0001209191-19-059975.txt : 20191211 0001209191-19-059975.hdr.sgml : 20191211 20191211101307 ACCESSION NUMBER: 0001209191-19-059975 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191210 FILED AS OF DATE: 20191211 DATE AS OF CHANGE: 20191211 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FRIEDLEY BLYTHE A CENTRAL INDEX KEY: 0001078308 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36192 FILM NUMBER: 191279118 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 2019-12-10 0 0000944745 CIVISTA BANCSHARES, INC. CIVBP 0001078308 FRIEDLEY BLYTHE A 423 WEST MAIN STREET NEW WASHINGTON OH 44854 0 0 0 1 Subsidiary Director Common 2019-12-10 4 J 0 555 0.00 D 11194 I Trusteee on Arlene M. Friedley CRUT Trust Common 2019-12-10 4 J 0 555 0.00 A 59667 I Trust Common 2019-12-10 4 C 0 639 7.82 A 11662 I Trusts Depositary Shares 2019-12-10 4 C 0 200 7.82 D 0 I BLYTHE A FRIEDLEY TRUST UAD 2/23/99 Common 4766 I TTEE on Arlene M. Friedley Trust Common 2878 D Transferred shares from CRUT account to Trust account. The reporting person exercised her right to convert depositary shares into common shares(based on a conversion ratio of 3.196931 common shares for each depositary share)effective December 10, 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 2019-12-11