SEC Form 5 · accession 0001209191-16-098800
Patriot National, Inc. · PN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steven M. Mariano
Officer — See Remarks · Director · 10% Owner
Period of report
Dec 31, 2015
Accepted (ET)
Feb 16, 2016 · 4:59 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001619917
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Aug 20, 2015 | P | 8,914 | $15.38 | A | 1,316,312 | I | By Steven M. Mariano Trust |
| Common Stock | Aug 26, 2015 | P | 100 | $16.00 | A | 1,316,412 | I | By Steven M. Mariano Trust |
| Common StockF2 | Aug 31, 2015 | P | 1,942 | $16.25 | A | 1,318,356 | I | By Steven M. Mariano Trust |
| Common Stock | holding | — | — | — | 12,066,175 | D | ||
| Common Stock | holding | — | — | — | 1,014,607 | I | By corporation |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $15.29 to $15.40, inclusive. The reporting person undertakes to provide to Patriot National, Inc., any security holder of Patriot National, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote.
- F2An audit of Mr. Mariano's trust account revealed the Form 3 filed on January 15, 2015 under-reported his ownership by two (2) shares. These shares have been added to correctly reflect his total indirect ownership through his trust.
Remarks
President and Chief Executive Officer. The Reporting Person disclaims beneficial ownership of the securities reported herein as indirectly beneficially owned, except to the extent of his pecuniary interest therein. The filing of this Form 5 shall not be deemed to be an admission that the Reporting Person is the beneficial owner of any of the securities reported herein for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise.