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