0001127602-24-016955.txt : 20240530 0001127602-24-016955.hdr.sgml : 20240530 20240530155921 ACCESSION NUMBER: 0001127602-24-016955 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240528 FILED AS OF DATE: 20240530 DATE AS OF CHANGE: 20240530 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TELLOCK GLEN E CENTRAL INDEX KEY: 0001205092 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 241005020 MAIL ADDRESS: STREET 1: 1725 SHEPHERD ROAD CITY: CHATTANOOGA STATE: TN ZIP: 37421 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NICOLET BANKSHARES INC CENTRAL INDEX KEY: 0001174850 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] ORGANIZATION NAME: 02 Finance 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 X0508 4 2024-05-28 0001174850 NICOLET BANKSHARES INC NIC 0001205092 TELLOCK GLEN E C/O NICOLET NATIONAL BANK 111 N. WASHINGTON STREET GREEN BAY WI 54301 1 0 Common Stock 2024-05-28 4 A 0 626 79.83 A 1524 D Common Stock 1000 I by Family Trust The Company paid Mr. Tellock the Board annual retainer, granted as a restricted stock award with an immediate full vest of 626 shares, as of May 28, 2024. /s/ H. Phillip Moore, Jr., as attorney-in-fact for Glen E. Tellock 2024-05-30