0001367859-19-000037.txt : 20190430 0001367859-19-000037.hdr.sgml : 20190430 20190430125545 ACCESSION NUMBER: 0001367859-19-000037 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190429 FILED AS OF DATE: 20190430 DATE AS OF CHANGE: 20190430 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: 19779932 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Citizens Community Bancorp Inc. CENTRAL INDEX KEY: 0001367859 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 205120010 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_155664333027599.xml FORM 4 X0306 4 2019-04-29 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 2019-04-29 4 F 0 108 12 D 6478 D Common Stock, par value $0.01 per share 25156 I By IRA Common Stock Option (right to buy) 13.6 2027-10-31 Common Stock 8000.0 8000 D The reporting person surrendered a total of 108 shares of the Company's common stock to satisfy the withholding taxes due upon the vesting of certain previously awarded shares of restricted stock issued under the Company's 2018 Equity Incentive Plan. 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 2019-04-30