SEC Form 4 · accession 0001367859-19-000017
Citizens Community Bancorp Inc. · CZWI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard McHugh
Director
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 share | Jan 24, 2019 | M | 14,240 | $7.04 | A | 176,737 | D | |
| Common Stock, par value $0.01 per shareF1 | holding | — | — | — | 34,596 | I | By Spouse |
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) | $7.04 | Jan 24, 2019 | M | 14,240 | D | Feb 4, 2010 | Feb 4, 2020 | Common Stock | 14,240 | 0 | D |
Explanation of responses
- F1The reporting person's spouse owns 34,275 shares of our common stock directly and 321 shares are held by the reporting person's spouse as custodian for her grandchildren. Mr. McHugh disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.