0001367859-18-000131.txt : 20181029
0001367859-18-000131.hdr.sgml : 20181029
20181029083751
ACCESSION NUMBER: 0001367859-18-000131
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181025
FILED AS OF DATE: 20181029
DATE AS OF CHANGE: 20181029
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lang James R
CENTRAL INDEX KEY: 0001563435
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33003
FILM NUMBER: 181142868
MAIL ADDRESS:
STREET 1: 2194 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: 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_154081665495143.xml
FORM 4
X0306
4
2018-10-25
0
0001367859
Citizens Community Bancorp Inc.
CZWI
0001563435
Lang James R
C/O CITIZENS COMMUNITY BANCORP, INC.
2174 EASTRIDGE CENTER
EAU CLAIRE
WI
54701
1
0
0
0
Common Stock, par value $.01 per share
2018-10-25
4
A
0
1792
0
A
2307
D
Common Stock, par value $.01 per share
49230
I
By IRA
Common Stock, par value $.01 per share
8460
I
By Roth IRA
Common Stock, par value $.01 per share
3980
I
By James & Patricia Lang Grandchildren Education Trust
Common Stock, par value $.01 per share
2500
I
By Leah Delaney Karge Trust
Represents restricted shares of Common Stock awarded under the Company's 2018 Equity Incentive Plan, which shares vest on December 31, 2019.
These shares are held in the reporting person's self-directed IRA.
These shares are held in the reporting person's self-directed Roth IRA.
These shares are held by the James & Patricia Lang Grandchildren Education Trust UAD 01/01/2002, pursuant to which Mr. Lang serves as an investment manager and has investment discretion over such shares. Mr. Lang disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
These shares are held by the Leah Delaney Karge Trust pursuant to which Mr. Lang serves as trustee and has investment discretion. Mr. Lang disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
/s/ Rebecca L. Johnson, by Power of Attorney
2018-10-29