0001127602-21-008067.txt : 20210226 0001127602-21-008067.hdr.sgml : 20210226 20210226155935 ACCESSION NUMBER: 0001127602-21-008067 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210226 FILED AS OF DATE: 20210226 DATE AS OF CHANGE: 20210226 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: 21688498 MAIL ADDRESS: STREET 1: C/O NICOLET BANKSHARES, INC. STREET 2: 111 NORTH WASHINGTON STREET CITY: GREEN BAY STATE: WI ZIP: 54301 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 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2021-02-26 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 2021-02-26 5 G 0 E 20 0 D 6886 D Common Stock 2021-02-26 5 G 0 E 20 0 A 20 I Daughter's UGMA/UTMA Account Common Stock 2021-02-26 5 G 0 E 20 0 D 6866 D Common Stock 2021-02-26 5 G 0 E 20 0 A 20 I Son's UGMA/UTMA Account Common Stock 2021-02-26 5 G 0 E 20 0 D 6846 D Common Stock 2021-02-26 5 G 0 E 20 0 A 20 I Daughter's UGMA/UTMA Account Common Stock 2021-02-26 5 G 0 E 10 0 D 6836 D Common Stock 2021-02-26 5 G 0 E 10 0 A 20 I Son's UGMA/UTMA Account Includes 409 total shares owned in the Employee Stock Purchase Plan. No additional shares have been acquired under the Employee Stock Purchase Plan since the reporting person's last Form 4 filing on February 24, 2021. /s/ Ann K. Lawson, attorney-in-fact for Patrick Madson 2021-02-26