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