0001140361-11-033771.txt : 20110622 0001140361-11-033771.hdr.sgml : 20110622 20110622113056 ACCESSION NUMBER: 0001140361-11-033771 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110622 FILED AS OF DATE: 20110622 DATE AS OF CHANGE: 20110622 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blosser Courtney CENTRAL INDEX KEY: 0001491924 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03922 FILM NUMBER: 11925090 MAIL ADDRESS: STREET 1: 107 W. FRANKLIN STREET STREET 2: P.O.BOX 638 CITY: ELKHART STATE: IN ZIP: 46515 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PATRICK INDUSTRIES INC CENTRAL INDEX KEY: 0000076605 STANDARD INDUSTRIAL CLASSIFICATION: MILLWOOD, VENEER, PLYWOOD & STRUCTURAL WOOD MEMBERS [2430] 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: 574-206-7515 MAIL ADDRESS: STREET 1: 107 WEST FRANKLIN STREET PO BOX 638 CITY: ELKHART STATE: IN ZIP: 46515 4 1 doc1.xml FORM 4 X0303 4 2011-06-22 0 0000076605 PATRICK INDUSTRIES INC PATK 0001491924 Blosser Courtney 107 W. FRANKLIN ST ELKHART IN 46515 0 1 0 0 VP Human Resources Common Stock 2011-06-22 4 P 0 400 2.06 A 41900 D Courtney Blosser by Andy L. Nemeth, attorney-in-fact 2011-06-22