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