-----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, G3+6OW08s1NQZ3jyp8mUI47hcjjSHgQA6Nq1bqkUJQRVImDaqLyk4SxkN0rndkfS EbB16HTCj8E1Y4oYMLn8ag== 0000700565-04-000032.txt : 20040206 0000700565-04-000032.hdr.sgml : 20040206 20040206163904 ACCESSION NUMBER: 0000700565-04-000032 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040206 ISSUER: 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 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TAYLOR MICHAEL L CENTRAL INDEX KEY: 0001185497 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 04574789 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172583306 MAIL ADDRESS: STREET 1: 19 CAMBRIDGE DRIVE CITY: MATTOON STATE: IL ZIP: 61938 5 1 form5_taylor-123103ex.xml X0201 5 2003-12-31 0 0 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185497 TAYLOR MICHAEL L 19 CAMBRIDGE DRIVE MATTOON IL 61938 0 1 0 0 Chief Financial Officer Common Stock 159.023 D Common Stock 2003-08-22 5 P 0 3.370 42.58 A 134.10 I By 401K Common Stock 2003-12-10 5 P 0 4.665 46.35 A 138.766 I By 401k Stock Option 18.83 2002-01-01 2010-12-18 Common Stock 2250 2250 D Stock Option 24.00 2003-01-01 2011-12-18 Common Stock 2250 4500 D Stock Option 27.25 2004-01-01 2012-12-16 Common Stock 2250 6750 D Stock Option 46.50 2005-01-01 2013-12-16 Common Stock 2250 9000 D Options become exercisable in 4 equal annual installments beginning on 1/1/2002. Options become exercisable in 4 equal annual installments beginning on 1/1/2003. Options become exercisable in 4 equal annual installments beginning on 1/1/2004. Options become exercisable in 4 equal annual installments beginning on 1/1/2005. Michael L. Taylor 2004-02-06 -----END PRIVACY-ENHANCED MESSAGE-----