0001104659-12-059292.txt : 20120821 0001104659-12-059292.hdr.sgml : 20120821 20120821165832 ACCESSION NUMBER: 0001104659-12-059292 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120817 FILED AS OF DATE: 20120821 DATE AS OF CHANGE: 20120821 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: 2500 LEGACY DRIVE STREET 2: SUITE 130 CITY: FRISCO STATE: TX ZIP: 75034 BUSINESS PHONE: 4693621214 MAIL ADDRESS: STREET 1: 2500 LEGACY DRIVE STREET 2: SUITE 130 CITY: FRISCO STATE: TX ZIP: 75034 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: 121048210 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 a4.xml 4 X0306 4 2012-08-17 0 0000814181 PENN TREATY AMERICAN CORP PTYA 0001252447 CLARK ALEXANDER 160 EAST 84TH STREET NEW YORK NY 10028 1 0 0 0 Common stock 2012-08-17 4 P 0 25000 0.65 A 79200 D /s/ Alexander M. Clark 2012-08-21