-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Fd3y2Nya+2ZCDCtfUg7NFkNSAsPT3jRo7I03Si0ZBJOmk6TE0Nawhk/NgU6fyb/m q84k06FW+g5+MkZnHKotTQ== 0000700565-03-000049.txt : 20030328 0000700565-03-000049.hdr.sgml : 20030328 20030328100651 ACCESSION NUMBER: 0000700565-03-000049 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20030328 FILED AS OF DATE: 20030328 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LUMPKIN RICHARD ANTHONY CENTRAL INDEX KEY: 0000925184 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: 121 SOUTH 17TH STREET CITY: MATTOON STATE: IL ZIP: 61938 MAIL ADDRESS: STREET 1: 121 SOUTH 17TH STREET CITY: MATTOON STATE: IL ZIP: 61938 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: FIRST MID ILLINOIS BANCSHARES INC CENTRAL INDEX KEY: 0000700565 STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022] IRS NUMBER: 371103704 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 03622863 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE STREET 2: PO BOX 499 CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172347454 MAIL ADDRESS: STREET 1: 1515 CHARLESTON AVENUE STREET 2: PO BOX 499 CITY: MATTOON STATE: IL ZIP: 61938 4/A 1 form-4_lumpkin32803amend.txt RICHARD A. LUMPKIN U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* LUMPKIN RICHARD A. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 121 SOUTH 17TH STREET, P.O. BOX 1234 - -------------------------------------------------------------------------------- (Street) MATTOON IL 61938 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol FIRST MID-ILLINOIS BANCSHARES, INC. (FMBH.OB) - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year March 28, 2003 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) August 2002 - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person - -------------------------------------------------------------------------------- ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 01/04/02 J(1) V(7) 1,063.063 A $23.70 D - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 06/14/02 J(1) V(7) 2,979.338 A $25.25 330,058.866 (2) D - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 01/04/02 J(1) V(7) 2,215.930 A $23.70 (2) I (4) - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 01/04/02 J(1) V(7) 2,215.930 A $23.70 I (5) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 02/26/02 J(3) 221,038.993 D I (5) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 01/04/02 J(1) V(7) 670.722 A $23.70 I (6) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 06/14/02 J(1) V(7) 609.428 A $25.25 67,513.984 I (6) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 01/04/02 J(1) V(7) 187.642 A $23.70 I DEF COMP - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 03/31/02 P V(7) 166.365 A $23.70 I DEF COMP - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 06/30/02 P V(7) 146.223 A $25.28 19,029.8631 I DEF COMP - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Response) (Over) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 4,750 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) SHARES PURCHASED THROUGH COMPANY'S DIVIDEND REINVESTMENT PLAN WITH DIVIDENDS PAID ON SHARES OF COMMON STOCK HELD. (2) DUE TO THE TERMINATION OF THE RICHARD A LUMPKIN TRUST UNDER ARTICLE V OF THE MARY G LUMPKIN TRUST DATED 1/31/84, 221,038.993 SHARES WERE TRANSFERRED TO MR. LUMPKIN ON 2/5/02 AND ARE NOW HELD DIRECTLY BY MR. LUMPKIN AND ARE INCLUDED AS PART OF HIS 330,058.866 SHARES. (3) DUE TO THE TERMINATION OF THE MARY LEE SPARKS TRUST UNDER ARTICLE V OF THE MARY G. LUMPKIN TRUST DATED 1/31/84, MR. LUMPKIN IS NO LONGER TRUSTEE OF THESE SHARES. THE SHARES WERE TRANSFERRED DIRECTLY TO MS. SPARKS ON 2/26/02 AND ARE NO LONGER REPORTABLE BY MR. LUMPKIN. (4) BY SELF AS TRUSTEE OF RICHARD A. LUMPKIN TRUST (5) BY SELF AS TRUSTEE OF THE MARY LEE SPARKS TRUST (6) SKL INVESTMENT GROUP R.A.LUMPKIN VOTING MEMBER (7) THE REPORTING PERSON FILED A FORM 4 ON AUGUST 2002 THAT INADVERTENTLY OMITTED THE "V" TRANSACTION CODE. THIS FORM 4 HAS BEEN AMENDED TO INCLUDE THE "V" TRANSACTION CODE TO INDICATE THAT THE TRANSACTION WAS VOLUNTARILY REPORTED EARLIER THAN REQUIRED. /S/ WILLIAM S. ROWLAND, PURSUANT TO A POWER OF ATTORNEY FILED CONTEMPORANEOUSLY HEREWITH 03/28/03 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Page 2 EX-24 2 powerofatt_lumpkin.txt RICHARD A. LUMPKIN 1 POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of William S. Rowland and Michael L. Taylor, signing singly, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as a beneficial owner of more than 10 percent of any class of equity security registered pursuant to Section 12 of the Securities Exchange Act of 1934, as amended (the "Act"), of and/or an officer and/or director of First Mid-Illinois Bancshares, Inc. (the "Company"), Forms ID, 3, 4, and 5 in accordance with Section 16(a) of the Act and the rules thereunder; (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form ID, 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact's discretion. The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Act. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms ID, 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 27th day of August, 2002. /s/ Richard A. Lumpkin ---------------------------- Print Name: Richard A. Lumpkin -----END PRIVACY-ENHANCED MESSAGE-----