01/23/2025 | Press release | Distributed by Public on 01/23/2025 16:56
FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
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. | SEC 1474 (9-02) |
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 Underlying Securities (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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WEYERS ROBERT J C/O NICOLET NATIONAL BANK 111 NORTH WASHINGTON STREET GREEN BAY, WI 54301 |
X |
/s/ H. Phillip Moore, Jr., as attorney-in-fact for Robert J. Weyers | 01/23/2025 |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Mr. Weyers acquired 55.525 shares in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors by deferring his fourth quarter 2024 earned board fees. |
(2) | Includes 23.170 shares received as dividend reinvestment in the Nicolet National Bank Deferred Compensation Plan for Non-employee Directors from Nicolet Bankshares, Inc. paid cash dividend on December 16, 2024. |
(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. |