Nicolet Bankshares : Statement of Changes in Beneficial Ownership (Form 4)
11/24/2021 | 01:10pm EST
Check this box if no longer subject to Section 16, Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person *
DANIELS MICHAEL E
2. Issuer Name and Ticker or Trading Symbol
NICOLET BANKSHARES INC [NCBS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
President & CEO /
C/O NICOLET NATIONAL BANK , 111 NORTH WASHINGTON STREET
3. Date of Earliest Transaction (Month/Day/Year)
4. If Amendment, Date Original Filed(Month/Day/Year)
6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
2. Transaction Date (Month/Day/Year)
2A. Deemed Execution Date, if any (Month/Day/Year)
3. Transaction Code
4. Securities Acquired (A) or Disposed of (D)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
2. Conversion or Exercise Price of Derivative Security
3. Transaction Date (Month/Day/Year)
3A. Deemed Execution Date, if any (Month/Day/Year)
4. Transaction Code
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
6. Date Exercisable and Expiration Date
7. Title and Amount of Securities Underlying Derivative Security
8. Price of Derivative Security
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
11. Nature of Indirect Beneficial Ownership
Amount or Number of Shares
Reporting Owner Name / Address
DANIELS MICHAEL E
C/O NICOLET NATIONAL BANK
111 NORTH WASHINGTON STREET
GREEN BAY, WI54301
President & CEO
/s/ H. Phillip Moore Jr., as attorney-in-fact for Michael E. Daniels
**Signature of Reporting Person
Explanation of Responses:
If the form is filed by more than one reporting person, see Instruction 5(b)(v).
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Restricted shares awarded November 22, 2021. Awarded shares will vest as follows: 1/3 immediate, 1/3 on November 22, 2022, and 1/3 on November 22, 2023.
Shares withheld to satisfy the tax obligation of restricted stock vesting.
Includes Mr. Daniels 491 shares owned in the Employee Stock Purchase Plan. Mr. Daniels has not acquired additional shares under the Employee Stock Purchase Plan since his previous Form 4 filing, November 22, 2021.
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
Nicolet Bankshares Inc. published this content on 24 November 2021 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 24 November 2021 18:09:04 UTC.