0001174850-21-000082.txt : 20211122 0001174850-21-000082.hdr.sgml : 20211122 20211122162928 ACCESSION NUMBER: 0001174850-21-000082 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211118 FILED AS OF DATE: 20211122 DATE AS OF CHANGE: 20211122 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: 211432900 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 primary_doc.xml PRIMARY DOCUMENT X0306 4 2021-11-18 0 0001174850 NICOLET BANKSHARES INC NCBS 0001666799 Madson Patrick Joseph C/O NICOLET BANKSHARES, INC. 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 0 1 0 0 SVP-Wealth Mgmt-NicoletNatBank Common Stock 2021-11-18 4 F 0 49 73.85 D 6797 D Shares withheld to satisfy tax obligation of vested restricted stock. Includes Mr. Madson's 488 shares owned in the Employee Stock Purchase Plan. Mr. Madson has not acquired additional shares under the Employee Stock Purchase Plan since his last Form 4 filing, November 15, 2021. /s/ H. Phillip Moore, Jr., as attorney-in-fact for Patrick Madson 2021-11-22