-----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, BPMpg2nsxwdd+/SddyMz38p2H2jX+/9edILTRI2lKHX/pvKcXd20EFC7itJFm76w 6Q5NWi/hBkAVoivIGQ783Q== 0001005150-99-001148.txt : 19991217 0001005150-99-001148.hdr.sgml : 19991217 ACCESSION NUMBER: 0001005150-99-001148 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991207 FILED AS OF DATE: 19991216 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PIONEER AMERICAN HOLDING CO CORP CENTRAL INDEX KEY: 0000760731 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 232319931 STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-14506 FILM NUMBER: 99775860 BUSINESS ADDRESS: STREET 1: 41 N MAIN ST CITY: CARBONDALE STATE: PA ZIP: 18407 BUSINESS PHONE: 7172822662 MAIL ADDRESS: STREET 1: 41 N MAIN STREET CITY: CARBONDALE STATE: PA ZIP: 18407 COMPANY DATA: COMPANY CONFORMED NAME: NBT BANCORP INC CENTRAL INDEX KEY: 0000790359 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] OWNER IRS NUMBER: 161268674 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 52 S BROAD ST CITY: NORWICH STATE: NY ZIP: 13815 BUSINESS PHONE: 6073376000 MAIL ADDRESS: STREET 1: 52 S. BROAD STREET CITY: NORWICH STATE: NY ZIP: 13815 3 1 FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ================================================================================ 1. Name and Address of Reporting Person NBT Bancorp Inc. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 52 South Broad Street - -------------------------------------------------------------------------------- (Street) Norwich New York 13815 - -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Date of Event Requiring Statement (Month/Day/Year) December 7, 1999 ================================================================================ 3. IRS or Social Security Number of Reporting Person (Voluntary) 16-1268674 ================================================================================ 4. Issuer Name and Ticker or Trading Symbol Pioneer American Holding Company Corp. (OTC BB: PAHC.OB) ================================================================================ 5. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) - -------------------------------------------------------------------------------- ================================================================================ 6. If Amendment, Date of Original (Month/Year) ================================================================================ Table I -- Non-Derivative Securities Beneficially Owned ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ N/A - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ==================================================================================================================================== Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(Print or Type Responses) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
==================================================================================================================================== 5.Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2.Date Exercisable (Instr. 4) Derivative and Expiration Date -------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 7. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Securit Exer- tion of Derivative (I) Ownership (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option * * Common stock, 569,997 $24.00 D N/A ----------------------------------------------------------------------------------------------------------------------------------- par value $1.00 ----------------------------------------------------------------------------------------------------------------------------------- per share ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
Explanation of Responses: * In connection with the Agreement and Plan of Merger (the "Merger Agreement"), dated December 7, 1999 whereby Pioneer American Holding Company Corp. ("Pioneer American") will merge with NBT Bancorp Inc. ("NBT"), Pioneer American has granted NBT an option to purchase up to 569,997 shares of Pioneer American's common stock. The option is exercisable only in the event of certain circumstances involving transactions with third parties, acts of third parties, or break-up of the Merger Agreement. If the option were exercised in full, NBT would own 16.6% of Pioneer American's then outstanding common stock. NBT disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that NBT is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. /s/ Daryl R. Forsythe December 16, 1999 - ---------------------------------------------- ---------------------- President of NBT Bancorp Inc. Date ** Signature of Reporting Person ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. -----END PRIVACY-ENHANCED MESSAGE-----