0001127602-22-015068.txt : 20220519 0001127602-22-015068.hdr.sgml : 20220519 20220519133250 ACCESSION NUMBER: 0001127602-22-015068 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220517 FILED AS OF DATE: 20220519 DATE AS OF CHANGE: 20220519 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tobias Paul Davison CENTRAL INDEX KEY: 0001312334 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37700 FILM NUMBER: 22942040 MAIL ADDRESS: STREET 1: 38710 WOODWARD AVENUE STREET 2: SUITE 240 CITY: BLOOMFIELD HILLS STATE: MI ZIP: 48304 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 2022-05-17 0001174850 NICOLET BANKSHARES INC NCBS 0001312334 Tobias Paul Davison C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY WI 54301 1 Common Stock 2022-05-17 4 A 0 648 77.06 A 23930 D The Company paid Mr. Tobias the Board annual retainer, granted as a restricted stock award with an immediate full vest of 648 shares, as of May 17, 2022. /s/ H. Phillip Moore, Jr., attorney-in-fact for Paul D. Tobias 2022-05-19