-----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, WyGUMdvoul15tvqcWV2gTyTOU/9j1AG8H2xbRruROIt0bnhC0Mx9FWMe2EysVcHz 4R6Syyoyo58Fn8c3edehDw== 0000700565-04-000191.txt : 20041216 0000700565-04-000191.hdr.sgml : 20041216 20041216144123 ACCESSION NUMBER: 0000700565-04-000191 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041214 FILED AS OF DATE: 20041216 DATE AS OF CHANGE: 20041216 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: HEDGES JOHN W CENTRAL INDEX KEY: 0001185494 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 041207783 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172580670 MAIL ADDRESS: STREET 1: 4 PINEHURST DRIVE CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_hedges-121404ex.xml X0202 4 2004-12-14 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185494 HEDGES JOHN W 4 PINEHURST DRIVE MATTOON IL 61938 0 1 0 0 Pres First Mid-Illinois Bank Common Stock 375 D Common Stock 574.9830 I By 401K Common Stock 2029.181 I By Deferred Comp Stock Option 15.33 2001-01-01 2009-12-13 Common Stock 4500 4500 D Stock Option 12.56 2002-01-01 2010-12-18 Common Stock 3375 7875 D Stock Option 16.00 2003-01-01 2011-12-18 Common Stock 3375 11250 D Stock Option 18.17 2004-01-01 2012-12-16 Common Stock 4875 16125 D Stock Option 31.00 2005-01-01 2013-12-16 Common Stock 4875 21000 D Stock Option 41.00 2004-12-14 4 A 0 4875 A 2006-01-01 2014-12-14 Common Stock 4875 25875 D Options become exercisable in 4 equal annual installments beginning on 1/1/2001. 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. Options become exercisable in 4 equal annual installments beginning on 1/1/2006. N/A Michael L. Taylor, pursuant to a Power of Attorney filed on 11/01/2002. 2004-12-16 -----END PRIVACY-ENHANCED MESSAGE-----