Statement of Changes in Beneficial Ownership (4)

Date : 11/20/2019 @ 9:59PM
Source : Edgar (US Regulatory)
Stock : Nicolet Bankshares Inc (NCBS)
Quote : 74.37  1.15 (1.57%) @ 8:59PM
After Hours
Last Trade
Last $ 74.37 ◊ 0.00 (0.00%)

Statement of Changes in Beneficial Ownership (4)

FORM 4 [ ] 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
                                                                                  
OMB APPROVAL
OMB Number: 3235-0287
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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
                      

1. Name and Address of Reporting Person *

Hutjens Brad Vincent
2. Issuer Name and Ticker or Trading Symbol

NICOLET BANKSHARES INC [ NCBS ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                    _____ 10% Owner
__X__ Officer (give title below)    _____ Other (specify below)
EVP - CCO - Nicolet Natl Bank
(Last)          (First)          (Middle)

C/O NICOLET NATIONAL BANK, 111 NORTH WASHINGTON STREET
3. Date of Earliest Transaction (MM/DD/YYYY)

11/18/2019
(Street)

GREEN BAY, WI 54301
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/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
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/18/2019  A  564 A$70.50 16378 (1)D  
Common Stock         1818 I By 401(k) Plan 

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security3. Trans. Date3A. Deemed Execution Date, if any4. 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 Date7. 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)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Stock Option (Right to Buy) $70.50 11/18/2019  A   25000     (2)11/18/2029 Common Stock 25000 $70.50 25000 D  

Explanation of Responses:
(1) Includes 44 shares acquired under the Employee Stock Purchase Plan to date.
(2) The nonqualified options vest in five annual installments of 5,000 shares on November 18 of each year, beginning on November 18, 2020 and will fully vest on November 18, 2024.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Hutjens Brad Vincent
C/O NICOLET NATIONAL BANK
111 NORTH WASHINGTON STREET
GREEN BAY, WI 54301


EVP - CCO - Nicolet Natl Bank

Signatures
/s/ Ann K. Lawson, as attorney-in-fact for Brad V. Hutjens11/20/2019
**Signature of Reporting PersonDate

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