UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b)(c), AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(b)
(Amendment No. )
Penn Treaty American Corp.
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(Name of Issuer)
Common Stock, par value $.10 per share
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(Title of Class of Securities)
707874400
(CUSIP Number)
December 31, 2011
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(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
[_] Rule 13d-1(b)
[X] Rule 13d-1(c)
[_] Rule 13d-1(d)
*The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
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1. NAME OF REPORTING PERSONS
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
Thomas P. Kikis (“Kikis”)
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [_]
(b) [ ]
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3. SEC USE ONLY
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4. CITIZENSHIP OR PLACE OF ORGANIZATION
United States
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|
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5.
6.
7.
8. |
SOLE VOTING POWER: 2,028,531
SHARED VOTING POWER:
SOLE DISPOSITIVE POWER: 2,028,531
SHARED DISPOSITIVE POWER: |
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9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES*
[_]
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11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
8.71%
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12. TYPE OF REPORTING PERSON*
IN
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(1) On the basis of 23,290,712 shares of common stock reported by the Company as outstanding as of March 28, 2008 in its annual report filed on Form 10-K for the period ending December 31, 2008. Such annual report was filed with the Securities and Exchange Commission on April 2, 2008 and is the most recent periodic report filed by the Company setting forth the number of shares of Common Stock outstanding.
(2) Includes 900,146 shares of common stock held by Thomas Kikis, 128,385 shares of common stock held by the Kikis Family Foundation, 500,000 shares of common stock held by Kikis Family Holdings, 200,000 shares of common stock held by Peter Kikis, and 300,000 shares of common stock held by Mr. Kikis’ minor children. Mr. Kikis has the power to vote and control all of the above holdings.
Item 1(a). Name of Issuer:
Penn Treaty American Corp.
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Item 1(b). Address of Issuer's Principal Executive Offices:
3440 Lehigh Street
Allentown, PA 18103
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Item 2(a). Name of Person Filing:
Thomas P. Kikis (the “Reporting Person”) ____________________________________________________________________
Item 2(b). Address of Principal Business Office, or if None, Residence:
The principal business address for the Reporting Persons is 720 Fifth Avenue, 10th Floor, New York, NY 10019
____________________________________________________________________
Item 2(c). Citizenship:
Mr. Kikis is a citizen of the United States.
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Item 2(d). Title of Class of Securities:
This statement on Schedule 13G is being filed with respect to Common Stock, $.10 par value per share (the “Common Stock”) of the Issuer.
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Item 2(e). CUSIP Number:
707874400 ____________________________________________________________________
Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b), or 13d-2(b) or (c). Check whether the person
filing is a: Not Applicable.
(a) [_] Broker or dealer registered under Section 15 of the Exchange Act;
(b) [_] Bank as defined in Section 3(a)(6) of the Exchange Act;
(c) [_] Insurance company as defined in Section 3(a)(19) of the Exchange Act;
(d) [_] Investment company registered under Section 8 of the Investment Company Act;
(e) [_] An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E);
(f) [_] An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F);
(g) [_] A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G);
(h) [_] A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act;
(i) [_] A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the
Investment Company Act;
(j) [_] Group, in accordance with Rule 13d-1(b)(1)(ii)(J).
Item 4. Ownership.
Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.
(a) Amount beneficially owned: The information in items 1 and 5 through 11 on the cover page on this Schedule 13G is hereby incorporated by reference.
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(b) Percent of class: The information in items 1 and 5 through 11 on the cover page on this Schedule 13G is hereby incorporated by reference.
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(c) Number of shares as to which such person has:
(i) Sole power to vote or direct the vote: The information in items 1 and 5 through 11 on each cover page of this Schedule 13G is hereby incorporated by reference.
(ii) Shared power to vote or direct the vote: The information in items 1 and 5 through 11 on each cover page of this Schedule 13G is hereby incorporated by reference.
(iii) Sole power to dispose or direct the disposition of: The information in items 1 and 5 through 11 on each cover page of this Schedule 13G is hereby incorporated by reference.
(iv) Shared power to dispose or direct the disposition of: The information in items 1 and 5 through 11 on each cover page of this Schedule 13G is hereby incorporated by reference.
The purpose of this Filing is to reflect the ownership by the Reporting Persons in the shares of the Issuer.
Thomas Kikis: 2,028,531 (1)
.
(1) Includes 900,146 shares of common stock held by Thomas Kikis, 128,385 shares of common stock held by the Kikis Family Foundation, 500,000 shares of common stock held by Kikis Family Holdings, 200,000 shares of common stock held by Peter Kikis, and 300,000 shares of common stock held by Mr. Kikis’ minor children. Mr. Kikis has the power to vote and control all of the above holdings.
Item 5. Ownership of Five Percent or Less of a Class.
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities check the following [ ].
Not Applicable
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Item 6. Ownership of More Than Five Percent on Behalf of Another Person.
Not Applicable
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Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person.
Not Applicable
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Item 8. Identification and Classification of Members of the Group.
Not Applicable
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Item 9. Notice of Dissolution of Group.
Not Applicable
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Item 10. Certifications.
(a) The following certification shall be included if the statement is filed pursuant to Rule 13d-1(c):
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Dated: February 14, 2012
By: /s/ Thomas P. Kikis
Thomas P. Kikis