-----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, DdqYpZKHVu77og20R3pnmWkpmFRYMPnvBrQr2gY6Tle2hQSbK5ir00ToemMQoS6G WyyKYOX4PvFJDOAKWaO0jQ== 0000700565-04-000160.txt : 20041001 0000700565-04-000160.hdr.sgml : 20041001 20041001084130 ACCESSION NUMBER: 0000700565-04-000160 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040930 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 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: SPARKS RAY A CENTRAL INDEX KEY: 0001012163 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 041056596 BUSINESS ADDRESS: STREET 1: 30 S COUNTY CLUB ROAD CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172588741 MAIL ADDRESS: STREET 1: 30 S COUNTRY CLUB RD CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_sparks-093004ex.xml X0202 4 2004-09-30 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001012163 SPARKS RAY A 30 S COUNTY CLUB ROAD MATTOON IL 61938 1 0 0 0 Common Stock 2004-06-18 5 J 0 24.914 48.75 A 5730.605 I By Wife Common Stock 2004-06-18 5 J 0 250.778 48.75 A 57682.916 I By Sparks Investment Group Common Stock 2004-06-18 5 J 0 471.158 48.75 A 105598.725 D Common Stock 2004-06-18 5 J 0 47.976 48.75 A 7356.846 I By Deferred Comp Common Stock 2004-09-30 4 P 0 169.016 32.50 A 11204.285 I By Deferred Comp Common Stock 675 I By Child Common Stock 2100 I By The Sparks Foundation Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 2250 D Shares purchased through the company's dividend reinvestment plan with dividends paid on shares of common stock held. Share balance has been adjusted to reflect a 3 for 2 stock split that occurred on July 16, 2004. Michael L. Taylor, pursuant to a power of attorney filed 09/06/2002 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----