SEC Form 4 · accession 0000076605-17-000012
PATRICK INDUSTRIES INC · PATK
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Courtney Blosser
Officer — Chief Human Resource Officer
Period of report
Jan 17, 2017
Accepted (ET)
Jan 19, 2017 · 9:09 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000076605
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 17, 2017 | A | 500 | $0.00 | A | 23,576 | D | |
| Common StockF2 | Jan 17, 2017 | A | 3,000 | $0.00 | A | 26,576 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options | $80.75 | Jan 17, 2017 | A | 1,658 | A | Jan 17, 2018 | Jan 17, 2026 | Common Stock | 1,658 | 1,658 | D |
| Stock Options | $80.75 | Jan 17, 2017 | A | 1,657 | A | Jan 17, 2019 | Jan 17, 2026 | Common Stock | 1,657 | 3,315 | D |
| Stock Options | $80.75 | Jan 17, 2017 | A | 1,658 | A | Jan 17, 2020 | Jan 17, 2026 | Common Stock | 1,658 | 4,973 | D |
| Stock Options | $80.75 | Jan 17, 2017 | A | 1,657 | A | Jan 17, 2021 | Jan 17, 2026 | Common Stock | 1,657 | 6,630 | D |
| Stock Appreciation Rights | $80.75 | Jan 17, 2017 | A | 414 | A | Jan 17, 2018 | Jan 17, 2026 | Common Stock | 414 | 414 | D |
| Stock Appreciation Rights | $80.75 | Jan 17, 2017 | A | 415 | A | Jan 17, 2019 | Jan 17, 2026 | Common Stock | 415 | 829 | D |
| Stock Appreciation Rights | $80.75 | Jan 17, 2017 | A | 414 | A | Jan 17, 2020 | Jan 17, 2026 | Common Stock | 414 | 1,243 | D |
| Stock Options | $80.75 | Jan 17, 2017 | A | 415 | A | Jan 17, 2021 | Jan 17, 2026 | Common Stock | 415 | 1,658 | D |
| Stock Appreciation Rights | $90.04 | Jan 17, 2017 | A | 414 | A | Jan 17, 2018 | Jan 17, 2026 | Common Stock | 414 | 414 | D |
| Stock Appreciation Rights | $90.04 | Jan 17, 2017 | A | 415 | A | Jan 17, 2019 | Jan 17, 2026 | Common Stock | 415 | 829 | D |
| Stock Appreciation Rights | $90.04 | Jan 17, 2017 | A | 414 | A | Jan 17, 2020 | Jan 17, 2026 | Common Stock | 414 | 1,243 | D |
| Stock Appreciation Rights | $90.04 | Jan 17, 2017 | A | 415 | A | Jan 17, 2021 | Jan 17, 2026 | Common Stock | 415 | 1,658 | D |
| Stock Appreciation Rights | $100.39 | Jan 17, 2017 | A | 414 | A | Jan 17, 2018 | Jan 17, 2026 | Common Stock | 414 | 414 | D |
| Stock Appreciation Rights | $100.39 | Jan 17, 2017 | A | 415 | A | Jan 17, 2019 | Jan 17, 2026 | Common Stock | 415 | 829 | D |
| Stock Appreciation Rights | $100.39 | Jan 17, 2017 | A | 414 | A | Jan 17, 2020 | Jan 17, 2026 | Common Stock | 414 | 1,243 | D |
| Stock Appreciation Rights | $100.39 | Jan 17, 2017 | A | 415 | A | Jan 17, 2021 | Jan 17, 2026 | Common Stock | 415 | 1,658 | D |
| Stock Appreciation Rights | $111.94 | Jan 17, 2017 | A | 414 | A | Jan 17, 2018 | Jan 17, 2026 | Common Stock | 414 | 414 | D |
| Stock Appreciation Rights | $111.94 | Jan 17, 2017 | A | 415 | A | Jan 17, 2019 | Jan 17, 2026 | Common Stock | 415 | 829 | D |
| Stock Appreciation Rights | $111.94 | Jan 17, 2017 | A | 414 | A | Jan 17, 2020 | Jan 17, 2026 | Common Stock | 414 | 1,243 | D |
| Stock Appreciation Rights | $111.94 | Jan 17, 2017 | A | 415 | A | Jan 17, 2021 | Jan 17, 2026 | Common Stock | 415 | 1,658 | D |
Explanation of responses
- F1Annual Management Grant awarded 01/17/2017 and vesting on 01/17/2020.
- F2Shares are performance-based and vest after three years upon achievement of target Company objectives.