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