UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
None (4) | Â (4) | Â (4) | None (4) | (4) | $ (4) | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Beutel Robert J 3440 LEHIGH STREET C/O PENN TREATY AMERICAN CORPORATION ALLENTOWN, PA 18103 |
 X |  |  |  |
/s/ Linda G. Carraghan, by Power of Attorney for Robert J. Beutel | 05/12/2008 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Shares held by Mr. Beutel via his retirement savings account and personal account. |
(2) | Shares held in two corporate accounts. Mr. Beutel is the president of both corporations and a holder of over 10% of each of these two accounts, but he is not the sole beneficiary. |
(3) | Shares held by Mr. Beutel's wife (via her retirement account and personal account) as to which beneficial ownership is disclaimed. |
(4) | No Table II securities beneficially owned. |