SEC Form 4 · accession 0001144204-16-118574
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Edward H Schaefer
Other
Period of report
Aug 11, 2016
Accepted (ET)
Aug 12, 2016 · 11:57 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001367859
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, par value $0.01 per shareF1 | May 23, 2016 | D | 22,162 | $0.00 | D | 42,780 | D | |
| Common Stock, par value $0.01 per share | Aug 11, 2016 | M | 4,000 | $9.20 | A | 46,780 | D | |
| Common Stock, par value $0.01 per share | Aug 11, 2016 | M | 8,000 | $8.00 | A | 54,780 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock Option (right to buy)F2 | $8.00 | Aug 11, 2016 | M | 4,000 | D | Jan 24, 2015 | Jan 24, 2019 | Common Stock | 4,000 | 4,000 | D |
| Common Stock Option (right to buy)F2 | $8.00 | Aug 11, 2016 | M | 4,000 | D | Jan 24, 2016 | Jan 24, 2019 | Common Stock | 4,000 | 0 | D |
| Common Stock Option (right to buy)F3 | $9.20 | Aug 11, 2016 | M | 4,000 | D | Jan 24, 2016 | Jan 24, 2020 | Common Stock | 4,000 | 0 | D |
Explanation of responses
- F1Represents the forfeiture of unvested restricted stock units granted to the reporting person that were eligible to vest pro rata over a five-year period that were forfeited due to the reporting person's resignation.
- F2The common stock option vests pro rata over a five-year period: 20% of the shares become exercisable on each January 24, 2015 and January 24, 2016. Due to the resignation of the reporting person, the remaining unvested options were forfeited.
- F3The common stock option vests pro rata over a five-year period: 20% of the shares become exercisable on January 24, 2016. Due to the resignation of the reporting person, the remaining unvested options were forfeited.