0001127602-16-050785.txt : 20160503 0001127602-16-050785.hdr.sgml : 20160503 20160503160702 ACCESSION NUMBER: 0001127602-16-050785 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160429 FILED AS OF DATE: 20160503 DATE AS OF CHANGE: 20160503 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NICOLET BANKSHARES INC CENTRAL INDEX KEY: 0001174850 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 000000000 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 111 N WASHINGTON ST CITY: GREEN BAY STATE: WI ZIP: 54301 BUSINESS PHONE: 920 430 1400 MAIL ADDRESS: STREET 1: 111 N WASHINGTON ST CITY: GREEN BAY STATE: WI ZIP: 54301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Radzak Eric Peter CENTRAL INDEX KEY: 0001664661 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 161615484 MAIL ADDRESS: STREET 1: C/O NICOLET BANKSHARES, INC. STREET 2: 111 NORTH WASHINGTON STREET CITY: GREEN BAY STATE: WI ZIP: 54301 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2016-04-29 0001174850 NICOLET BANKSHARES INC NCBS 0001664661 Radzak Eric Peter C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 1 Corp Dev Off Nicolet Nat Bank Common Stock 2016-04-29 4 A 0 451 A 451 D Acquired in connection with the Baylake Corp., and Nicolet Bankshares, Inc. merger, effective April 29, 2016. /s/ Ann K. Lawson, as attorney-in-fact for Eric P. Radzak 2016-05-03