0001209191-16-096308.txt : 20160208 0001209191-16-096308.hdr.sgml : 20160208 20160208134418 ACCESSION NUMBER: 0001209191-16-096308 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151231 FILED AS OF DATE: 20160208 DATE AS OF CHANGE: 20160208 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CIVISTA BANCSHARES, INC. CENTRAL INDEX KEY: 0000944745 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 341558688 STATE OF INCORPORATION: OH FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 EAST WATER ST STREET 2: P O BOX 5016 CITY: SANDUSKY STATE: OH ZIP: 44870 BUSINESS PHONE: 4196254121 MAIL ADDRESS: STREET 1: 100 EAST WATER ST STREET 2: P O BOX 5016 CITY: SANDUSKY STATE: OH ZIP: 44870 FORMER COMPANY: FORMER CONFORMED NAME: FIRST CITIZENS BANC CORP /OH DATE OF NAME CHANGE: 19950502 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FRIEDLEY BLYTHE A CENTRAL INDEX KEY: 0001078308 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36192 FILM NUMBER: 161395090 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2015-12-31 0 0 0 0000944745 CIVISTA BANCSHARES, INC. CIVB 0001078308 FRIEDLEY BLYTHE A 423 WEST MAIN STREET NEW WASHINGTON OH 44854 0 0 0 1 Subsidiary Director Common 2015-12-31 5 J 0 730 0.00 D 13799 I Trusteee on Arlene M. Friedley CRUT Trust Common 2015-12-31 5 J 0 730 0.00 A 57062 I Trust Common 210 D Common 11023 I Trusts Common 4766 I TTEE on Arlene M. Friedley Trust Depositary Shares 200 I BLYTHE A FRIEDLEY TRUST UAD 2/23/99 End of year - transferred shares from CRUT account to Trust account. /s/Blythe A Friedley 2016-02-08