0000076605-21-000200.txt : 20211206
0000076605-21-000200.hdr.sgml : 20211206
20211206204930
ACCESSION NUMBER: 0000076605-21-000200
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211202
FILED AS OF DATE: 20211206
DATE AS OF CHANGE: 20211206
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Petkovich Jacob R
CENTRAL INDEX KEY: 0001834052
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-03922
FILM NUMBER: 211474487
MAIL ADDRESS:
STREET 1: 107 W. FRANKLIN STREET
STREET 2: PO BOX 638
CITY: ELKHART
STATE: IN
ZIP: 46515
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_163884175658096.xml
FORM 4
X0306
4
2021-12-02
0
0000076605
PATRICK INDUSTRIES INC
PATK
0001834052
Petkovich Jacob R
107 W. FRANKLIN STREET
ELKHART
IN
46515
0
1
0
0
EVP Finance, CFO & Treasurer
Common Stock
2021-12-02
4
M
0
10500
66.66
A
51121
D
Common Stock
2021-12-02
4
F
0
8871
84.83
D
42250
D
Common Stock Options
66.66
2021-12-02
4
M
0
10500
0
D
2021-05-14
2029-05-14
Common Stock
10500.0
19500
D
Reflects the date the stock options became fully exercisable.
/s/ Jacob R. Petkovich by Andy L. Nemeth, attorney-in-fact
2021-12-06