-----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, AvWgB9Z7GNtcWZqlibYct7R9dyEe6huyvFMTbqxOPoutIFbbJ9jZY8cgXkalu9YT PdKE0a22mXtqVeWLdYCx0g== 0000814181-04-000035.txt : 20040601 0000814181-04-000035.hdr.sgml : 20040601 20040601144749 ACCESSION NUMBER: 0000814181-04-000035 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040528 FILED AS OF DATE: 20040601 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: CLARK ALEXANDER CENTRAL INDEX KEY: 0001252447 STANDARD INDUSTRIAL CLASSIFICATION: ACCIDENT & HEALTH INSURANCE [6321] STATE OF INCORPORATION: PA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 04840932 BUSINESS ADDRESS: STREET 1: 3440 LEHIGH ST CITY: ALLENTOWN STATE: PA ZIP: 18103 BUSINESS PHONE: 212 484 2900 MAIL ADDRESS: STREET 1: 106 EAST 84TH STREET 8E CITY: NEW YORK STATE: NY ZIP: 10028 4 1 form4_acex.xml X0202 4 2004-05-28 0 0000814181 PENN TREATY AMERICAN CORP PTA 0001252447 CLARK ALEXANDER 3440 LEHIGH ST ALLENTOWN PA 18103 1 0 0 0 Incentive Stock Option (right to buy) 2.13 2004-05-28 4 A 0 20000 A 2005-05-28 2014-05-28 Common Stock 20000 40000 D F1 Grant of incentive stock options as director /s/ Linda G. Carraghan, by Power of Attorney for Alexander M. Clark 2004-06-01 -----END PRIVACY-ENHANCED MESSAGE-----