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