0001367859-23-000105.txt : 20230522 0001367859-23-000105.hdr.sgml : 20230522 20230522090046 ACCESSION NUMBER: 0001367859-23-000105 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230519 FILED AS OF DATE: 20230522 DATE AS OF CHANGE: 20230522 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: 23942606 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 wk-form4_1684760437.xml FORM 4 X0407 4 2023-05-19 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 0 Common Stock, par value $0.01 per share 2023-05-19 4 P 0 100 8.10 A 41724 I By IRA Common Stock, par value $0.01 per share 18877 D Common Stock Option (right to buy) 13.60 2027-10-31 Common Stock 8000 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 2023-05-22