| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
NICOLET BANKSHARES INC [ NIC ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 01/17/2023 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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 | 01/17/2023 | A | 81(1) | A | $80.3 | 8,534 | I | By Nicolet National Bank Deferred Compensation Plan For Non-employee Directors | ||
| Common Stock | 87,715(2) | D | ||||||||
| Common Stock | 3,500 | I | by RJW Family Investments LLC(3) | |||||||
| Common Stock | 4,000 | I | By Ronald and Colleen Weyers Grandchildren's Trust #2(4) | |||||||
| Common Stock | 25,250 | I | By Weyers Family Limited Partnership(5) | |||||||
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | ||||||||
| Explanation of Responses: |
| 1. Mr. Weyers acquired 81 shares in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors by deferring his fourth quarter 2022 earned board fees. |
| 2. Reflects an adjustment of 9 shares omitted from Mr. Weyers original Form 3 filed on February 24, 2016. These shares were also omitted from 38 Form 4's filed by Mr. Weyers after the original Form 3 was filed. |
| 3. Represents the holdings of RJW Family Investments, LLC of which the reporting person is an owner. The reporting person disclaims beneficial ownership of registrant common stock held by RJW Family Investments, LLC except to the extent of his pecuniary interest. |
| 4. Represents the holdings of Ronald and Colleen Weyers Grandchildren's Trust #2 of which the reporting person is trustee. The reporting person disclaims beneficial ownership of registrant common stock held by Ronald and Colleen Weyers Grandchildren's Trust #2 except to the extent of his pecuniary interest. |
| 5. Represents the holdings of Weyers Family Limited Partnership, of which the reporting person is a general partner. The reporting person disclaims beneficial ownership of registrant common stock held by Weyers Family Limited Partnership except to the extent of his pecuniary interest. |
| Remarks: |
| Mr. Weyers previously reported indirect ownership of 20,000 shares through WB Regency Limited Partnership, which he is general partner. The partnership distributed all 20,000 shares to the limited partners. Mr. Weyers did not receive any of the distributed shares from the partnership. |
| /s/ H. Phillip Moore, Jr., as attorney-in-fact for Robert J. Weyers | 01/19/2023 | |
| ** 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 Number. | ||