0001367859-23-000057.txt : 20230123 0001367859-23-000057.hdr.sgml : 20230123 20230123162100 ACCESSION NUMBER: 0001367859-23-000057 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230119 FILED AS OF DATE: 20230123 DATE AS OF CHANGE: 20230123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MCHUGH RICHARD CENTRAL INDEX KEY: 0001279160 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33003 FILM NUMBER: 23544724 MAIL ADDRESS: STREET 1: C/O CITIZENS COMMUNITY BANCORP STREET 2: 2174 EASTRIDGE CENTER CITY: EAU CLAIRE STATE: WI ZIP: 54701 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_167450884105497.xml FORM 4 X0306 4 2023-01-19 0 0001367859 Citizens Community Bancorp Inc. CZWI 0001279160 MCHUGH RICHARD C/O CITIZENS COMMUNITY BANCORP, INC. 2174 EASTRIDGE CENTER EAU CLAIRE WI 54701 1 0 0 0 Common Stock, par value $0.01 per share 2023-01-19 4 A 0 1213 12.36 A 190600 D Common Stock, par value $0.01 per share 34596 I By Spouse Represents restricted shares of Common Stock awarded under the Company's 2018 Equity Incentive Plan, which shares vest June 30, 2023. The reporting person's spouse owns 34,275 shares of our common stock directly and 321 shares are held by the reporting person's spouse as custodian for her grandchildren. Mr. McHugh disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. /s/ Rebecca L. Johnson, Attorney-in-fact 2023-01-23