Sec Form 4 Filing - SHANFELTER AUSTIN J @ Patriot National, Inc. - 2015-11-20

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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1. Name and Address of Reporting Person
SHANFELTER AUSTIN J
2. Issuer Name and Ticker or Trading Symbol
Patriot National, Inc. [ PN]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O PATRIOT NATIONAL, INC., 401 E. LAS OLAS BLVD., SUITE 1650
3. Date of Earliest Transaction (MM/DD/YY)
11/20/2015
(Street)
FORT LAUDERDALE, FL33301
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/20/2015 M( 1 )( 2 ) 618,478 A 885,478 I By LLC
Common Stock 11/20/2015 D( 1 )( 2 ) 309,239 D 576,239 I By LLC
Common Stock 02/24/2016 A( 3 ) 11,456 A $ 0 27,999 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Deferred Consideration ( 2 ) 11/20/2015 M( 1 )( 2 ) 618,478 ( 2 ) ( 2 ) Common Stock 618,478 ( 1 ) ( 2 ) 0 I By LLC
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
SHANFELTER AUSTIN J
C/O PATRIOT NATIONAL, INC.
401 E. LAS OLAS BLVD., SUITE 1650
FORT LAUDERDALE, FL33301
X
Signatures
By: /s/ Christopher A. Pesch, by power of attorney 02/26/2016
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Pursuant to a purchase agreement dated July 20, 2015, by and among Patriot National, Inc. (the "Issuer") and the other parties thereto, as amended (the "Purchase Agreement"), the Issuer purchased all of the membership interests of Global HR Research, LLC ("Global"). The purchase closed on August 21, 2015. In connection with the purchase, a limited liability company controlled by the Reporting Person (the "LLC") received in exchange for its membership interests in Global: (a) cash, (b) 267,000 shares of Issuer common stock, and (c) the Deferred Consideration (as defined below). The shares issued were based on the closing price of the Issuer's shares on July 20, 2015, which was $16.94 per share.
( 2 )The "Deferred Consideration" described above payable to the LLC consisted of, to be determined in the Issuer's sole discretion, 618,478 shares of Issuer common stock or $10,477,017 in cash. The Deferred Compensation became payable on November 20, 2015. The Issuer paid the Reporting Person 309,239 shares of Common Stock and $5,238,508.50.
( 3 )Award of restricted stock that vests in full on August 24, 2016.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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