15-12B 1 tm2134418d3_1512b.htm FORM 15-12B

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 15

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

Commission File Number 001-36808

COUNTY BANCORP, INC.

(NICOLET BANKSHARES, INC., as successor by merger to

COUNTY BANCORP, INC.

(Exact name of registrant as specified in its charter)

c/o Nicolet Bankshares, Inc.

111 North Washington Street

Green Bay, Wisconsin 54301

(920) 430-1400

(Address, including zip code, and telephone number, including area code, of registrant’s principal executive offices)

Common Stock, $0.01 par value per share

(Title of each class of securities covered by this form)

None

(Title of all other classes of securities for which a duty to file reports under Section 13(a) or 15(d) remains)

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

Rule 12g-4(a)(1)	x
Rule 12g-4(a)(2)	¨
Rule 12h-3(b)(1)(i)	x
Rule 12h-3(b)(1)(ii)	¨
Rule 15d-6	¨
Rule 15d-22(b)	¨

Approximate number of holders of record as of the certification or notice date:

Common Stock, $0.01 par value per share: None*

*County Bancorp, Inc. (the “Registrant”) merged with and into Nicolet Bankshares, Inc. on December 3, 2021, at which time the separate corporate existence of the Registrant ended.

Pursuant to the requirements of the Securities Exchange Act of 1934, Nicolet Bankshares, Inc., as successor by merger to the Registrant, has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

Date: December 13, 2021

NICOLET BANKSHARES, INC., as successor
by merger to County Bancorp, Inc.

	By:	/s/ Michael E. Daniels
		Michael E. Daniels
		President and Chief Executive Officer

SEC Form 15-12B filed by County Bancorp, Inc.