-----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, JospcfyIMJqdS6Aw0MsJFJkief2I66vqWy/XQbwqwTG3d4AVnhxbhSps4FSUyitY cK2VlUO101R9KzM0VHuIqQ== 0000814181-04-000054.txt : 20040602 0000814181-04-000054.hdr.sgml : 20040602 20040602165205 ACCESSION NUMBER: 0000814181-04-000054 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040528 FILED AS OF DATE: 20040602 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FALCONIO PATRICK E CENTRAL INDEX KEY: 0001261599 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 04844976 BUSINESS ADDRESS: STREET 1: 2101 OAKWOOD AVE CITY: BLOOMINGTON STATE: IL ZIP: 61704 MAIL ADDRESS: STREET 1: 2 SYMONS LANE CITY: SAVANNAH STATE: GA ZIP: 31411 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 4 1 form4_pfex.xml X0202 4 2004-05-28 0 0000814181 PENN TREATY AMERICAN CORP PTA 0001261599 FALCONIO PATRICK E 2101 OAKWOOD AVE BLOOMINGTON IL 61704 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 20000 D Grant of incentive stock options as Director /s/ Linda G. Carraghan, by Power of Attorney for Patrick E. Falconio 2004-06-02 -----END PRIVACY-ENHANCED MESSAGE-----