SEC Form 4 · accession 0001367859-19-000008
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Rebecca Johnson
Officer — Vice President/Controller
Period of report
Jan 17, 2019
Accepted (ET)
Jan 22, 2019 · 8:03 am EST
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 | Jan 17, 2019 | F | 78 | $11.32 | D | 3,668 | D | |
| Common Stock, par value $0.01 per shareF2 | holding | — | — | — | 12,841 | I | By 401(k) Plan |
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 | $9.62 | holding | — | — | — | — | Jun 14, 2026 | Common Stock | 2,000 | 2,000 | D |
Explanation of responses
- F1The reporting person surrendered a total of 78 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.
- F2Represents shares held under the Citizens Community Federal 401(k) Profit Sharing Plan.
- 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 14, 2017, June 14, 2018, June 14, 2019, June 14, 2020 and June 14, 2021.