0001367859-23-000116.txt : 20230614 0001367859-23-000116.hdr.sgml : 20230614 20230614092633 ACCESSION NUMBER: 0001367859-23-000116 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230612 FILED AS OF DATE: 20230614 DATE AS OF CHANGE: 20230614 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SKARVAN KATHLEEN CENTRAL INDEX KEY: 0001266296 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33003 FILM NUMBER: 231013155 MAIL ADDRESS: STREET 1: 40 WEST HIGHLAND PARK DR NE CITY: HUTCHINSON STATE: MN ZIP: 55350 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Citizens Community Bancorp Inc. CENTRAL INDEX KEY: 0001367859 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 205120010 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2174 EASTRIDGE CENTER CITY: EAU CLAIRE STATE: WI ZIP: 54701 BUSINESS PHONE: 715 836 9994 MAIL ADDRESS: STREET 1: 2174 EASTRIDGE CENTER CITY: EAU CLAIRE STATE: WI ZIP: 54701 4 1 wk-form4_1686749184.xml FORM 4 X0407 4 2023-06-12 0 0001367859 Citizens Community Bancorp Inc. CZWI 0001266296 SKARVAN KATHLEEN C/O CITIZENS COMMUNITY BANCORP, INC. 2174 EASTRIDGE CENTER EAU CLAIRE WI 54701 1 0 0 0 0 Common Stock, par value $.01 per share 2023-06-12 4 P 0 300 8.80 A 300 I By PK Skarvan Trust Common Stock, par value $0.01 per share 6708 D These shares are held by the PK Skarvan Trust pursuant to which Kathleen Skarvan and Paul Skarvan are trustees. /s/ Rebecca L. Johnson, Attorney-in-fact 2023-06-14