0001140361-11-058830.txt : 20111223 0001140361-11-058830.hdr.sgml : 20111223 20111223132925 ACCESSION NUMBER: 0001140361-11-058830 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111222 FILED AS OF DATE: 20111223 DATE AS OF CHANGE: 20111223 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: 111279883 MAIL ADDRESS: STREET 1: 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 X0304 4 2011-12-22 0 0000076605 PATRICK INDUSTRIES INC PATK 0001407402 Cleveland Todd M 107 W. FRANKLIN ST ELKHART IN 46515 1 1 0 0 President & CEO Common Stock 2011-12-22 4 P 0 200 3.55 A 317591 D Todd M. Cleveland by Andy L. Nemeth, attorney-in-fact 2011-12-23