0001127602-22-022443.txt : 20220915 0001127602-22-022443.hdr.sgml : 20220915 20220915130317 ACCESSION NUMBER: 0001127602-22-022443 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220826 FILED AS OF DATE: 20220915 DATE AS OF CHANGE: 20220915 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JOHNSON BRENDA L CENTRAL INDEX KEY: 0001942061 FILING VALUES: FORM TYPE: 3/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 221245333 MAIL ADDRESS: STREET 1: C/O NICOLET BANKSHARES, INC. STREET 2: 111 N. 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 3/A 1 form3a.xml PRIMARY DOCUMENT X0206 3/A 2022-08-26 2022-08-30 0 0001174850 NICOLET BANKSHARES INC NIC 0001942061 JOHNSON BRENDA L C/O NICOLET NATIONAL BANK 111 N. WASHINGTON STREET GREEN BAY WI 54301 1 Common Stock 30906 D This report on Form 3/A amends the original Form 3 filed by Ms. Johnson on August 30, 2022. These shares were omitted from Ms. Johnson's original Form 3, and omitted from one Form 4 filing on August 30, 2022 related to the merger consideration Ms. Johnson received after the original Form 3 was filed. This Form 3/A report is being filed to correct Ms. Johnson's Nicolet Bankshares, Inc. direct beneficial ownership total prior to the Charter Bankshares, Inc. and Nicolet Bankshares, Inc. merger, effective August 26, 2022. Ms. Johnson's total beneficial ownership in Nicolet Bankshares, Inc. as of the date of this report is 669,965 shares. /s/ H. Phillip Moore, Jr., as attorney-in-fact for Brenda L. Johnson 2022-09-15