SEC Form 4 · accession 0001367859-18-000113
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
Sep 28, 2018
Accepted (ET)
Sep 28, 2018 · 6:56 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 | 7,690 | — | A | 12,690 | I | By IRA |
| Common Stock, par value $0.01 per shareF1,F3 | Sep 28, 2018 | C | 7,690 | — | A | 7,690 | I | By Ag Risk Managers LLC |
| Common Stock, par value $0.01 per share | holding | — | — | — | 1,515 | 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 | 769 | D | — | — | Common Stock | 7,690 | 0 | I |
| Series A Preferred StockF3,F1 | — | Sep 28, 2018 | C | 769 | D | — | — | Common Stock | 7,690 | 0 | I |
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 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.