0001209191-19-059573.txt : 20191209 0001209191-19-059573.hdr.sgml : 20191209 20191209132840 ACCESSION NUMBER: 0001209191-19-059573 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191206 FILED AS OF DATE: 20191209 DATE AS OF CHANGE: 20191209 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLER JAMES O CENTRAL INDEX KEY: 0001193441 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36192 FILM NUMBER: 191274870 MAIL ADDRESS: STREET 1: 100 EAST WATER STREET CITY: SANDUSKY STATE: OH ZIP: 44870 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-12-06 0 0000944745 CIVISTA BANCSHARES, INC. CIVBP 0001193441 MILLER JAMES O 3922 DEERPATH DRIVE SANDUSKY OH 44870 1 0 0 1 Chairman of the Board Common 2019-12-06 4 C 0 4475 7.82 A 8715 I IRA Common 2019-12-06 4 C 0 1918 7.82 A 5718 I Spouse IRA Depositary Shares 2019-12-06 4 C 0 600 7.82 D 0 I FBO MARTHA M MILLER IRA 900183013 Depositary Shares 2019-12-06 4 C 0 1400 7.82 D 0 D Common 2000 D Common 9406 D The reporting person exercised his right to convert depositary shares into common shares(based on a conversion ratio of 3.196931 common shares for each depositary share)effective December 6, 2019. Each depositary share represented 1/40th interest in a share of the Company's 6.50% Series B Preferred Shares and was convertible into common shares at any time. /s/Amy L. Grant, by Power of Attorney 2019-12-09