-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, BE5/uB8FgaLfpt/1eUB3Lbf3R46INfwbifSwWrCj7rSBMONB0I0hrLGSNrxxNkE5 5eF2As/vjFcj4PcYYGzxiQ== 0000950116-97-000861.txt : 19970507 0000950116-97-000861.hdr.sgml : 19970507 ACCESSION NUMBER: 0000950116-97-000861 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19970506 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PROVIDENT AMERICAN CORP CENTRAL INDEX KEY: 0000768892 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 232214195 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-38359 FILM NUMBER: 97596174 BUSINESS ADDRESS: STREET 1: 2500 DEKALB PIKE CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 BUSINESS PHONE: 2152792500 MAIL ADDRESS: STREET 1: 2500 DEKALB PIKE STREET 2: PO BOX 511 CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: PROVIDENT AMERICAN CORP CENTRAL INDEX KEY: 0000768892 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 232214195 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 2500 DEKALB PIKE CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 BUSINESS PHONE: 2152792500 MAIL ADDRESS: STREET 1: 2500 DEKALB PIKE STREET 2: PO BOX 511 CITY: NORRISTOWN STATE: PA ZIP: 19404-0511 SC 13D 1 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D Under the Securities Exchange Act of 1934 PROVIDENT AMERICAN CORPORATION - -------------------------------------------------------------------------------- (Name of Issuer) Common Voting Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 743832-990 - -------------------------------------------------------------------------------- (CUSIP Number) Anthony R. Verdi, Chief Financial Officer, Provident American Corporation, 2500 DeKalb Pike, P. O. Box 511, Norristown, PA 19404-0511 Telephone: (610) 279-2500 - -------------------------------------------------------------------------------- (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) July 24, 1996 - -------------------------------------------------------------------------------- (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 which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-1(b)(3) or (4), check the following box [ ]. CUSIP No. 743832-990 - -------------------------------------------------------------------------------- 1) Names of Reporting Persons S.S. or I.R.S. Identification Nos. of Above Persons Richard E. Field ("Field") ......Social Security No.:###-##-#### - -------------------------------------------------------------------------------- 2) Check the Appropriate Box if a Member of a Group (See Instructions) (a) ............................................. (b) ........................................... X - -------------------------------------------------------------------------------- 3) SEC Use Only - -------------------------------------------------------------------------------- 4) Source of Funds (See Instructions) ..................SC, PF - -------------------------------------------------------------------------------- 5) Check 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 - -------------------------------------------------------------------------------- Number of 7) Sole Voting Power.............707,500 Shares Bene- ficially 8) Shared Voting Power.................. Owned by Each 9) Sole Dispositive Power........707,500 Reporting Person With 10) Shared Dispositive Power............. - -------------------------------------------------------------------------------- 11) Aggregate Amount Beneficially Owned by Each Reporting Person..........................................707,500 - -------------------------------------------------------------------------------- 12) Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions)............................. - -------------------------------------------------------------------------------- 13) Percent of Class Represented by Amount in Row (11)......7.0% - -------------------------------------------------------------------------------- 14) Type of Reporting Person (See Instructions)............IN .............................................................. .............................................................. .............................................................. .............................................................. Item 1. Security and Issuer. Common Voting Stock Provident American Corporation 2500 DeKalb Pike P. O. Box 511 Norristown, PA 19404-0511 Item 2. Identity and Background. (a) Richard E. Field ("Field") (b) 2500 DeKalb Pike, Norristown, Pennsylvania 19404-0511 (c) Consultant Provident Indemnity Life Insurance Company 2500 DeKalb Pike, P.O. Box 511 Norristown, PA 19404-0511 Sale of health and life insurance products (d) No (e) No (f) United States of America Item 3. Source and Amount of Funds or Other Consideration. o Effective January 1, 1996, pursuant to a Stock Option/Warrant Agreement dated as of January 1, 1996, Field received an option to purchase 100,000 shares of Issuer's Common Voting Stock at a price of $7.25 per share. The Warrant also provides that Field may acquire 100,000 additional shares of Issuer's Common Voting Stock in each of 1997 and 1998 provided certain premium levels are attained. o Effective July 24, 1996, Field purchased 150,000 shares of Issuer's Common Voting Stock for total consideration of $1,406,250 in a market transaction using borrowed funds collateralized by shares of Issuer's Common Voting Stock. o Pursuant to a Stock Exchange Agreement dated June 18, 1996, Issuer acquired all of the issued and outstanding stock of Richard E. Field & Associates, Inc. ("REF") in exchange for 457,000 shares of Issuer's Common Voting Stock. - 1 - Item 4. Purpose of Transaction. Investment Pursuant to the Stock Option/Warrant Agreement dated as of January 1, 1996, Field also may acquire 100,000 additional shares of Issuer's Common Voting Stock in each of 1997 and 1998 provided certain premium levels are attained. Item 5. Interest in Securities of the Issuer. Richard E. Field (a) 707,500 shares of Issuer's Common Voting Stock, representing 7.0% of outstanding shares (b) Sole power to vote and dispose of 707,500 shares (c) On March 14, 1997, Field received options to purchase 100,000 shares of Issuer's Common Voting Stock at a price of $7.25 per share, effective as of December 31, 1996 (d) Not applicable (e) Not applicable Item 6. Contracts, Arrangements, Understandings or Relationships With Respect to Securities of the Issuer. Pursuant to the Stock Option/Warrant Agreement dated as of January 1, 1996, Field also may acquire 100,000 additional shares of Issuer's Common Voting Stock in each of 1997 and 1998 provided certain premium levels are attained. Item 7. Material to be Filed as Exhibits. (1) Field Stock Option/Warrant Agreement dated as of January 1, 1996 (2) Stock Exchange Agreement dated June 18, 1996 among Issuer, Field, Arthur Ivey, and REF. - 2 - 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. March 27, 1997 - ------------------------------- Date /s/ Richard E. Field - ------------------------------- Signature Richard E. Field - ------------------------------- Name/Title - 3 - -----END PRIVACY-ENHANCED MESSAGE-----