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