SEC Form 4 · accession 0001209191-17-058895
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James S Broucek
Officer — Chief Financial Officer
Period of report
Oct 31, 2017
Accepted (ET)
Nov 2, 2017 · 4:42 pm 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 | Oct 31, 2017 | A | 4,000 | $0.00 | A | 4,000 | 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 | $13.60 | Oct 31, 2017 | A | 8,000 | A | — | Oct 31, 2027 | Common Stock | 8,000 | 8,000 | D |
Explanation of responses
- F1Represents restricted shares of Common Stock awarded under the Company's 2008 Equity Incentive Plan, which shares vest equally over three years on each of October 31, 2018, October 31, 2019 and October 31, 2020.
- F2The common stock option awarded under the Company's 2008 Equity Incentive Plan vests as follows: 20% of the shares vest on each of October 31, 2018, October 31, 2019, October 31, 2020, October 31, 2021 and October 31, 2022.