0000076605-21-000125.txt : 20210514 0000076605-21-000125.hdr.sgml : 20210514 20210514213547 ACCESSION NUMBER: 0000076605-21-000125 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210513 FILED AS OF DATE: 20210514 DATE AS OF CHANGE: 20210514 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WELCH M SCOTT CENTRAL INDEX KEY: 0001189422 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03922 FILM NUMBER: 21927153 MAIL ADDRESS: STREET 1: 6 LONGWOOD COURT CITY: ELKHART STATE: IN ZIP: 46516 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PATRICK INDUSTRIES INC CENTRAL INDEX KEY: 0000076605 STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLE PARTS & ACCESSORIES [3714] IRS NUMBER: 351057796 STATE OF INCORPORATION: IN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 107 WEST FRANKLIN STREET PO BOX 638 CITY: ELKHART STATE: IN ZIP: 46515 BUSINESS PHONE: 574-294-7511 MAIL ADDRESS: STREET 1: 107 WEST FRANKLIN STREET PO BOX 638 CITY: ELKHART STATE: IN ZIP: 46515 4 1 wf-form4_162104253286930.xml FORM 4 X0306 4 2021-05-13 0 0000076605 PATRICK INDUSTRIES INC PATK 0001189422 WELCH M SCOTT 107 W. FRANKLIN ST ELKHART IN 46515 1 0 0 0 Common Stock 2021-05-13 4 A 0 1373 0 A 15066 D Common Stock 7899 I See footnote Common Stock 84000 I By Spouse Annual Director's Stock Grant awarded on May 13, 2021 and vesting on May 13, 2022. Reflects portion of the shares purchased through an entity that is controlled by the reporting person in which the reporting person has a pecuniary interest. The reporting person disclaims beneficial ownership of other shares purchased by the entity. /s/ M. Scott Welch by Jacob R. Petkovich, attorney-in-fact 2021-05-14