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