0001209191-15-047494.txt : 20150528 0001209191-15-047494.hdr.sgml : 20150528 20150528160538 ACCESSION NUMBER: 0001209191-15-047494 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150527 FILED AS OF DATE: 20150528 DATE AS OF CHANGE: 20150528 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: Mariano Steven M. CENTRAL INDEX KEY: 0001480753 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36804 FILM NUMBER: 15895550 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 2015-05-27 0 0001619917 Patriot National, Inc. PN 0001480753 Mariano Steven M. C/O PATRIOT NATIONAL, INC. 401 EAST LAS OLAS BOULEVARD, SUITE 1650 FORT LAUDERDALE FL 33301 1 1 1 0 See Remarks Common Stock 2015-05-27 4 P 0 15000 15.50 A 979607 I By Corporation Common Stock 14516175 D Common Stock 835995 I By Steven M. Mariano Trust President and Chief Executive Officer The Reporting Person disclaims beneficial ownership of the securities reported herein as indirectly beneficially owned, except to the extent of his pecuniary interest therein. /s/ Christopher A. Pesch, by power of attorney 2015-05-28