-----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, OkBGlZaY96hVDHa2X/OZSJc3FOSRWNgiD3/I0t1QNmKQS1WQgJOFXpJN2WvphV0W 7DKDLHI+56CV43FjwKrQMA== 0000700565-04-000206.txt : 20041216 0000700565-04-000206.hdr.sgml : 20041216 20041216145522 ACCESSION NUMBER: 0000700565-04-000206 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: MARVIN DANIEL E JR CENTRAL INDEX KEY: 0001186266 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 041207902 BUSINESS ADDRESS: BUSINESS PHONE: 2172352015 MAIL ADDRESS: STREET 1: 12 ST ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_marvin-121404ex.xml DANIEL E. MARVIN, JR. FORM 4 X0202 4 2004-12-14 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001186266 MARVIN DANIEL E JR 20 GREENBRIAR MATTOON IL 61938 1 0 0 0 Common Stock 25282 D Common Stock 19750 I By Wife Common Stock 23950.386 I By IRA Common Stock 2293.986 I Cust for minor grandchildren Common Stock 6856.996 I By Deferred Comp Stock Options 14.99 1999-01-01 2008-01-12 Common Stock 5625 5625 D Stock Options 15.55 2000-01-01 2008-12-22 Common Stock 5625 11250 D Stock Options 15.33 1999-12-13 2009-12-13 Common Stock 1125 12375 D Stock Options 12.55 2000-12-18 2010-12-18 Common Stock 1125 13500 D Stock Options 16.00 2001-12-18 2011-12-18 Common Stock 1500 15000 D Stock Options 18.17 2002-12-16 2012-12-16 Common Stock 1500 16500 D Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 18750 D Stock Option 41.00 2004-12-14 4 A 0 2250 A 2004-12-14 2014-12-14 Common Stock 2250 21000 D 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. N/A Michael L. Taylor, pursuant to a power of attorney filed 11/01/2002 2004-12-16 -----END PRIVACY-ENHANCED MESSAGE-----