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