Statement of Changes in Beneficial Ownership (4)
November 15 2019 - 3:49PM
Edgar (US Regulatory)
FORM 4
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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. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Steppe Michael Joseph |
2. Issuer Name and Ticker or Trading Symbol
NICOLET BANKSHARES INC
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NCBS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CIO - Nicolet National Bank |
(Last)
(First)
(Middle)
C/O NICOLET NATIONAL BANK, 111 NORTH WASHINGTON STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/15/2019 |
(Street)
GREEN BAY, WI 54301
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 11/15/2019 | | M | | 5000 | A | $16.80 | 24800 | D | |
Common Stock | 11/15/2019 | | M | | 2600 | A | $16.50 | 27400 | D | |
Common Stock | | | | | | | | 2300 | I | By 401(k) Plan |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Right to Buy) | $16.80 | 11/15/2019 | | M | | | 5000 | (1) | 12/15/2019 | Common Stock | 5000 | $0 | 0 | D | |
Stock Option (Right to Buy) | $16.50 | 11/15/2019 | | M | | | 2600 | (2) | 4/10/2022 | Common Stock | 2600 | $0 | 2400 | D | |
Explanation of Responses: |
(1) | The stock option is fully exercised. The options vested in five annual installments of 1,000 shares annually on December 15 of each year, beginning on December 15, 2010 and fully vesting on December 15, 2014. |
(2) | The stock option is currently exercisable as to 1,400 shares. The options vest in ten annual installments of 500 shares annually on April 10 of each year, beginning on April 10, 2012 and fully vesting on April 10, 2021. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Steppe Michael Joseph C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY, WI 54301 |
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| CIO - Nicolet National Bank |
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Signatures
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/s/ Ann K. Lawson, as attorney-in-fact for Michael J. Steppe | | 11/15/2019 |
**Signature of Reporting Person | Date |
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