SEC Form 4 · accession 0001367859-18-000072
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Francis E Felber
Director
Period of report
Jun 20, 2018
Accepted (ET)
Jun 21, 2018 · 5:40 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 share | holding | — | — | — | 1,515 | D | ||
| Common Stock, par value $0.01 per shareF1 | holding | — | — | — | 5,000 | I | By IRA |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Preferred StockF1,F2 | — | Jun 20, 2018 | A | 769 | A | — | — | Common Stock | 7,690 | 769 | I |
| Series A Preferred StockF3,F2 | — | Jun 20, 2018 | A | 769 | A | — | — | Common Stock | 7,690 | 769 | I |
Explanation of responses
- F1These shares are held in the reporting person's self-directed IRA.
- F2Each share of 8.00% Series A Mandatorily Convertible Non-Cumulative Non-Voting Perpetual Preferred Stock is mandatorily convertible into ten shares of the Company's common stock upon stockholder approval of the issuance of the underlying common stock and has no expiration date.
- F3The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.