SEC Form 4 · accession 0001437749-16-039222
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
Sep 26, 2016
Accepted (ET)
Sep 28, 2016 · 9:13 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000076605
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Options | $61.43 | Sep 26, 2016 | A | 1,552 | A | Sep 26, 2017 | Sep 26, 2025 | Common Stock | 1,552 | 1,552 | D |
| Stock Options | $61.43 | Sep 26, 2016 | A | 1,552 | A | Sep 26, 2018 | Sep 26, 2025 | Common Stock | 1,552 | 3,104 | D |
| Stock Options | $61.43 | Sep 26, 2016 | A | 1,552 | A | Sep 26, 2019 | Sep 26, 2025 | Common Stock | 1,552 | 4,656 | D |
| Stock Options | $61.43 | Sep 26, 2016 | A | 1,552 | A | Sep 26, 2020 | Sep 26, 2025 | Common Stock | 1,552 | 6,208 | D |
| Stock Appreciation Rights | $61.43 | Sep 26, 2016 | A | 388 | A | Sep 26, 2017 | Sep 26, 2025 | Common Stock | 388 | 388 | D |
| Stock Appreciation Rights | $61.43 | Sep 26, 2016 | A | 388 | A | Sep 26, 2018 | Sep 26, 2025 | Common Stock | 388 | 776 | D |
| Stock Appreciation Rights | $61.43 | Sep 26, 2016 | A | 388 | A | Sep 26, 2019 | Sep 26, 2025 | Common Stock | 388 | 1,164 | D |
| Stock Appreciation Rights | $61.43 | Sep 26, 2016 | A | 388 | A | Sep 26, 2020 | Sep 26, 2025 | Common Stock | 388 | 1,552 | D |
| Stock Appreciation Rights | $71.26 | Sep 26, 2016 | A | 388 | A | Sep 26, 2017 | Sep 26, 2025 | Common Stock | 388 | 388 | D |
| Stock Appreciation Rights | $71.26 | Sep 26, 2016 | A | 388 | A | Sep 26, 2018 | Sep 26, 2025 | Common Stock | 388 | 776 | D |
| Stock Appreciation Rights | $71.26 | Sep 26, 2016 | A | 388 | A | Sep 26, 2019 | Sep 26, 2025 | Common Stock | 388 | 1,164 | D |
| Stock Appreciation Rights | $71.26 | Sep 26, 2016 | A | 388 | A | Sep 26, 2020 | Sep 26, 2025 | Common Stock | 388 | 1,552 | D |
| Stock Appreciation Rights | $82.66 | Sep 26, 2016 | A | 388 | A | Sep 26, 2017 | Sep 26, 2025 | Common Stock | 388 | 388 | D |
| Stock Appreciation Rights | $82.66 | Sep 26, 2016 | A | 388 | A | Sep 26, 2018 | Sep 26, 2025 | Common Stock | 388 | 776 | D |
| Stock Appreciation Rights | $82.66 | Sep 26, 2016 | A | 388 | A | Sep 26, 2019 | Sep 26, 2025 | Common Stock | 388 | 1,164 | D |
| Stock Appreciation Rights | $82.66 | Sep 26, 2016 | A | 388 | A | Sep 26, 2020 | Sep 26, 2025 | Common Stock | 388 | 1,552 | D |
| Stock Appreciation Rights | $95.89 | Sep 26, 2016 | A | 388 | A | Sep 26, 2017 | Sep 26, 2025 | Common Stock | 388 | 388 | D |
| Stock Appreciation Rights | $95.89 | Sep 26, 2016 | A | 388 | A | Sep 26, 2018 | Sep 26, 2025 | Common Stock | 388 | 776 | D |
| Stock Appreciation Rights | $95.89 | Sep 26, 2016 | A | 388 | A | Sep 26, 2019 | Sep 26, 2025 | Common Stock | 388 | 1,164 | D |
| Stock Appreciation Rights | $95.89 | Sep 26, 2016 | A | 388 | A | Sep 26, 2020 | Sep 26, 2025 | Common Stock | 388 | 1,552 | D |