-----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, EYI3Gvc2HxuPNrzQVE0TLOPqEoeT+ojHCDKk9IurSqm+PgHbo6nOpfEEx+ChVBt1 UHafRkq1e75ddwzi95S0GA== 0000893220-02-001303.txt : 20021030 0000893220-02-001303.hdr.sgml : 20021030 20021030164923 ACCESSION NUMBER: 0000893220-02-001303 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20021030 GROUP MEMBERS: WILBUR ROSS GROUP MEMBERS: WL ROSS & CO. LLC GROUP MEMBERS: WLR RECOVERY ASSOCIATES II, L.P. GROUP MEMBERS: WLR RECOVERY FUND II, L.P. FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: WL ROSS & CO LLC CENTRAL INDEX KEY: 0001202045 IRS NUMBER: 134106462 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 101 EAST 52ND STREET STREET 2: 19TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2128262042 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PENN TREATY AMERICAN CORP CENTRAL INDEX KEY: 0000814181 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] IRS NUMBER: 231664166 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-38689 FILM NUMBER: 02803434 BUSINESS ADDRESS: STREET 1: 3440 LEHIGH ST CITY: ALLENTOWN STATE: PA ZIP: 18103 BUSINESS PHONE: 6109652222 MAIL ADDRESS: STREET 1: 3440 LEHIGH ST CITY: ALLENTOWN STATE: PA ZIP: 18103 SC 13G 1 w64951sc13g.txt PENN TREATY AMERICAN CORPORATION SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 SCHEDULE 13G (Rule 13d-102) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b), (c) AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO 13d-2(b) (Amendment No. ____________)(1) Penn Treaty American Corporation (Name of Issuer) Common Stock, $0.10 par value (Title of Class of Securities) 707874103 (CUSIP NUMBER) October 21, 2002 (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) (1) 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 disclosures provided in a prior cover page. 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 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). - -------------------------------------------------------------------------------- 1. NAME OF REPORTING PERSONS: WLR Recovery Fund II, L.P. I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) 80-0030486 - -------------------------------------------------------------------------------- 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] - -------------------------------------------------------------------------------- 3. SEC USE ONLY - -------------------------------------------------------------------------------- 4. CITIZENSHIP OR PLACE OF ORGANIZATION Delaware - -------------------------------------------------------------------------------- NUMBER OF 5. SOLE VOTING POWER 0 SHARES ----------------------------------------------------------------- BENEFICIALLY 6. SHARED VOTING POWER 2,160,444 OWNED BY ----------------------------------------------------------------- EACH 7. SOLE DISPOSITIVE POWER 0 REPORTING ----------------------------------------------------------------- PERSON 8. SHARED DISPOSITIVE POWER 2,160,444 WITH - -------------------------------------------------------------------------------- 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,160,444 - -------------------------------------------------------------------------------- 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.79% - -------------------------------------------------------------------------------- 12. TYPE OF REPORTING PERSON* PN - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! -2- - -------------------------------------------------------------------------------- 1. NAME OF REPORTING PERSONS: WLR Recovery Associates II LLC I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) 80-0032277 - -------------------------------------------------------------------------------- 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] - -------------------------------------------------------------------------------- 3. SEC USE ONLY - -------------------------------------------------------------------------------- 4. CITIZENSHIP OR PLACE OF ORGANIZATION Delaware - -------------------------------------------------------------------------------- NUMBER OF 5. SOLE VOTING POWER 0 SHARES ----------------------------------------------------------------- BENEFICIALLY 6. SHARED VOTING POWER 2,160,444 OWNED BY ----------------------------------------------------------------- EACH 7. SOLE DISPOSITIVE POWER 0 REPORTING ----------------------------------------------------------------- PERSON 8. SHARED DISPOSITIVE POWER 2,160,444 WITH - -------------------------------------------------------------------------------- 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,160,444 - -------------------------------------------------------------------------------- 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.79% - -------------------------------------------------------------------------------- 12. TYPE OF REPORTING PERSON* OO - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! -3- - -------------------------------------------------------------------------------- 1. NAME OF REPORTING PERSONS: WL Ross & Co. LLC I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) 13-4106462 - -------------------------------------------------------------------------------- 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] - -------------------------------------------------------------------------------- 3. SEC USE ONLY - -------------------------------------------------------------------------------- 4. CITIZENSHIP OR PLACE OF ORGANIZATION Delaware - -------------------------------------------------------------------------------- NUMBER OF 5. SOLE VOTING POWER 0 SHARES ----------------------------------------------------------------- BENEFICIALLY 6. SHARED VOTING POWER 2,160,444 OWNED BY ----------------------------------------------------------------- EACH 7. SOLE DISPOSITIVE POWER 0 REPORTING ----------------------------------------------------------------- PERSON 8. SHARED DISPOSITIVE POWER 2,160,444 WITH - -------------------------------------------------------------------------------- 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,160,444 - -------------------------------------------------------------------------------- 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.79% - -------------------------------------------------------------------------------- 12. TYPE OF REPORTING PERSON* OO - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! -4- - -------------------------------------------------------------------------------- 1. NAME OF REPORTING PERSONS: Wilbur Ross I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) - -------------------------------------------------------------------------------- 2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [_] (b) [_] - -------------------------------------------------------------------------------- 3. SEC USE ONLY - -------------------------------------------------------------------------------- 4. CITIZENSHIP OR PLACE OF ORGANIZATION New York - -------------------------------------------------------------------------------- NUMBER OF 5. SOLE VOTING POWER 0 SHARES ----------------------------------------------------------------- BENEFICIALLY 6. SHARED VOTING POWER 2,160,444 OWNED BY ----------------------------------------------------------------- EACH 7. SOLE DISPOSITIVE POWER 0 REPORTING ----------------------------------------------------------------- PERSON 8. SHARED DISPOSITIVE POWER 2,160,444 WITH - -------------------------------------------------------------------------------- 9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 2,160,444 - -------------------------------------------------------------------------------- 10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.79% - -------------------------------------------------------------------------------- 12. TYPE OF REPORTING PERSON* IN - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! -5- - -------------------------------------------------------------------------------- Item 1(a). Name of Issuer: Penn Treaty American Corporation - -------------------------------------------------------------------------------- Item 1(b). Address of Issuer's Principal Executive Offices: 3440 Lehigh Street Allentown, Pennsylvania 18103 - -------------------------------------------------------------------------------- Item 2(a). Name of Person Filing: (i) WLR Recovery Fund II, L.P. ("WLR II LP") (ii) WLR Recovery Associates II LLC ("WLR II LLC") (iii) WL Ross & Co. LLC ("WL Ross") (iv) Wilbur Ross ("Ross") - -------------------------------------------------------------------------------- Item 2(b). Address of Principal Business Office, or if None, Residence: (i) The principal business address of WLR II LP is: 101 East 52nd Street, 19th Floor New York, NY 10022 (ii) The principal business address of WLR II LLC is: 101 East 52nd Street, 19th Floor New York, NY 10022 (iii) The principal business address of WL Ross is: 101 East 52nd Street, 19th Floor New York, NY 10022 (iv) The principal business address of Ross is: c/o WL Ross & Co. LLC 101 East 52nd Street, 19th Floor New York, NY 10022 - -------------------------------------------------------------------------------- Item 2(c). Citizenship: (i) The state of organization of WLR II LP is Delaware. (ii) The state of organization of WLR II LLC is Delaware. (iii) The state of organization of WL Ross is Delaware. (iv) The state of residence of Ross is New York. -6- - -------------------------------------------------------------------------------- Item 2(d). Title of Class of Securities: Common Stock, $0.10 par value ("Common Stock") - -------------------------------------------------------------------------------- Item 2(e). CUSIP Number: 707874103 - -------------------------------------------------------------------------------- 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: Not Applicable (a) [_] Broker or dealer registered under Section 15 of the Exchange Act; (b) [_] Bank as defined in Section 3(a)(6) of the Exchange Act; (c) [_] Insurance Company as defined in Section 3(a)(19) of the Exchange Act; (d) [_] Investment Company registered under Section 8 of the Investment Company Exchange Act; (e) [_] Investment Adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) [_] Employee Benefit Plan or Endowment Fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) [_] Parent Holding Company or Control Person in accordance with Rule 13d-1(b)(1)(ii)(G); (h) [_] Savings Association as defined in Section 3(b) of the Federal Deposit Insurance Act; (i) [_] Church Plan that is excluded from the definition of an Investment Company under Section 3(c)(14) of the Investment Company Act; (j) [_] Group, in accordance with Rule 13d-1(b)(1)(ii)(J). Item 4. Ownership. Ownership percentages are based on 19,907,737 shares of Common Stock reported to be outstanding as of August 12, 2002, as reflected in the Issuer's quarterly report on Form 10-Q filed on August 14, 2002. For each of the reporting persons, beneficial ownership of 2,160,444 shares represents the total number of shares of Common Stock issuable upon conversion of a 6-1/4% convertible subordinated note held by WLR II LP. The note, acquired pursuant to an exchange offer with the Issuer, is convertible into Common Stock of the Issuer at a price of $4.50 per share. -7- (I) WLR II LP (a) Amount beneficially owned: 2,160,444 (b) Percent of Class: 9.79% (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 2,160,444 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 2,160,444 (II) WLR II LLC (a) Amount beneficially owned: 2,160,444 (b) Percent of Class: 9.79% (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 2,160,444 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 2,160,444 (III) WL Ross (a) Amount beneficially owned: 2,160,444 (b) Percent of Class: 9.79% (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 2,160,444 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 2,160,444 (IV) Ross (a) Amount beneficially owned: 2,160,444 (b) Percent of Class: 9.79% (c) Number of shares as to which such person has: (i) Sole power to vote or direct the vote: 0 (ii) Shared power to vote or to direct the vote: 2,160,444 (iii)Sole power to dispose or direct the disposition of: 0 (iv) Shared power to dispose or to direct the disposition of: 2,160,444
-8- - -------------------------------------------------------------------------------- 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. Not Applicable - -------------------------------------------------------------------------------- Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company. 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. -9- SIGNATURE 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. Dated: October 29, 2002 WLR RECOVERY FUND II , L.P. By: WLR Recovery Associates II LLC, its General Partner By: /s/ Wilbur L. Ross --------------------------- Name: Wilbur L. Ross Its: Managing Member WLR RECOVERY ASSOCIATES II, LLC By: /s/ Wilbur L. Ross -------------------------- Name: wilbur L. Ross Its: Managing Member WLR ROSS & CO. LLC By: /s/ Wilbur L. Ross ------------------------- Name: WIlbur L. Ross Its: Managing Member /s/ Wilbur L. Ross -------------------- Wilbur Ross -10- AGREEMENT In accordance with Rule 13d-1(k) under the Securities Exchange Act of 1934, as amended, the undersigned hereby agree that only one statement containing the information required by Schedule 13G and any further amendments thereto need be filed with respect to the beneficial ownership by each of the undersigned of shares of common stock of Penn Treaty American Corporation. This Agreement may be executed in any number of counterparts, all of which together shall constitute one and the same instrument. EXECUTED this 29th day of October, 2002. WLR RECOVERY FUND II, L.P. By: WLR Recovery Associates II LLC, its General Partner By: /s/ Wilbur L. Ross ------------------------ Name: Wilbur L. Ross Its: Managing Member WLR RECOVERY ASSOCIATES II, LLC By: /s/ Wilbur L. Ross ----------------------- Name: Wilbur L. Ross Its: Managing Member WLR ROSS & CO. LLC By: /s/ Wilbur L. Ross ---------------------- Name: Wilbur L. Ross Its: Managing Member /s/ Wilbur L. Ross ----------------------- Wilbur L. Ross -11- -----END PRIVACY-ENHANCED MESSAGE-----