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