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