0001209191-17-003238.txt : 20170110
0001209191-17-003238.hdr.sgml : 20170110
20170110172217
ACCESSION NUMBER: 0001209191-17-003238
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170105
FILED AS OF DATE: 20170110
DATE AS OF CHANGE: 20170110
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: 17521429
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
2017-01-05
0
0001619917
Patriot National, Inc.
PN
0001480753
Mariano Steven M.
C/O PATRIOT NATIONAL, INC.
401 E. LAS OLAS BLVD., SUITE 1650
FORT LAUDERDALE
FL
33301
1
1
1
0
See Remarks
Common Stock
2017-01-05
4
S
0
3130
5.00
D
12019485
D
Common Stock
2017-01-10
4
S
0
4247
5.01
D
12015238
D
Common Stock
626428
I
By Steven M. Mariano Trust
Common Stock
1980088
I
By Corporation
The sale reported in this Form 4 was effected pursuant to a Rule 10b5-1 trading plan.
The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $5.00 to $5.03, inclusive. The reporting person undertakes to provide to Patriot National, Inc., any security holder of Patriot National, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote.
The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $5.00 to $5.04, inclusive. The reporting person undertakes to provide to Patriot National, Inc., any security holder of Patriot National, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote.
President and Chief Executive Officer.
The Reporting Person disclaims beneficial ownership of the securities reported herein as indirectly owned, except to the the extent of his pecuniary interest therein.
/s/ Christopher A. Pesch, by power of attorney
2017-01-10