Edgar Filing: Citizens Community Bancorp Inc.

Ownership Submission

FORM 4

Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

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(h) of the Investment Company Act of 1940

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3235-0287

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(Print or Type Responses)

1. Name and Address of Reporting Person ^*

Schaefer Edward H

2. Issuer Name and Ticker or Trading Symbol
Citizens Community Bancorp Inc. [CZWI]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

_____ Director	_____ 10% Owner
_____ Officer (give title below)	__X__ Other (specify below)
Former CEO and President

(Last)

(First)

(Middle)

C/O CITIZENS COMMUNITY BANCORP, INC., 2174 EASTRIDGE CENTER

3. Date of Earliest Transaction (Month/Day/Year)
08/11/2016

(Street)

EAU CLAIRE, WI 54701

4. If Amendment, Date Original Filed(Month/Day/Year)

6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

(City)

(State)

(Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
1.Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock, par value $0.01 per share	05/23/2016		D		22,162 ⁽¹⁾	D	$ 0	42,780	D
Common Stock, par value $0.01 per share	08/11/2016		M		4,000	A	$ 9.2	46,780	D
Common Stock, par value $0.01 per share	08/11/2016		M		8,000	A	$ 8	54,780	D

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative Security
(Instr. 3)

2. Conversion or Exercise Price of Derivative Security

3. Transaction Date (Month/Day/Year)

3A. Deemed Execution Date, if any (Month/Day/Year)

4. Transaction Code
(Instr. 8)

5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)

6. Date Exercisable and Expiration Date
(Month/Day/Year)

7. Title and Amount of Underlying Securities
(Instr. 3 and 4)

8. Price of Derivative Security
(Instr. 5)

9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)

10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)

11. Nature of Indirect Beneficial Ownership
(Instr. 4)

Code

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

Common Stock Option (right to buy)

$ 8

08/11/2016

4,000

01/24/2015⁽²⁾

01/24/2019

Common Stock

4,000

$ 0

4,000

Common Stock Option (right to buy)

$ 8

08/11/2016

4,000

01/24/2016⁽²⁾

01/24/2019

Common Stock

4,000

$ 0

Common Stock Option (right to buy)

$ 9.2

08/11/2016

4,000

01/24/2016⁽³⁾

01/24/2020

Common Stock

4,000

$ 0

Reporting Owners

Reporting Owner Name / Address	Relationships
Reporting Owner Name / Address	Director	10% Owner	Officer	Other
Schaefer Edward H C/O CITIZENS COMMUNITY BANCORP, INC. 2174 EASTRIDGE CENTER EAU CLAIRE, WI 54701				Former CEO and President

Signatures

/s/ Becky L. Johnson as Attorney-in-Fact		08/12/2016
^**Signature of Reporting Person		Date

Explanation of Responses:

*	If the form is filed by more than one reporting person, see Instruction 4(b)(v).
**	Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
(1)	Represents the forfeiture of unvested restricted stock units granted to the reporting person that were eligible to vest pro rata over a five-year period that were forfeited due to the reporting person's resignation.
(2)	The common stock option vests pro rata over a five-year period: 20% of the shares become exercisable on each January 24, 2015 and January 24, 2016. Due to the resignation of the reporting person, the remaining unvested options were forfeited.
(3)	The common stock option vests pro rata over a five-year period: 20% of the shares become exercisable on January 24, 2016. Due to the resignation of the reporting person, the remaining unvested options were forfeited.

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