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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Options | $ 18.45 | 03/30/2016 | M | 15,000 | (4) | 12/18/2022(4) | Common Stock | 15,000 | $ 0 | 185,000 | D | ||||
Stock Appreciation Rights (5) | $ 18.45 | 03/30/2016 | M | 25,000 | (6) | 12/18/2022 | Common Stock | 25,000 | $ 0 | 24,999 | D | ||||
Stock Appreciation Rights (5) | $ 22.13 | 03/30/2016 | M | 25,000 | (6) | 12/18/2022 | Common Stock | 25,000 | $ 0 | 24,999 | D | ||||
Stock Appreciation Rights (5) | $ 26.56 | 03/30/2016 | M | 25,000 | (6) | 12/18/2022 | Common Stock | 25,000 | $ 0 | 24,999 | D | ||||
Stock Appreciation Rights (5) | $ 31.87 | 03/30/2016 | M | 25,000 | (6) | 12/18/2022 | Common Stock | 25,000 | $ 0 | 24,999 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Cleveland Todd M 107 W. FRANKLIN ST ELKHART, IN 46515 |
X | CEO |
/s/ Todd M. Cleveland by Joshua A. Boone, attorney-in-fact | 04/01/2016 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the Reporting Person on March 11, 2016. |
(2) | The price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $48.25 to $48.50, inclusive. The reporting person undertakes to provide to Patrick Industries, Inc., any security holder of Patrick Industries, Inc., or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the price range set forth in this footnote. |
(3) | Reflects exercise of the stock appreciation rights reported on Table II of this Form 4. |
(4) | Common stock options granted on December 18, 2013, of which 100,000 option awards vested on December 18, 2014 and 100,000 option awards vested on December 18, 2015. The remaining options will vest on December 18, 2016. |
(5) | Reflects stock appreciation rights that were granted on December 18, 2013. |
(6) | The stock appreciation rights exercised on March 30, 2016 became exercisable on December 18, 2015 and 24,999 additional stock appreciation rights will become exercisable on December 18, 2016. |