Amended Statement of Changes in Beneficial Ownership (4/a)

Date : 05/22/2019 @ 7:40PM
Source : Edgar (US Regulatory)
Stock : Nicolet Bankshares Inc. (NCBS)
Quote : 61.205  -0.605 (-0.98%) @ 8:40PM

Amended Statement of Changes in Beneficial Ownership (4/a)

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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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 *

ATWELL ROBERT BRUCE
2. Issuer Name and Ticker or Trading Symbol

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

__ X __ Director                      _____ 10% Owner
__ X __ Officer (give title below)      _____ Other (specify below)
Chairman, President & CEO
(Last)          (First)          (Middle)

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

2/7/2019
(Street)

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

2/8/2019 
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   2/7/2019     M    3312   A $23.80   40366   (1) D    
Common Stock                  12565   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 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)   $23.80   2/7/2019     M         3312      (2) 10/28/2024   Common Stock   3312   (3) $0   47500   D    

Explanation of Responses:
(1)  Includes 57 shares acquired under the Employee Stock Purchase Plan.
(2)  The stock option is currently exercisable as to 34,000 shares. The options vest in five annual installments of 13,500 shares annually on October 28 of each year, beginning on October 28, 2015 and fully vesting on October 28, 2019.
(3)  The reporting person exercised and sold 3,312 shares of Nicolet Bankshares, Inc. common stock through a broker-assisted cashless stock option exercise transaction on February 7, 2019. The original Form 4 filed on February 8, 2019 omitted the exercise of 3,312 shares, therefore the holdings were understated by 3,312 shares.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
ATWELL ROBERT BRUCE
C/O NICOLET NATIONAL BANK
111 NORTH WASHINGTON STREET
GREEN BAY, WI 54301
X
Chairman, President & CEO

Signatures
/s/ Ann K. Lawson, as attorney-in-fact for Robert B. Atwell 5/22/2019
** Signature of Reporting Person Date


Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

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