SEC Form 4 · accession 0001209191-18-004539
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard McHugh
Director
Period of report
Jan 17, 2018
Accepted (ET)
Jan 19, 2018 · 4:02 pm EST
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 | Jan 17, 2018 | A | 515 | $0.00 | A | 160,139 | D | |
| Common Stock, par value $0.01 per shareF2 | holding | — | — | — | 34,596 | I | By Spouse |
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) | $7.04 | holding | — | — | — | Feb 4, 2010 | Feb 4, 2020 | Common Stock | 14,240 | 14,240 | D |
Explanation of responses
- F1Represents restricted shares of Common Stock awarded under the Company's 2008 Equity Incentive Plan, which shares vest on October 1, 2018.
- F2The reporting person's spouse owns 34,275 shares of our common stock directly and 321 shares are held by the reporting person's spouse as custodian for her grandchildren. Mr. McHugh disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.