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