SEC Form 4 · accession 0001367859-19-000016
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
Jan 24, 2019
Accepted (ET)
Jan 28, 2019 · 2:50 pm 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 24, 2019 | A | 1,681 | $0.00 | A | 6,586 | D | |
| Common Stock, par value $0.01 per shareF2 | holding | — | — | — | 25,156 | 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
- F1Represents restricted shares of Common Stock awarded under the Company's 2018 Equity Incentive Plan, which shares vest equally over three years on each of January 24, 2020, January 24, 2021 and January 24, 2022.
- 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.