0001127602-17-004676.txt : 20170208 0001127602-17-004676.hdr.sgml : 20170208 20170208193625 ACCESSION NUMBER: 0001127602-17-004676 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170206 FILED AS OF DATE: 20170208 DATE AS OF CHANGE: 20170208 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: Madson Patrick Joseph CENTRAL INDEX KEY: 0001666799 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 17584044 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 2017-02-06 0001174850 NICOLET BANKSHARES INC NCBS 0001666799 Madson Patrick Joseph C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 1 SVP-Wealth Mgmt-NicoletNatBank Common Stock 2017-02-06 4 F 0 1161 48.50 D 35002 D Received in exchange for the Issuer's purchase of brokerage books of business. /s/ Ann K. Lawson, attorney-in-fact for Patrick Madson 2017-02-08