0001209191-17-032079.txt : 20170512
0001209191-17-032079.hdr.sgml : 20170512
20170512171858
ACCESSION NUMBER: 0001209191-17-032079
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161130
FILED AS OF DATE: 20170512
DATE AS OF CHANGE: 20170512
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: 17839938
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
2016-11-30
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
2016-11-30
4
J
0
3950000
D
8065238
D
Common Stock
2017-05-10
4
J
0
900000
D
7165238
D
Common Stock
6830088
I
By Corporation
Common Stock
626428
I
By Steven M. Mariano Trust
On November 30, 2016, the Reporting Person transferred 3,950,000 shares of common stock that were previously held directly to a corporation controlled by the Reporting Person. The 3,950,000 shares were previously incorrectly reported on the Form 4 filed on January 10, 2017 as being held directly by the Reporting Person.
On May 10, 2017, the Reporting Person transferred 900,000 shares of common stock that were previously held directly to a corporation controlled by the Reporting Person for value.
Includes the 3,950,000 shares and 900,000 shares transferred from direct ownership to indirect ownership, as reported herein.
/s/ Beth Crews, by power of attorney
2017-05-12