0001127602-21-017626.txt : 20210520 0001127602-21-017626.hdr.sgml : 20210520 20210520165853 ACCESSION NUMBER: 0001127602-21-017626 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210518 FILED AS OF DATE: 20210520 DATE AS OF CHANGE: 20210520 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McClone Dustin James CENTRAL INDEX KEY: 0001702968 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 21945218 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 2021-05-18 0001174850 NICOLET BANKSHARES INC NCBS 0001702968 McClone Dustin James C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 1 Common Stock 2021-05-18 4 A 0 642 77.82 A 2244 D Common Stock 660 I By Nicolet National Bank Deferred Compensation Plan for Non-employee Directors /s/ Ann K. Lawson, as attorney-in-fact for Dustin J. McClone 2021-05-20