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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
( ) Check box if no longer subject to Section 16.
Form 4 or Form 5 obligations may continue. See Instructions 1(b).
(X) Form 3 Holdings Reported
( ) Form 4 Transactions Reported
1. Name and Address of Reporting Person
Klein, David E.
P.O. Box 1191
Marco Island, FL 34146
USA
2. Issuer Name and Ticker or Trading Symbol
Citizens Community Bancorp, Inc.
CCBI
3. IRS or Social Security Number of Reporting Person (Voluntary)
###-##-####
4. Statement for Month/Year
12/97
5. If Amendment, Date of Original (Month/Year)
6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
( ) Director ( ) 10% Owner ( ) Officer (give title below) (X) Other
(specify below)
Officer of Subsidiary
Executive Vice President
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Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect |
|Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership |
|Date |Code| | Beneficially |(D)or | |
| | | | A/| | Owned at |Indir | |
| | | Amount | D | Price | End of Year |ect(I)| |
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Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned |
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of|
Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect |
|or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial |
|cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership |
|ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | |
|Deriva | | | |Date |Expir| | |ficially |Ind| |
|tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| |
|Secu | | | | D |cisa-|Date | of Shares | |End of |ct | |
|rity | | | Amount | |ble | | | |Year |(I)| |
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Options (1) |$5.50 |8/19 |A3(2)| 600 | |8/19 |8/18 |Common Stock | | -- | | | |
| |1997 | | | |/2000|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$5.50 |8/19 |A3(2)| 600 | |8/19 |8/18 |Common Stock | | -- | | | |
| |1997 | | | |/2001|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$5.50 |8/19 |A3(2)| 600 | |8/19 |8/18 |Common Stock | | -- | | | |
| |1997 | | | |/2002|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$6.00 |10/21|A3(2)| 600 | |10/21|10/20|Common Stock | | -- | | | |
| |1997 | | | |/1998|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$6.00 |10/21|A3(2)| 600 | |10/21|10/20|Common Stock | | -- | | | |
| |1997 | | | |/1999|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$6.00 |10/21|A3(2)| 600 | |10/21|10/20|Common Stock | | -- | | | |
| |1997 | | | |/2000|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$6.00 |10/21|A3(2)| 600 | |10/21|10/20|Common Stock | | -- | | | |
| |1997 | | | |/2001|/2007|Par Value $.01| 600| | 600 | D | |
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Options (1) |$6.00 |10/21|A3(2)| 600 | |10/21|10/20|Common Stock | | -- | | | |
| |1997 | | | |/2002|/2007|Par Value $.01| 600| | 600 | D | |
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Explanation of Responses:
(1) Shares and exercise price adjusted to reflect two-for-one stock split
on 12/15/97.
(2) Employment commenced at Citizens Community Bank in April 1997.
/S/ David E. Klein 2/10/98
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** Signature of Reporting Person Date
