SEC Form 4 · accession 0001367859-18-000075
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James S Broucek
Officer — EVP/CFO/Treasurer/Secretary
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 | — | — | — | 5,320 | D | ||
| Common Stock, par value $0.01 per shareF1 | holding | — | — | — | 14,866 | 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 |
| Common Stock Option (right to buy)F3 | $13.60 | holding | — | — | — | — | Oct 31, 2027 | Common Stock | 8,000 | 8,000 | 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.
- F3The 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.