|
1)
|
NAME
OF REPORTING PERSON
Citizens
Community Bancorp, Inc. Employee Stock Ownership
Plan
|
|
2)
|
CHECK
THE APPROPRIATE BOX IF A MEMBER OF A GROUP
a) [ ]
b) [X]
|
|
3)
|
SEC
USE ONLY
|
|
4)
|
CITIZENSHIP
OR PLACE OF ORGANIZATION
Not
applicable
|
|
NUMBER
OF
SHARES
BENEFICIALLY
OWNED
BY
EACH
REPORTING
PERSON
WITH
|
||
|
5)
|
SOLE
VOTING POWER
387,116
|
|
|
6)
|
SHARED
VOTING POWER
176,514
|
|
|
7)
|
SOLE
DISPOSITIVE POWER
563,630
|
|
|
8)
|
SHARED
DISPOSITIVE POWER
-0-
|
|
9)
|
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH REPORTING
PERSON
563,630
|
|
10)
|
CHECK
BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN
SHARES [
]
|
|
11)
|
PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW 9
9.2%
|
|
12
|
TYPE
OF REPORTING PERSON
EP
|
|
ITEM
1(a)
|
NAME
OF ISSUER:
Citizens
Community Bancorp, Inc. (the
"Corporation")
|
|
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. Employee Ownership Plan (the
"ESOP")
|
|
ITEM
2(b)
|
ADDRESS
OF PRINCIPAL BUSINESS OFFICE:
The business address of the ESOP is:
2174
EastRidge Center, Equ Claire, Wisconsin 54701
|
|
ITEM
2(c)
|
CITIZENSHIP:
Not
Applicable.
|
|
ITEM
2(d)
|
TITLE
OF CLASS OF SECURITIES
Common
stock, par value $.01 per share (the "Common
Stock")
|
|
ITEM
2(e)
|
CUSIP
NUMBER: 174
903 104
|
|
ITEM
3
|
IF
THIS STATEMENT IS FILED PURSUANT TO SECTION 240.13d-1(b) OR 240.13d-2(b)
or (c), CHECK WHETHER THE PERSON FILING IS:
|
||
|
(a)
|
[ ]
|
Broker
or dealer registered under section 15 of the Act (15 U.S.C.
78o);
|
|
|
(b)
|
[ ]
|
Bank
as defined in section 3(a)(6) of the Act (15 U.S.C.
78c);
|
|
|
(c)
|
[ ]
|
Insurance
company as defined in section 3(a)(19) of the Act (15 U.S.C.
78c);
|
|
|
|
(d)
|
[ ]
|
Investment
company registered under section 8 of the Investment Company Act of 1940
(15 U.S.C. 80a-8);
|
|
(e)
|
[ ]
|
An
investment adviser in accordance with Section
240.13d-1(b)(1)(ii)(E);
|
|
|
(f)
|
[X
]
|
An
employee benefit plan or endowment fund in accordance with Section
240.13d-1(b)(1)(ii)(F);
|
|
|
(g)
|
[ ]
|
A
parent holding company or control person in accordance with Section
240.13d-1(b)(1)(ii)(G);
|
|
|
(h)
|
[ ]
|
A
savings association as defined in Section 3(b) of the Federal Deposit
Insurance Act (12 U.S.C. 1813);
|
|
|
(i)
|
[ ]
|
A
church plan that is excluded from the definition of an investment company
under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C.
80a-3); and
|
|
|
(j)
|
[ ]
|
Group,
in accordance with Section
240.13d-1(b)(1)(ii)(J).
|
|
|
ITEM
4
|
OWNERSHIP:
The ESOP holds an aggregate of 563,630 shares of Common Stock (9.2% of
the outstanding shares). The ESOP has sole voting power with respect
to shares held by it which have not been allocated to participant
accounts, shared voting power with respect to shares held by it which have
been allocated to participant accounts and sole dispositive power with
respect to all shares (allocated and unallocated) held by the
ESOP.
The Trustee may be deemed to beneficially own the 563,630
shares held by the ESOP. However, the Trustee expressly disclaims
beneficial ownership of all of such shares. Other than the shares
held by the ESOP, the Trustee does not beneficially own any shares of
Common Stock.
Pursuant to the ESOP, participants in the ESOP are entitled to
instruct the Trustee as to the voting of the shares allocated to their
ESOP accounts. On each issue with respect to which shareholders are
entitled to vote, the Trustee is required to vote the shares held by the
ESOP which have not been allocated to participant accounts in the manner
directed under the ESOP.
|
||
|
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:
Not
Applicable.
|
||
|
ITEM
7.
|
IDENTIFICATION
AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING
REPORTED ON BY THE PARENT HOLDING COMPANY:
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. |
CERTIFICATIONS
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 my knowledge and belief, I certify
that the information set forth in this statement is true, complete and
correct.
|
|
Date:
February 13, 2009
|
CITIZENS
COMMUNITY BANCORP, INC.
EMPLOYEE
STOCK OWNERSHIP PLAN
|
||
|
By:
|
/s/ Linda
Shultz
First
Bankers Trust Services, Inc.,
as
Trustee
|
||
| Name: | Linda Shultz | ||
| Title: | Trust Officer | ||
|
Date:
February 13, 2009
|
FIRST
BANKERS TRUST SERVICES, INC.
|
||
|
By:
|
/s/ Linda
Shultz
|
||
| Name: | Linda Shultz | ||
| Title: | Trust Officer | ||
| By: | /s/ Linda Shultz |
|
Name:
Linda Shultz
Title: Trust
Officer
|
| By: | /s/ Linda Shultz |
|
First
Bankers Trust Services, Inc.,
as Trustee
Name:
Linda Shultz
Title: Trust
Officer
|