-----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, AqLWRWhUrNwudJT9bwV59rTF1ueu+UAjvP2Rp0M+dvBNXQT3vdiTLhOeFWNFuUHC lDDepWTSWFeS76lP9r5f1A== 0000700565-04-000124.txt : 20040701 0000700565-04-000124.hdr.sgml : 20040701 20040701094034 ACCESSION NUMBER: 0000700565-04-000124 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040630 FILED AS OF DATE: 20040701 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LUMPKIN RICHARD ANTHONY CENTRAL INDEX KEY: 0000925184 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 04893059 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 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 FORMER COMPANY: FORMER CONFORMED NAME: FIRST-MID ILLINOIS BANCSHARES INC DATE OF NAME CHANGE: 19920703 4 1 form4_lumpkin-063004ex.xml RICHARD A. LUMPKIN 020904 X0202 4 2004-06-30 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0000925184 LUMPKIN RICHARD ANTHONY 121 SOUTH 17TH STREET MATTOON IL 61938 1 0 0 0 Common Stock 119592.479 D Common Stock 44368.367 I By SKL Investment Group, R.A. Lumpkin voting member Common Stock 25000.00 I By Trust Common Stock 2004-06-30 4 P 0 101.800 48.00 A 20860.761 I By Deferred Comp Stock Option 15.67 1997-10-21 2007-10-21 Common Stock 750 750 D Stock Option 22.49 1997-12-15 2008-01-12 Common Stock 750 1500 D Stock Option 23.33 1998-12-15 2008-12-22 Common Stock 750 2250 D Stock Option 23 1999-12-13 2009-12-13 Common Stock 750 3000 D Stock Option 18.83 2000-12-18 2010-12-18 Common Stock 750 3750 D Stock Option 24 2001-12-18 2011-12-18 Common Stock 1000 4750 D Stock Option 27.25 2002-12-16 2012-12-16 Common Stock 1000 5750 D Stock Option 46.50 2003-12-16 2013-12-16 Common Stock 1500 7250 D Michael L. Taylor, pursuant to a power of attorney filed 12/19/2002 2004-07-01 -----END PRIVACY-ENHANCED MESSAGE-----