0001170961-11-000002.txt : 20111017 0001170961-11-000002.hdr.sgml : 20111017 20111017145852 ACCESSION NUMBER: 0001170961-11-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111013 FILED AS OF DATE: 20111017 DATE AS OF CHANGE: 20111017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROSS PETER M CENTRAL INDEX KEY: 0001274426 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14681 FILM NUMBER: 111143669 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0304 4 2011-10-13 0 0000814181 PENN TREATY AMERICAN CORP PTA 0001274426 ROSS PETER M 726 BENT LANE NEWARK DE 19711 1 0 0 0 Common Stock 2011-10-13 4 P 0 2500 0.2 A 7800 I See Ftn. The shares are held in Peter M. Ross's Revocable Trust whereby Peter M. Ross is the Grantor and Trustee pursuant to the Revocable Trust Agreement. /s/ Linda G. Carraghan, Esq., as Power of Attorney for Peter M. Ross 2011-10-17