-----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, JigxZgFBQhyLj2mVdK7igvvkboShfX2jJ6eIve2bUZSlcx8mUf7pc3TFCFplp/W2 5Hmyaaq/7m5sh+rSEuK0ig== 0000700565-04-000166.txt : 20041001 0000700565-04-000166.hdr.sgml : 20041001 20041001084814 ACCESSION NUMBER: 0000700565-04-000166 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040930 FILED AS OF DATE: 20041001 DATE AS OF CHANGE: 20041001 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: 041056602 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-093004ex.xml RICHARD A. LUMPKIN 020904 X0202 4 2004-09-30 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 2004-06-18 5 J 0 785.017 48.75 A 180566.245 D Common Stock 2004-06-18 5 J 0 291.239 48.75 A 66989.408 I By SKL Investment Group, R.A. Lumpkin voting member Common Stock 2004-06-18 5 J 0 164.103 48.75 A 37746.154 I By Trust Common Stock 2004-06-18 5 J 0 136.932 48.75 A 20997.693 I By Deferred Comp Common Stock 2004-09-30 4 P 0 154.250 32.50 A 31650.790 I By Deferred Comp Stock Option 10.45 1997-10-21 2007-10-21 Common Stock 1125 1125 D Stock Option 14.99 1997-12-15 2008-01-12 Common Stock 1125 2250 D Stock Option 15.55 1998-12-15 2008-12-22 Common Stock 1125 3375 D Stock Option 15.33 1999-12-13 2009-12-13 Common Stock 1125 4500 D Stock Option 12.55 2000-12-18 2010-12-18 Common Stock 1125 5625 D Stock Option 16.00 2001-12-18 2011-12-18 Common Stock 1500 7125 D Stock Option 18.17 2002-12-16 2012-12-16 Common Stock 1500 8625 D Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 10875 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 12/19/2002 2004-10-01 -----END PRIVACY-ENHANCED MESSAGE-----