkway, Suite 600,
Atlanta, Georgia 30328. Mr. Stumbaugh's present occupation is as Chief Executive
Officer and President of the Issuer.
During the last five years, to the best of their knowledge, none of the
Reporting Persons have been convicted in a criminal proceeding, excluding
traffic violations or similar misdemeanors, or been a party to a civil
proceeding of a judicial or administrative body of competent jurisdiction and as
a result of such proceeding was or is subject to a judgment, decree or final
order enjoining future violations of, or prohibiting or mandating activities
subject to, federal or state securities laws or finding any violation with
respect to such laws."
Item 3. Source and Amount of Funds or Other Consideration.
No change.
Item 4. Purpose of Transaction
No change.
Item 5. Interest in Securities of the Issuer
Item 5 of the Schedule 13D is hereby amended by replacing subsections(a)
through (c) thereof with the following:
"(a) The following calculations are based on the Issuer having 45,171,090
shares of Common Stock issued and outstanding as of the date hereof.
CUSIP No. 0462M 1 02 13D Page 6 of 7 Pages
Guy Millner beneficially owns 36,255,653 shares of Common Stock, which
represents approximately 80.3% of the outstanding shares of Common Stock.
Included in this amount are 2,119,500 shares of Common Stock owned by MI
Holdings, Inc., all of the outstanding capital stock of which is controlled by
Mr. Millner.
Lawrence Stumbaugh beneficially owns 5,089,347 shares of Common Stock,
which represents approximately 11.3% of the outstanding shares of Common Stock.
Of this amount, 5,084,347 shares of Common Stock are held by Mr. Stumbaugh
directly and 5,000 shares are held by his spouse as custodian for her grandson.
(b) Guy Millner holds the sole power to vote and dispose of, or to direct
the disposition of 36,255,653 shares of Common Stock, which includes 2,119,500
shares held by MI Holdings, Inc., all of the outstanding capital stock of which
is controlled by Mr. Millner.
Lawrence Stumbaugh holds the sole power to vote and dispose of or to
direct the disposition of 5,084,347 shares of Common Stock and has holds shared
power to vote and shared power to dispose of 5,000 shares of Common Stock held
by his spouse as custodian for her grandson.
(c) On December 23, 2003, Guy W. Millner disposed of 825,000 shares of
Common Stock by gift to his children and grandchildren. Also on December 23,
2003, Lawrence Stumbaugh disposed of 225,000 shares of Common Stock by gift to
his former spouse, his children and grandchildren."
Item 5 of the Schedule 13D is hereby further amended by adding the
following as subsection (e):
"On October 31, 2003, Sercap Holdings, LLC, was dissolved in accordance
with Georgia law and the shares it owned were distributed to the Reporting
Persons. As a result, it no longer beneficially owns any shares of Common
Stock."
Item 6. Contracts, Arrangements, Understandings or Relationships with respect to
Securities of the Issuer.
No change.
CUSIP No. 0462M 1 02 13D Page 7 of 7 Pages
SIGNATURES
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
Date: January 13, 2004 /s/ Guy W. Millner
------------------------------------
GUY W. MILLNER
Date: January 13, 2004 /s/ Lawrence Stumbaugh
------------------------------------
LAWRENCE STUMBAUGH
ATTENTION: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACT CONSTITUTE FEDERAL
CRIMINAL VIOLATIONS (SEE 18 U.S.C. ss.1001).