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