0001127602-19-024706.txt : 20190717 0001127602-19-024706.hdr.sgml : 20190717 20190717110650 ACCESSION NUMBER: 0001127602-19-024706 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190716 FILED AS OF DATE: 20190717 DATE AS OF CHANGE: 20190717 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McClone Dustin James CENTRAL INDEX KEY: 0001702968 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 19958441 MAIL ADDRESS: STREET 1: C/O NICOLET BANKSHARES, INC. STREET 2: 111 NORTH WASHINGTON STREET CITY: GREEN BAY STATE: WI ZIP: 54301 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NICOLET BANKSHARES INC CENTRAL INDEX KEY: 0001174850 STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021] IRS NUMBER: 000000000 STATE OF INCORPORATION: WI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 111 N WASHINGTON ST CITY: GREEN BAY STATE: WI ZIP: 54301 BUSINESS PHONE: 920 430 1400 MAIL ADDRESS: STREET 1: 111 N WASHINGTON ST CITY: GREEN BAY STATE: WI ZIP: 54301 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2019-07-16 0001174850 NICOLET BANKSHARES INC NCBS 0001702968 McClone Dustin James C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 1 Common Stock 2019-07-16 4 A 0 42 62.81 A 455 I By Nicolet National Bank Deferred Compensation Plan for Non-employee Directors Common Stock 657 D Common Stock 909 I By RMD Management Group, LLC Represents the holdings of RMD Management Group, LLC, of which the reporting person is a member. The reporting person disclaims beneficial ownership of registrant common stock held by RMD Management Group, LLC except to the extent of his pecuniary interest. /s/ Ann K. Lawson, as attorney-in-fact for Dustin J. McClone 2019-07-17