SEC Form 4 · accession 0001367859-18-000111
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Stephen M Bianchi
Officer — CEO and President · Director
Period of report
Sep 28, 2018
Accepted (ET)
Sep 28, 2018 · 6:55 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,F2 | Sep 28, 2018 | C | 11,540 | — | A | 30,781 | I | By IRA |
| Common Stock, par value $0.01 per share | holding | — | — | — | 30,509 | D |
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,F1 | — | Sep 28, 2018 | C | 1,154 | D | — | — | Common Stock | 11,540 | 0 | I |
| Common Stock Option (right to buy)F3 | $11.00 | holding | — | — | — | — | Jun 24, 2026 | Common Stock | 20,000 | 20,000 | D |
Explanation of responses
- F1Each share of 8% Series A Mandatorily Convertible Non-Cumulative Non-Voting Perpetual Stock was mandatorily converted into ten (10) shares of the Company's common stock three days following stockholder approval of the issuance of the underlying common stock and had no expiration date.
- F2These shares are held in the reporting person's self-directed IRA.
- F3The common stock option awarded under the Company's 2008 Equity Incentive Plan vests as follows: 20% of the shares vest on each of June 24, 2017, June 24, 2018, June 24, 2019, June 24, 2020 and June 24, 2021.