-----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, NNfRhK3UbIGjO87nugbcbgJ9muU+v2AhFcZkHbfR+hj6DUf4E0l+1H5LAkHAVJE+ h3SMwaO0Cu5dy/dwzgJY8w== 0001140361-03-004430.txt : 20031121 0001140361-03-004430.hdr.sgml : 20031121 20031121151413 ACCESSION NUMBER: 0001140361-03-004430 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031119 FILED AS OF DATE: 20031121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROSS WILBUR L JR CENTRAL INDEX KEY: 0001026610 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 031017981 BUSINESS ADDRESS: STREET 1: C/O SYMS CORP STREET 2: SYMS WAY CITY: SECAUCUS STATE: NJ ZIP: 07094 MAIL ADDRESS: STREET 1: ROTHOCHILD INC STREET 2: 1251 AVENUE OF AMERICAS CITY: NEW YORK STATE: NY ZIP: 10020 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WL ROSS & CO LLC CENTRAL INDEX KEY: 0001202045 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 031017980 BUSINESS ADDRESS: STREET 1: 101 EAST 52ND STREET STREET 2: 19TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2128262042 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WLR RECOVERY ASSOCIATES II LLC CENTRAL INDEX KEY: 0001266093 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 031017979 BUSINESS ADDRESS: STREET 1: C/O WL ROSS CO LLC STREET 2: 101 EAST 52ND 19TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2128262042 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WLR RECOVERY FUND II LLC CENTRAL INDEX KEY: 0001266096 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 031017978 BUSINESS ADDRESS: STREET 1: C/O WL ROSS CO LLC STREET 2: 101 EAST 52ND 19TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2128262042 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 doc1.xml FORM 4 X0201 4 2003-11-19 0 0000814181 PENN TREATY AMERICAN CORP PTA 0001202045 WL ROSS & CO LLC 101 EAST 52ND STREET 19TH FLOOR NEW YORK NY 10022 0 0 1 0 0001266093 WLR RECOVERY ASSOCIATES II LLC 101 EAST 52ND STREET 19TH FLOOR NEW YORK NY 10022 0 0 1 0 0001266096 WLR RECOVERY FUND II LLC 101 EAST 52ND STREET 19TH FLOOR NEW YORK NY 10022 0 0 1 0 0001026610 ROSS WILBUR L JR 101 EAST 52ND STREET 19TH FLOOR NEW YORK NY 10022 0 0 1 0 Convertible Notes Due 2008 1.75 2003-11-07 4 S 0 222000 221975 D 1988-08-08 2008-10-15 Common Stock 126857.14 10200000 I By WLR Recovery Fund II L.P. The convertible notes are immediately exerciseable. The shares are held directly by WLR Recovery Fund II, L.P. The general partner of WLR Recovery Fund II, L.P. is WLR Recovery Associates II LLC. Wilbur L. Ross, Jr. is the managing member, and W.L. Ross & Co. LLC is the advisor, of WLR Recovery Associates II LLC. (3) Signing individually and on behalf of WLR Recovery Fund II, L.P., WLR Recovery Associates II LLC, and W.L. Ross & Co. LLC. Wilbur L. Ross, Jr. (3) 2003-11-21 -----END PRIVACY-ENHANCED MESSAGE-----