0001209191-16-096311.txt : 20160208 0001209191-16-096311.hdr.sgml : 20160208 20160208143346 ACCESSION NUMBER: 0001209191-16-096311 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: HECKELMAN JAMES D CENTRAL INDEX KEY: 0001193427 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36192 FILM NUMBER: 161395298 MAIL ADDRESS: STREET 1: 100 EAST WATER STREET CITY: SANDUSKY STATE: OH ZIP: 44870 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2015-12-31 0 0 0 0000944745 CIVISTA BANCSHARES, INC. CIVB 0001193427 HECKELMAN JAMES D 4694 OLD STATE ROAD NORWALK OH 44857 0 0 0 1 Director Emeritus Common 2015-12-31 5 J 0 51.539 0.00 A 2785.468 I IRA Common 2015-12-31 5 J 0 51.539 0.00 A 2785.468 I Spouse IRA Common 9518 I Spouse Common 9517 D Depositary Shares 2500 I James D Heckelman Trust UAD 6/1/06 Depositary Shares 2500 I Margaret F Heckelman Trust UAD 6/1/06 End of year - common shares acquired on company dividend reinvestment feature. /s/James D Heckelman 2016-02-08