0001127602-22-001687.txt : 20220120 0001127602-22-001687.hdr.sgml : 20220120 20220120152451 ACCESSION NUMBER: 0001127602-22-001687 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211020 FILED AS OF DATE: 20220120 DATE AS OF CHANGE: 20220120 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: 22542136 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 2021-10-20 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 2021-10-20 4 A 0 47 75.19 A 750 I By Nicolet National Bank Deferred Compensation Plan for Non-employee Directors Common Stock 2022-01-18 4 A 0 40 88.12 A 790 I By Nicolet National Bank Deferred Compensation Plan for Non-employee Directors Mr. McClone acquired 47 shares in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors by deferring his third quarter 2021 earned board fees. Mr. McClone acquired 40 shares in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors by deferring his fourth quarter 2021 earned board fees. /s/ H. Phillip Moore, Jr., as attorney-in-fact for Dustin J. McClone 2022-01-20