czwi13g401k.htm
UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
DC 20549
SCHEDULE 13G
(Rule
13d–102)
INFORMATION
TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1(b), (c) AND (d) AND
AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2
(Amendment
No. ___)*
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CITIZENS
COMMUNITY BANCORP, INC.
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(Name
of Issuer)
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Common
Stock, par value $0.01
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(Title
of Class of Securities)
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December 31,
2009
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Date
of Event Which Requires Filing of this Statement
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Check the
appropriate box to designate the rule pursuant to which this Schedule is
filed:
| x |
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Rule
13d–1(b) |
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| o |
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Rule
13d–1(c) |
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Rule
13d–1(d) |
________________
*The
remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities, and
for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The
information required in the remainder of this cover page shall not be deemed to
be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act,
but shall be subject to all other provisions of the Act (however, see the Notes).
CUSIP
No. 174903104
| 1) |
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Name of Reporting
Person Citizens Community
Bancorp, Inc. 401(k) Profit Sharing
Plan
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| 2) |
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Check the
Appropriate Box if a Member of a Group (See Instructions) |
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(a) |
o |
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(b) |
x |
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| 3) |
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SEC Use
Only |
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| 4) |
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Citizenship or Place
of Organization United States of
America
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Number of
Shares |
5) |
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Sole Voting
Power |
0
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Beneficially
Owned |
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By Each
Reporting |
6) |
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Shared Voting
Power |
276,004 |
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Person
With |
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7) |
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Sole Dispositive
Power |
276,004 |
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8) |
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Shared
Dispositive Power |
0 |
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| 9) |
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Aggregate Amount
Beneficially Owned by Each Reporting Person 276,004
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Check Box if the
Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)
o |
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| 11) |
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Percent of Class
Represented by Amount in Row 9 5.4%
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| 12) |
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Type of Reporting
Person (See
Instructions) EP
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Item 1(a) Name of
Issuer
Citizens
Community Bancorp, Inc. (the "Company")
Item 1(b) Address of
Issuer's Principal Executive Offices.
2174
EastRidge Center
Eau
Claire, Wisconsin 54701
Item 2(a) Name of Person
Filing.
Citizens
Community Bancorp, Inc. 401(k) Profit Sharing Plan (the "Plan").
Item 2(b) Address of
Principal Business Office or, if None, Residence.
2174
EastRidge Center
Eau
Claire, Wisconsin 54701
Item 2(c)
Citizenship.
United
States of America.
Item 2(d) Title of Class of
Securities.
Common
Stock, par value $0.01 per share (the "Common Stock).
Item 2(e) CUSIP
Number.
174903104
Item 3. If this
statement is filed pursuant to §§ 240.13d-1(b) or 240.13d-2(b) or (c), check
whether the person filing is a:
| (f) |
x |
An employee benefit
plan or endowment fund in accordance § 240.13d -
(b)(1)(ii)(F). |
Item
4. Ownership.
| (a) |
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Amount Beneficially
Owned: 276,004 |
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Percent of
Class: 5.4% (based on 5,113,278 shares of Common Stock
outstanding as of February 12, 2010, as disclosed
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by the Company in
its Form 10-Q filed with the Securities and Exchange Commission on
February 12, 2010).
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Number of Shares as to
Which Such Person Has: |
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(i) |
Sole Power to Vote or
to Direct the Vote: 0 |
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(ii) |
Shared Power to Vote
or to Direct the Vote: 276,004 |
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(iii) |
Sole Power to Dispose
or Direct the Disposition of: 276,004 |
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(iv) |
Shared Power to
Dispose or Direct the Disposition
of: 0 |
As of
December 31, 2009, the Plan was the beneficial owner, as that term is defined
under Rule 13d-3 under the Securities Exchange Act of 1934, as amended, of a
total of 276,004 shares of the Company's Common Stock or approximately 5.4% of
the total outstanding shares of the Company's Common Stock. The Plan
has shared voting power and sole dispositive power with respect to the shares of
Common Stock held by the Plan in participant accounts.
The
trustee of the Plan (the "Trustee") may be deemed to beneficially own all of the
shares of Common Stock held by the Plan. However, the Trustee expressly
disclaims beneficial ownership of all of such shares. Other than the
shares held by the Plan, the Trustee does not beneficially own any shares of
Common Stock. Pursuant to the Plan, participants in the Plan are
entitled to instruct the Trustee as to the voting of the shares of Common Stock
held in their Plan accounts. On each issue with respect to which
shareholders are entitled to vote, the Trustee is required to vote the shares
held by the Plan for which the Trustee has not received voting instructions from
the participants in the manner directed under the Plan.
Item 5. Ownership
of Five Percent or Less of a Class.
Not
applicable.
Item 6. Ownership
of More Than Five Percent on Behalf of Another Person.
No
additional shares of Common Stock may be purchased by participants through the
Plan. Participants in the Plan have the right to direct the
disposition of the shares of Common Stock held in their plan accounts which were
previously acquired under the terms of the Plan. Vested participants
also have the right upon employment termination, pursuant to the terms of the
Plan, to elect an in-kind distribution of the Company's Common Stock to the
extent of their holdings in the Common Stock. Accordingly, any
dividends on the Common Stock and the proceeds from the sale of the shares of
Common Stock are credited to participants who hold such shares and/or have
elected to dispose of such shares.
Item
7. Identification and Classification of the Subsidiary Which Acquired
the Security Being Reported on by the Parent Holding Company or Control
Person.
Not
applicable.
Item
8. Identification and Classification of Members of the
Group.
Not
applicable.
Item 9. Notice of
Dissolution of Group.
Not
applicable.
Item
10. Certification.
By
signing below I certify that, to the best of my knowledge and belief, the
securities referred to above were acquired and are held in the ordinary course
of business and were not acquired and are not held for the purpose of or with
the effect of changing or influencing the control of the issuer of the
securities and were not acquired and are not held in connection with or as a
participant in any transaction having that purpose or effect.
SIGNATURE
After
reasonable inquiry and to the best of its knowledge and belief, the undersigned
certifies that the information set forth in this statement is true, complete and
correct.
Dated:
February 12,
2010
CITIZENS
COMMUNITY BANCORP, INC.
401(k)
PROFIT SHARING PLAN
By: First
Bankers Trust Services, Inc., as Trustee
By
/s/ Linda
Shultz
Print
Name: Linda Shultz
Title: Trust
Officer