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