0001367859-21-000070.txt : 20210316 0001367859-21-000070.hdr.sgml : 20210316 20210316093628 ACCESSION NUMBER: 0001367859-21-000070 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210315 FILED AS OF DATE: 20210316 DATE AS OF CHANGE: 20210316 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: 21744065 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 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_161590177551579.xml FORM 4 X0306 4 2021-03-15 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 2021-03-15 4 P 0 200 12.39 A 38624 I By IRA Common Stock, par value $0.01 per share 10521 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 2021-03-16