SEC Form 4 · accession 0001367859-18-000074
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James D Moll
Director
Period of report
Jun 20, 2018
Accepted (ET)
Jun 21, 2018 · 5:41 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 | — | — | — | 11,582 | D | ||
| Common Stock, par value $0.01 per shareF1 | holding | — | — | — | 9,624 | 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 StockF2 | — | Jun 20, 2018 | A | 1,000 | A | — | — | Common Stock | 10,000 | 1,000 | D |
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.