0001367859-18-000164.txt : 20181120
0001367859-18-000164.hdr.sgml : 20181120
20181120121354
ACCESSION NUMBER: 0001367859-18-000164
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181116
FILED AS OF DATE: 20181120
DATE AS OF CHANGE: 20181120
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BROUCEK JAMES S
CENTRAL INDEX KEY: 0001204872
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33003
FILM NUMBER: 181194842
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Citizens Community Bancorp Inc.
CENTRAL INDEX KEY: 0001367859
STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035]
IRS NUMBER: 000000000
STATE OF INCORPORATION: MD
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2174 EASTRIDGE CENTER
CITY: EAU CLAIRE
STATE: WI
ZIP: 54701
BUSINESS PHONE: 715 836 9994
MAIL ADDRESS:
STREET 1: 2174 EASTRIDGE CENTER
CITY: EAU CLAIRE
STATE: WI
ZIP: 54701
4
1
wf-form4_154273401786359.xml
FORM 4
X0306
4
2018-11-16
0
0001367859
Citizens Community Bancorp Inc.
CZWI
0001204872
BROUCEK JAMES S
C/O CITIZENS COMMUNITY BANCORP, INC.
2174 EASTRIDGE CENTER
EAU CLAIRE
WI
54701
0
1
0
0
EVP/CFO/Treasurer/Secretary
Common Stock, par value $0.01 per share
2018-11-16
4
P
0
600
11.99
A
25156
I
By IRA
Common Stock, par value $0.01 per share
4905
D
Common Stock Option (right to buy)
13.6
2027-10-31
Common Stock
8000.0
8000
D
These shares are held in the reporting person's self-directed IRA.
The common stock option awarded under the Company's 2008 Equity Incentive Plan vests as follows: 20% of the shares vest on each of October 31, 2018, October 31, 2019, October 31, 2020, October 31, 2021 and October 31, 2022.
/s/ Rebecca L. Johnson, Attorney-in-fact
2018-11-20