0001209191-17-002583.txt : 20170106
0001209191-17-002583.hdr.sgml : 20170106
20170106141602
ACCESSION NUMBER: 0001209191-17-002583
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170103
FILED AS OF DATE: 20170106
DATE AS OF CHANGE: 20170106
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: Smith Quentin P. Jr.
CENTRAL INDEX KEY: 0001624976
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36804
FILM NUMBER: 17513825
MAIL ADDRESS:
STREET 1: 10361 N. 117TH PLACE
CITY: SCOTTSDALE
STATE: AZ
ZIP: 85259
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-01-03
0
0001619917
Patriot National, Inc.
PN
0001624976
Smith Quentin P. Jr.
C/O PATRIOT NATIONAL, INC.
401 E. LAS OLAS BLVD., SUITE 1650
FORT LAUDERDALE
FL
33301
1
0
0
0
Common Stock
2017-01-03
4
A
0
24731
0.00
A
39262
D
Award of restricted stock that vests in full on April 1, 2017.
/s/ Christopher A. Pesch, by power of attorney
2017-01-06