0001367859-20-000020.txt : 20200127
0001367859-20-000020.hdr.sgml : 20200127
20200127132636
ACCESSION NUMBER: 0001367859-20-000020
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200123
FILED AS OF DATE: 20200127
DATE AS OF CHANGE: 20200127
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: 20548539
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: 205120010
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_158014957915942.xml
FORM 4
X0306
4
2020-01-23
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
2020-01-23
4
A
0
1589
11.95
A
3896
D
Common Stock, par value $.01 per share
40230
I
By IRA
Common Stock, par value $.01 per share
17460
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 equally over three years on each of January 23, 2021, January 23, 2022 and January 23, 2023.
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
2020-01-27