SEC Form 4 · accession 0001367859-18-000139
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
Oct 31, 2018
Accepted (ET)
Nov 2, 2018 · 5:53 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 | Oct 31, 2018 | F | 415 | $12.75 | D | 4,905 | D | |
| Common Stock, par value $0.01 per shareF2 | Nov 2, 2018 | P | 500 | $12.50 | A | 23,056 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock Option (right to buy)F3 | $13.60 | holding | — | — | — | — | Oct 31, 2027 | Common Stock | 8,000 | 8,000 | D |
Explanation of responses
- F1The reporting person surrendered a total of 581 shares of the Company's common stock to satisfy the withholding taxes due upon the vesting of certain previously awarded shares of restricted stock issued under the Company's 2008 Equity Incentive Plan.
- 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 October 31, 2018, October 31, 2019, October 31, 2020, October 31, 2021 and October 31, 2022.