0001209191-21-008440.txt : 20210208 0001209191-21-008440.hdr.sgml : 20210208 20210208133903 ACCESSION NUMBER: 0001209191-21-008440 CONFORMED SUBMISSION TYPE: 5/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201231 FILED AS OF DATE: 20210208 DATE AS OF CHANGE: 20210208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WURM GERALD B CENTRAL INDEX KEY: 0001193469 FILING VALUES: FORM TYPE: 5/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-36192 FILM NUMBER: 21600634 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/A 1 doc5a.xml FORM 5/A SUBMISSION X0306 5/A 2020-12-31 2021-02-04 0 0 0 0000944745 CIVISTA BANCSHARES, INC. CIVB 0001193469 WURM GERALD B 4905 ALBAUGH ROAD NEW WASHINGTON OH 44854 0 0 0 1 Subsidiary Director Common 2020-11-02 5 J 0 262.081 0.00 A 36811.196 I Trust Common 1275 I Grandson #1 Trust Common 51461 I Trust Common 32253 I Mary L. Wurm Trust Reflects shares in dividend reinvestment. Total of 11/02/2020 reinvestment was 276.609 (14.528 was reported on 02/04/21 + the difference of 262.081 reported in this amended filing) /s/ Amy L. Grant, by Power of Attorney 2021-02-08