0001209191-17-004230.txt : 20170118
0001209191-17-004230.hdr.sgml : 20170118
20170118172718
ACCESSION NUMBER: 0001209191-17-004230
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170118
FILED AS OF DATE: 20170118
DATE AS OF CHANGE: 20170118
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Patriot National, Inc.
CENTRAL INDEX KEY: 0001619917
STANDARD INDUSTRIAL CLASSIFICATION: INSURANCE AGENTS BROKERS & SERVICES [6411]
IRS NUMBER: 464151376
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 401 E. LAS OLAS BLVD.
STREET 2: SUITE 1650
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33301
BUSINESS PHONE: (954) 670-2900
MAIL ADDRESS:
STREET 1: 401 E. LAS OLAS BLVD.
STREET 2: SUITE 1650
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Halter Paul
CENTRAL INDEX KEY: 0001414214
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36804
FILM NUMBER: 17534219
MAIL ADDRESS:
STREET 1: PATRIOT NATIONAL, INC.
STREET 2: 401 EAST LAS OLAS BOULEVARD, SUITE 1650
CITY: FORT LAUDERDALE
STATE: FL
ZIP: 33301
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-01-18
0
0001619917
Patriot National, Inc.
PN
0001414214
Halter Paul
C/O PATRIOT NATIONAL, INC.
401 E. LAS OLAS BLVD., SUITE 1650
FORT LAUDERDALE
FL
33301
0
1
0
0
See Remarks
Common Stock
2017-01-18
4
S
0
2794
4.71
D
35736
D
Common Stock
1000
I
By Wife
The sale reported in this Form 4 was effected pursuant to a Rule 10b5-1 trading plan to cover the Reporting Person's tax obligations in connection with the vesting of restricted stock.
/s/ Christopher A. Pesch, by power of attorney
2017-01-18