0001127602-21-029248.txt : 20211115
0001127602-21-029248.hdr.sgml : 20211115
20211115210741
ACCESSION NUMBER: 0001127602-21-029248
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211112
FILED AS OF DATE: 20211115
DATE AS OF CHANGE: 20211115
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: 211413817
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
2021-11-12
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
2021-11-12
4
F
0
69
74.88
D
6846
D
Shares withheld to satisfy tax obligation of vested restricted stock.
Includes an additional 45 shares acquired under the Employee Stock Purchase Plan since the reporting person's last Form 4 filing on June 10, 2021. The reporting person owns a total of 488 shares in the Employee Stock Purchase Plan as of the date of this report.
/s/ H. Phillip Moore, Jr., attorney-in-fact for Patrick Madson
2021-11-15