0001127602-21-022397.txt : 20210722
0001127602-21-022397.hdr.sgml : 20210722
20210722193930
ACCESSION NUMBER: 0001127602-21-022397
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210720
FILED AS OF DATE: 20210722
DATE AS OF CHANGE: 20210722
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: 211108735
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
2021-07-20
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
2021-07-20
4
A
0
43
68.79
A
703
I
By Nicolet National Bank Deferred Compensation Plan for Non-employee Directors
Common Stock
2244
D
Mr. McClone acquired 43 shares in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors by deferring his second quarter 2021 earned board fees.
/s/ H. Phillip Moore, Jr., as attorney-in-fact for Dustin J. McClone
2021-07-22