-----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, Erg975GY1f9vv4ABuqKoETJLEJJ4PZbRUC5IYsJLPK+v3q4Mb5ESeRAtzLoUpyd+ Ciog21+xbXMBAq5gH+k6bQ== 0000700565-04-000210.txt : 20041216 0000700565-04-000210.hdr.sgml : 20041216 20041216145854 ACCESSION NUMBER: 0000700565-04-000210 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: GRISSOM STEVEN L CENTRAL INDEX KEY: 0001073304 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 041207923 BUSINESS ADDRESS: STREET 1: C/O CONSOLIDATED COMMUNICATIONS INC STREET 2: 121 S 17TH ST CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172354410 MAIL ADDRESS: STREET 1: CONSOLIDATED COMMUNICATIONS INC STREET 2: 121 S 17TH ST CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_grissom-121404ex.xml X0202 4 2004-12-14 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001073304 GRISSOM STEVEN L C/O CONSOLIDATED COMMUNICATIONS INC 121 S 17TH ST MATTOON IL 61938 1 0 0 0 Common Stock 26137.415 D Common Stock 127983.616 I By Trust Common Stock 127983.616 I By Trust Stock Options 12.55 2000-12-18 2010-12-18 Common Stock 1125 1125 D Stock Options 16.00 2001-12-18 2011-12-18 Common Stock 1500 2625 D Stock Options 18.17 2002-12-16 2012-12-16 Common Stock 1500 4125 D Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 6375 D Stock Option 41.00 2004-12-14 4 A 0 2250 A 2004-12-14 2014-12-14 Common Stock 2250 8625 D BY MR. GRISSOM AS CO-TRUSTEE OF THE RICHARD ANTHONY LUMPKIN 1990 PERSONAL INCOME TRUST FOR THE BENEFIT OF BENJAMIN IVERSON LUMPKIN DATED 4/20/90. MR. GRISSOM DISCLAIMS BENEFICIAL OWNERSHIP OF THESE SHARES. BY MR. GRISSOM AS CO-TRUSTEE OF THE RICHARD ANTHONY LUMPKIN 1990 PERSONAL INCOME TRUST FOR THE BENEFIT OF ELIZABETH ARABELLA LUMPKIN CELIO DATED 4/20/90. MR. GRISSOM DISCLAIMS BENEFICIAL OWNERSHIP OF THESE SHARES. N/A Michael L. Taylor, Pursuant to a Power of Attorney filed on 12/19/2002 2004-12-16 -----END PRIVACY-ENHANCED MESSAGE-----