-----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, HALi46w5A2/SmX9OdX7lJ9bcvXh71+iXQp1zwR4zyw1QH4HKpCieHgns7QgRAfYy H/9CGPxFBF/AIeqDl+LB6w== 0000700565-04-000144.txt : 20040818 0000700565-04-000144.hdr.sgml : 20040818 20040818122611 ACCESSION NUMBER: 0000700565-04-000144 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040817 FILED AS OF DATE: 20040818 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MARVIN DANIEL E JR CENTRAL INDEX KEY: 0001186266 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 04983562 BUSINESS ADDRESS: STREET 1: 12 ST ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172352015 MAIL ADDRESS: STREET 1: 12 ST ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_marvin-081704ex.xml DANIEL E. MARVIN, JR. FORM 4 X0202 4 2004-08-17 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001186266 MARVIN DANIEL E JR 12 ST. ANDREWS PLACE MATTOON IL 61938 1 0 0 0 Common Stock 2004-08-17 4 G 0 350 D 20782.00 D Common Stock 21913 I By Wife Common Stock 2004-06-18 5 J 0 91.872 48.75 A 23950.386 I By IRA Common Stock 2004-06-18 5 J 0 8.676 48.75 A 1330.325 I Cust for minor grandchildren Common Stock 2004-08-17 4 G 0 300.00 A 2293.986 I Cust for minor grandchildren Common Stock 2004-06-18 5 J 0 29.811 48.75 A 6856.996 I By Deferred Comp Stock Options 10.45 2000-10-21 2007-10-21 Common Stock 4500 4500 D Stock Options 14.99 1999-01-01 2008-01-12 Common Stock 5625 10125 D Stock Options 15.55 2000-01-01 2008-12-22 Common Stock 5625 15750 D Stock Options 15.33 1999-12-13 2009-12-13 Common Stock 1125 16875 D Stock Options 12.55 2000-12-18 2010-12-18 Common Stock 1125 18000 D Stock Options 16.00 2001-12-18 2011-12-18 Common Stock 1500 19500 D Stock Options 18.17 2002-12-16 2012-12-16 Common Stock 1500 21000 D Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 23250 D Options became exercisable as follows: 281.25 on 10/21/2000; 4,218.75 on 10/21/2001. Options become exercisable in 4 equal annual installments beginning on 1/1/1999. Options become exercisable in 4 equal annual installments beginning on 1/1/2000. The share balance has been adjusted to reflect a 3 for 2 stock split that ocurred on July 16, 2004. On August 17, 2004 Mr. Marvin gifted 300 shares to his grandchildren and 50 shares to Eastern Illinois University. Shares acquired through the Company's dividend reinvestment plan with dividends paid on shares of common stock held. Michael L. Taylor, pursuant to a power of attorney filed11/01/2002 2004-08-18 -----END PRIVACY-ENHANCED MESSAGE-----