0001367859-24-000028.txt : 20240129 0001367859-24-000028.hdr.sgml : 20240129 20240129160209 ACCESSION NUMBER: 0001367859-24-000028 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240125 FILED AS OF DATE: 20240129 DATE AS OF CHANGE: 20240129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SKARVAN KATHLEEN CENTRAL INDEX KEY: 0001266296 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33003 FILM NUMBER: 24573581 MAIL ADDRESS: STREET 1: 40 WEST HIGHLAND PARK DR NE CITY: HUTCHINSON STATE: MN ZIP: 55350 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Citizens Community Bancorp Inc. CENTRAL INDEX KEY: 0001367859 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] ORGANIZATION NAME: 02 Finance 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_1706562114.xml FORM 4 X0508 4 2024-01-25 0 0001367859 Citizens Community Bancorp Inc. CZWI 0001266296 SKARVAN KATHLEEN C/O CITIZENS COMMUNITY BANCORP, INC. 2174 EASTRIDGE CENTER EAU CLAIRE WI 54701 1 0 0 0 0 Common Stock, par value $0.01 per share 2024-01-25 4 A 0 1893 11.88 A 8601 D Common Stock, par value $.01 per share 300 I By PK Skarvan Trust Represents restricted shares of Common Stock awarded under the Company's 2018 Equity Incentive Plan, which shares vest December 31, 2024. These shares are held by the PK Skarvan Trust pursuant to which Kathleen Skarvan and Paul Skarvan are trustees. /s/ Rebecca L. Johnson, Attorney-in-fact 2024-01-29