UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
1. Name and Address of Reporting Person:
Karla M. Violetto
1 S.-484 Leahy Rd.
Oakbrook Terrace, Illinois 60181
2. Date of Event Requiring Statement (Month/Day/Year)
March 3, 2000
3. I.R.S. Identification Number of Reporting Person, if an entity
(Voluntary):
4. Issuer Name and Ticker of Trading Symbol:
American Country Holdings Inc.
5. Relationship of Reporting Person(s) to Issuer (Check all
applicable):
( ) Director
(x) Officer (give title below)
( ) 10% Owner
( ) Other (specify below)
Vice President and Chief Financial Officer
------------------------------------------
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Filing (Check Applicable Line)
(x) Form filed by One Reporting Person
( ) Form filed by More than One Reporting Person
TABLE 1 - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
2. Amount of 3. Ownership 4. Nature of
Securities Form: Direct Indirect
Beneficially (D) or Beneficial
1. Title of Security Owned (Inst. Indirect (I) Ownership
(Instr. 4) 4) (Instr. 5) (Instr. 5)
-------------------- ------------ ------------ ------------
No securities are
beneficially owned
<TABLE>
<CAPTION>
TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
5. Ownership
Form of
4. Conver- Derivative
3. Title and Amount sion or Security: 6. Nature
1. Title of of Securities Exercise Direct (D) of Indirect
Derivative 2. Date Exercisable Underlying Price of or Indirect Beneficial
Security (Instr. and Expiration Date Derivative Security Derivative (I) (Instr. Ownership
4) (Month/Day/Year) (Instr. 4) Security 5) (Instr. 5)
---------------- ------------------- ------------------- ---------- ------------ -----------
<S> <C> <C> <C> <C> <C>
No securities are
beneficially owned Amount
or
Date Expira- Number
Exer- tion of
cisable Date Title Shares
------- ------ ----- ------
</TABLE>
SIGNATURE OF REPORTING PERSON:
/s/ Karla M. Violetto
-----------------------
Karla M. Violetto
Dated: April 10, 2000
