0001209191-18-004509.txt : 20180119
0001209191-18-004509.hdr.sgml : 20180119
20180119154248
ACCESSION NUMBER: 0001209191-18-004509
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180117
FILED AS OF DATE: 20180119
DATE AS OF CHANGE: 20180119
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lang James R
CENTRAL INDEX KEY: 0001563435
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33003
FILM NUMBER: 18537328
MAIL ADDRESS:
STREET 1: 2194 EASTRIDGE CENTER
CITY: EAU CLAIRE
STATE: WI
ZIP: 54701
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Citizens Community Bancorp Inc.
CENTRAL INDEX KEY: 0001367859
STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035]
IRS NUMBER: 000000000
STATE OF INCORPORATION: MD
FISCAL YEAR END: 0930
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
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-01-17
0
0001367859
Citizens Community Bancorp Inc.
CZWI
0001563435
Lang James R
C/O CITIZENS COMMUNITY BANCORP, INC.
2174 EASTRIDGE CENTER
EAU CLAIRE
WI
54701
1
0
0
0
Common Stock, par value $.01 per share
2018-01-17
4
A
0
515
0.00
A
515
D
Common Stock, par value $.01 per share
30000
I
By IRA
Common Stock, par value $.01 per share
2500
I
By Leah Delaney Karge Trust
Common Stock, par value $.01 per share
3980
I
By James & Patricia Lang Grandchildren Education Trust
Represents restricted shares of Common Stock awarded under the Company's 2008 Equity Incentive Plan, which shares vest on October 1, 2018.
These shares are held in the reporting person's self-directed IRA.
These shares are held by the Leah Delaney Karge Trust pursuant to which Mr. Lang serves as trustee and has investment discretion. Mr. Lang disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
These shares are held by the James & Patricia Lang Grandchildren Education Trust UAD 01/01/2002, pursuant to which Mr. Lang serves as an investment manager and has investment discretion over such shares. Mr. Lang disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
/s/ Rebecca L. Johnson, Attorney-in-fact
2018-01-19