0001209191-20-007139.txt : 20200206
0001209191-20-007139.hdr.sgml : 20200206
20200206154355
ACCESSION NUMBER: 0001209191-20-007139
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191231
FILED AS OF DATE: 20200206
DATE AS OF CHANGE: 20200206
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WURM GERALD B
CENTRAL INDEX KEY: 0001193469
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36192
FILM NUMBER: 20582543
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
5
1
doc5.xml
FORM 5 SUBMISSION
X0306
5
2019-12-31
0
0
0
0000944745
CIVISTA BANCSHARES, INC.
CIVBP
0001193469
WURM GERALD B
4905 ALBAUGH ROAD
NEW WASHINGTON
OH
44854
0
0
0
1
Subsidiary Director
Common
2019-12-31
5
J
0
2878
0.00
A
34777
I
Trust
Common
2019-12-31
5
J
0
0.81
0.00
D
31899
I
Trust
Common
2019-12-31
5
J
0
2878
0.00
D
0
D
Common
1275
I
Grandson #1 Trust
Common
51461
I
Trust
Common
21900
I
Mary L. Wurm Trust
Transferred shares to Trust.
/s/Amy L. Grant, by Power of Attorney
2020-02-06