0000076605-22-000029.txt : 20220131
0000076605-22-000029.hdr.sgml : 20220131
20220131211128
ACCESSION NUMBER: 0000076605-22-000029
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220125
FILED AS OF DATE: 20220131
DATE AS OF CHANGE: 20220131
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cleveland Todd M
CENTRAL INDEX KEY: 0001407402
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-03922
FILM NUMBER: 22576497
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/A
1
wf-form4a_164368147120612.xml
FORM 4/A
X0306
4/A
2022-01-25
2022-01-27
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
2022-01-25
4
J
0
33333
0
A
230517
D
Common Stock
182237
I
Consists of shares held by family members and shares held in a limited liability corporation
Reflects an adjustment to the number of shares that the reporting owner is entitled to upon vesting in January 2022 of a performance-based grant originally awarded in January 2019.
/s/ Todd M. Cleveland by Jacob R. Petkovich, Attorney-in-fact
2022-01-31