-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, AEgKc28IQdz4stKPRystzRX7kixsnG704FzMGOyghcB2lJHeF44jNnZ57Hep5mfm PWd1UuKIl9oxYnN3mxLWsA== 0000919607-99-000343.txt : 19991018 0000919607-99-000343.hdr.sgml : 19991018 ACCESSION NUMBER: 0000919607-99-000343 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990728 FILED AS OF DATE: 19991006 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CITIZENS COMMUNITY BANCORP INC CENTRAL INDEX KEY: 0001002214 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 650614044 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-22547 FILM NUMBER: 99723838 BUSINESS ADDRESS: STREET 1: 650 EAST ELKCAM CIRCLE STREET 2: CHAMBER OF COMMERCE PLAZA CITY: MARCO ISLAND STATE: FL ZIP: 34145 BUSINESS PHONE: 9413891800 MAIL ADDRESS: STREET 1: C/O IGLER & DOUGHERTY PA STREET 2: 604 EAST ELKCAM CIRCLE CITY: MARCO ISLAND STATE: FL ZIP: 34145 COMPANY DATA: COMPANY CONFORMED NAME: CITIZENS COMMUNITY BANCORP INC CENTRAL INDEX KEY: 0001002214 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] DIRECTOR IRS NUMBER: 650614044 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 650 EAST ELKCAM CIRCLE STREET 2: CHAMBER OF COMMERCE PLAZA CITY: MARCO ISLAND STATE: FL ZIP: 34145 BUSINESS PHONE: 9413891800 MAIL ADDRESS: STREET 1: C/O IGLER & DOUGHERTY PA STREET 2: 604 EAST ELKCAM CIRCLE CITY: MARCO ISLAND STATE: FL ZIP: 34145 4 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 1. Name and Address of Reporting Person Storm, Richard J. 264 Rock Hill Court Marco Island, FL 34145 2. Issuer Name and Ticker or Trading Symbol CCBI 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 6/99 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) President & CEO
- ------------------------------------------------------------------------------------------------------------------------------------ Table I -- Non-Derivatie Securities Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Transaction 3. Transaction 4. Securities 5. Amount of 6. Ownership 7. Nature of Date Code Acquired (A) Securities Form: Indirect (Month/Year) or Disposal (D) Benefially Direct (D) Beneficial Owned at end Indirect (I) Ownership of Month Amount A/D Price - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock - 6/24/99 S 856 D 9.29 472,448 I By Spouse Par Value - $.01 - ------------------------------------------------------------------------------------------------------------------------------------ 6/26/99 S 2146 D 9.36 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 6/21/99 S 1000 D 10.00 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 6/16/99 S 3400 D 9.37 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 6/10/99 S 700 D 10.00 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 6/3/99 S 200 D 9.85 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 5/26/99 S 2000 D 10.12 480,750 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 5/24/99 S 300 D 10.23 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ 5/21/99 S 2000 D 10.00 I By Spouse - ------------------------------------------------------------------------------------------------------------------------------------ Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertibel securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 4. Transaction Code 5. Number of Derivative Securities Acquired (A) or Disposed of (D) 6. Date Exercisable and Expiration Date (Month/Day/Year) Date Exercisable Expiration Date 7. Title and Amount of Underlying Securities Title Amount or Number of Shares 8. Price of Derivative Security 9. Number of Derivative Securities Beneficially Owned at End of Month 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) 11. Nature of Indirect Benefical Ownership - ------------------------------------------------------------------------------------------------------------------------------------
/s/Richard J. Storm 7/28/99 ------------------- ------- Signature of Reporting Person Date -----END PRIVACY-ENHANCED MESSAGE-----