0001127602-21-020823.txt : 20210629
0001127602-21-020823.hdr.sgml : 20210629
20210629181348
ACCESSION NUMBER: 0001127602-21-020823
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210625
FILED AS OF DATE: 20210629
DATE AS OF CHANGE: 20210629
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lawson Ann Kuchera
CENTRAL INDEX KEY: 0001664666
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37700
FILM NUMBER: 211059513
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
2021-06-25
0001174850
NICOLET BANKSHARES INC
NCBS
0001664666
Lawson Ann Kuchera
C/O NICOLET NATIONAL BANK
111 NORTH WASHINGTON STREET
GREEN BAY
WI
54301
1
Common Stock
2021-06-25
4
D
0
165
0
D
31737
D
Common Stock
2021-06-25
4
D
0
206
0
D
31531
D
Common Stock
800
I
By 401(k) Plan
Forfeit of unvested restricted stock upon retirement of the Former CFO. The restricted stock was originally granted April 10, 2012, with a ten year annual vesting schedule and fully vested as of April 10, 2022.
Forfeit of unvested restricted stock upon retirement of the Former CFO. The restricted stock was originally granted November 18, 2019, with a one-third immediate vest, and annually thereafter on November 18, becoming fully vested November 18, 2021.
/s/ H. Phillip Moore, Jr., attorney-in-fact for Ann K. Lawson
2021-06-29