0001367859-18-000114.txt : 20180928 0001367859-18-000114.hdr.sgml : 20180928 20180928185733 ACCESSION NUMBER: 0001367859-18-000114 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180928 FILED AS OF DATE: 20180928 DATE AS OF CHANGE: 20180928 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bourget Kristina M CENTRAL INDEX KEY: 0001736360 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33003 FILM NUMBER: 181095402 MAIL ADDRESS: STREET 1: 1703 PINE PARK DRIVE 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: 000000000 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_153817543663815.xml FORM 4 X0306 4 2018-09-28 0 0001367859 Citizens Community Bancorp Inc. CZWI 0001736360 Bourget Kristina M 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 2018-09-28 4 C 0 2500 A 3178 D Series A Preferred Stock 2018-09-28 4 C 0 250 0 D Common Stock 2500.0 0 D Each share of 8% Series A Mandatorily Convertible Non-Cumulative Non-Voting Perpetual Stock was mandatorily converted into ten (10) shares of the Company's common stock three days following stockholder approval of the issuance of the underlying common stock and had no expiration date. /s/ Rebecca L. Johnson, Attorney-in-fact 2018-09-28