0000076605-21-000206.txt : 20211208 0000076605-21-000206.hdr.sgml : 20211208 20211208213548 ACCESSION NUMBER: 0000076605-21-000206 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211203 FILED AS OF DATE: 20211208 DATE AS OF CHANGE: 20211208 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: 211480124 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_163901733282063.xml FORM 4 X0306 4 2021-12-03 0 0000076605 PATRICK INDUSTRIES INC PATK 0001189422 WELCH M SCOTT 107 W. FRANKLIN ST ELKHART IN 46515 1 0 0 0 Common Stock 15066 D Common Stock 84000 I By Spouse Common Stock 2021-12-03 4 G 0 177 0 D 7722 I See footnote Reflects portion of the shares gifted 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 held by the entity. Reflects portion of the shares held 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 held by the entity. /s/ M. Scott Welch by Jacob R. Petkovich, attorney-in-fact 2021-12-08