0001367859-19-000108.txt : 20191101
0001367859-19-000108.hdr.sgml : 20191101
20191101164313
ACCESSION NUMBER: 0001367859-19-000108
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191031
FILED AS OF DATE: 20191101
DATE AS OF CHANGE: 20191101
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: 191187285
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_157264097582489.xml
FORM 4
X0306
4
2019-10-31
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
2019-10-31
4
F
0
370
11.12
D
6108
D
Common Stock, par value $0.01 per share
26657
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 370 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 2008 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
2019-11-01