-----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, QnB9mC5xiR21VauwZnYAFLI8M7Gd6z4jaiCaXBtTZiq17RymbSzmad2/E9YoyVqF YOhHYBg7AMfvEkrdzsk8rg== 0000814181-04-000014.txt : 20040213 0000814181-04-000014.hdr.sgml : 20040213 20040213161615 ACCESSION NUMBER: 0000814181-04-000014 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040213 ISSUER: 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 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LEVIT IRVING CENTRAL INDEX KEY: 0000905017 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 04599327 BUSINESS ADDRESS: STREET 1: 3440 LEHIGH ST CITY: ALLENTOWN STATE: PA ZIP: 18103 BUSINESS PHONE: 610 965 2020 MAIL ADDRESS: STREET 1: 2565 GRACIE LONE CITY: MACUNGIE STATE: PA ZIP: 18062 5 1 form5_il03ex.xml X0201 5 2003-12-31 0 0 1 0000814181 PENN TREATY AMERICAN CORP PTA 0000905017 LEVIT IRVING 3440 LEHIGH ST ALLENTOWN PA 18103 1 0 0 0 Incentive Stock Option (Right to Buy) 1.640 2003-05-23 4 A 0 L 20000 A 2004-05-23 2013-05-23 Common Stock 20000 261455 D Grant of Incentive Stock Options as Director /s/ Linda G. Carraghan by Power of Attorney for Irving Levit 2004-02-13 -----END PRIVACY-ENHANCED MESSAGE-----