UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
( ) Check this box if no longer subject to Section 16. Form 4 or
Form 5 obligations may continue. See Instructions 1(b).
1. Name and Address of Reporting Person:
Martin L. Solomon
P.O. Box 70
Coconut Grove, Florida 33233
U.S.A.
2. Issuer Name and Ticker or Trading Symbol:
American Country Holdings Inc.
ACHI
3. IRS or Social Security Number of Reporting Person (Voluntary):
4. Statement for Month/Year:
November 2000
5. If Amendment, Date of Original (Month/Year):
August 1997
6. Relationship of Reporting Person(s) to Issuer (Check all
applicable):
(x) Director (x) 10% Owner (x) Officer (give title below)
( ) Other (specify below):
Co-Chairman
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>
<CAPTION>
Table I -- Non-Derivative Securities Acquired,
Disposed of, or Beneficially Owned
5. Amount of
2. Trans- Securities 6. Owner-
action 3. Trans- Beneficially ship Form:
1. Title of Date action 4. Securities Acquired Owned at End Direct (D) or 7. Nature of Indirect
Security (Month/ Code (A) or Disposed of (D) of Month Indirect (I) Beneficial Ownership
(Instr. 3) Day/Year) (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr. 4) (Instr. 4)
----------- --------- ---------- ---------------------- ---------------- ------------- ---------------------
Code V Amount(A)or(D) Price
---- - -------------- -----
<S> <S> <C> <C> <C> <C> <C> <C> <C>
Common Stock, 2,012,585 D
$.01 par value
</TABLE>
<TABLE>
<CAPTION>
Table II -- Derivative Securities Acquired,
Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
10.
9. Owner-
5. Number ship
Number of Deri- Form of 11.
2. of Deriv- vative Deri- Nature
Conver- ative 8. Securi- vative of
sion or Secur- Price ties Secur- Indi-
Exer- 3. ities 7. of Benefi- ity: rect
1. cise Trans- Acquired 6. Title and Deriv- cially Direct Benefi-
Title of Price action 4. (A) or Date Exer- Amount of ative Owned at (D) or cial
Deriv- of Date Trans- Disposed cisable and Underlying Secur- End of Indirect Owner-
ative Deriv- (Month/ action of (D) Expiration Securities ity Month (I) ship
Security ative Day/ Code (Instr. 3, Date(Month/ (Instr. 3 (Instr. (Instr. (Instr. (Instr.
(Instr. 3) Security Year) (Instr. 8) 4 and 5) Day/Year) and 4) 5) 4) 4) 4)
---------- -------- ------- ---------- ---------- --------------- ---------------- ------ -------- -------- -------
Date Expir- Amount or
Exer- ation Number of
Code V (A) (D) cisable Date Title Shares
---- - --- --- ------- ------ ----- ---------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Option 3.25 A 11/14/00 11/13/05 Common 5,000 5,000 D
Stock
$.01 D
par
value
Option 125,000 125,000 D
Redeemable 22,705 D
Common
Stock
Purchase
Warrants
</TABLE>
Explanation of Responses:
SIGNATURE OF REPORTING PERSON:
/s/ Martin L. Solomon
-----------------------------
Martin L. Solomon
Dated: December 15, 2000
