0000076605-22-000135.txt : 20221114 0000076605-22-000135.hdr.sgml : 20221114 20221114210708 ACCESSION NUMBER: 0000076605-22-000135 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221110 FILED AS OF DATE: 20221114 DATE AS OF CHANGE: 20221114 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: 221389010 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_166847798497906.xml FORM 4 X0306 4 2022-11-10 0 0000076605 PATRICK INDUSTRIES INC PATK 0001189422 WELCH M SCOTT 107 W. FRANKLIN ST ELKHART IN 46515 1 0 0 0 Put Option (obligation to buy) 50.0 2022-11-10 4 S 0 10 5 D 2022-11-10 2023-05-19 Common Stock 1000.0 10 I See footnote Put Option (obligation to buy) 50.0 2022-11-10 4 S 0 90 5.01 D 2022-11-10 2023-05-19 Common Stock 9000.0 90 I See footnote Put Option (obligation to buy) 50.0 2022-11-10 4 S 0 50 5.10 D 2022-11-10 2023-05-19 Common Stock 5000.0 50 I See footnote Reflects derivative securities of the Issuer held through entities that are controlled by the reporting person. The reporting person disclaims beneficial ownership of the derivative securities held by these entities except to the extent of his pecuniary interest. /s/ M. Scott Welch by Jacob R. Petkovich, attorney-in-fact 2022-11-14