Statement of Changes in Beneficial Ownership (4)
February 24 2021 - 2:17PM
Edgar (US Regulatory)
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
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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
*
Lawson Ann Kuchera |
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) Chief Financial Officer |
(Last)
(First)
(Middle)
C/O NICOLET NATIONAL BANK, 111 NORTH WASHINGTON STREET |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/23/2021 |
(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 | 2/23/2021 | | M | | 2800 | A | $37.18 | 31947 | D | |
Common Stock | 2/23/2021 | | F | | 1826 | D | $76.14 | 30121 | D | |
Common Stock | 2/23/2021 | | M | | 5000 | A | $48.85 | 35121 | D | |
Common Stock | 2/23/2021 | | F | | 3781 | D | $76.14 | 31340 | D | |
Common Stock | 2/23/2021 | | S | | 2193 | D | $76.14 | 29147 (1) | D | |
Common Stock | | | | | | | | 800 | 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) | $37.18 | 2/23/2021 | | M | | | 2800 | (2) | 9/20/2026 | Common Stock | 2800 | $0 | 2000 | D | |
Stock Option (Right to Buy) | $48.85 | 2/23/2021 | | M | | | 5000 | (3) | 5/16/2027 | Common Stock | 5000 | $0 | 49000 | D | |
Explanation of Responses: |
(1) | Includes 11 additional shares acquired under the Employee Stock Purchase Plan since the reporting person's last Form 4 filing on December 9, 2020. The reporting person owns a total of 122 shares in the Employee Stock Purchase Plan as of the date of this report. |
(2) | The remaining nonqualified options outstanding will become exercisable as of September 20, 2021. The nonqualified options grant of 10,000 shares will vest in five annual installments of 2,000 shares annually on September 20 of each year, beginning on September 20, 2017 and fully vests on September 20, 2021. |
(3) | The nonqualified options are currently exercisable to 27,400 shares. The nonqualified options grant of 54,000 shares will vest in five annual installments of 10,800 shares annually on May 16 of each year, beginning on May 16, 2018 and fully vests on May 16, 2022. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lawson Ann Kuchera C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY, WI 54301 |
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| Chief Financial Officer |
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Signatures
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/s/ Ann K. Lawson | | 2/24/2021 |
**Signature of Reporting Person | Date |
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