U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL 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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
NBT Bancorp Inc.
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(Last) (First) (Middle)
52 South Broad Street
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(Street)
Norwich New York 13815
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
December 7, 1999
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3. IRS or Social Security Number of Reporting Person (Voluntary)
16-1268674
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4. Issuer Name and Ticker or Trading Symbol
Pioneer American Holding Company Corp. (OTC BB: PAHC.OB)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[ ] Director [X] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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6. If Amendment, Date of Original (Month/Year)
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Table I -- Non-Derivative Securities Beneficially Owned
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<CAPTION>
<S> <C> <C> <C>
3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5)
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N/A
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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(Print or Type Responses)
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FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned (e.g., puts,
calls, warrants, options, convertible securities)
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<CAPTION>
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<S> <C> <C> <C> <C>
5.Owner-
3. Title and Amount of Securities ship
Underlying Derivative Security Form of
2.Date Exercisable (Instr. 4) Derivative
and Expiration Date -------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 7. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Securit Exer- tion of Derivative (I) Ownership
(Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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Stock Option * * Common stock, 569,997 $24.00 D N/A
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par value $1.00
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per share
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Explanation of Responses:
* In connection with the Agreement and Plan of Merger (the "Merger
Agreement"), dated December 7, 1999 whereby Pioneer American Holding
Company Corp. ("Pioneer American") will merge with NBT Bancorp Inc.
("NBT"), Pioneer American has granted NBT an option to purchase up to
569,997 shares of Pioneer American's common stock. The option is
exercisable only in the event of certain circumstances involving
transactions with third parties, acts of third parties, or break-up of the
Merger Agreement. If the option were exercised in full, NBT would own 16.6%
of Pioneer American's then outstanding common stock. NBT disclaims
beneficial ownership of these securities, and this report shall not be
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deemed an admission that NBT is the beneficial owner of such securities for
purposes of Section 16 or for any other purpose.
/s/ Daryl R. Forsythe December 16, 1999
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President of NBT Bancorp Inc. Date
** Signature of Reporting Person
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
