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