0000076605-22-000003.txt : 20220104 0000076605-22-000003.hdr.sgml : 20220104 20220104213452 ACCESSION NUMBER: 0000076605-22-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211227 FILED AS OF DATE: 20220104 DATE AS OF CHANGE: 20220104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cleveland Todd M CENTRAL INDEX KEY: 0001407402 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03922 FILM NUMBER: 22509160 MAIL ADDRESS: STREET 1: 107 W. FRANKLIN ST. 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_164135006479806.xml FORM 4 X0306 4 2021-12-27 0 0000076605 PATRICK INDUSTRIES INC PATK 0001407402 Cleveland Todd M 107 W. FRANKLIN ST ELKHART IN 46515 1 1 0 0 Executive Board Chairman Common Stock 2021-12-27 4 G 0 6500 0 D 265431 D Common Stock 2021-12-31 4 F 0 11474 80.69 D 253957 D Common Stock 182237 I Consists of shares held by family members and shares held in a limited liability corporation Represents shares of common stock gifted by the reporting person. Represents total shares in the aggregate of common stock returned to the Company to satisfy the tax withholding obligation associated with the vesting as of December 31, 2021 of time-based stock grants initially awarded in January 2019, January 2020, and January 2021. /s/ Todd M. Cleveland by Jacob R. Petkovich, Attorney-in-fact 2022-01-04