-----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, MCb7npGzWtiRJVkUdzyH39TaFt+ntU5Zpw833jqR7CNDfFgvmS44vvXPLzc0NlJd xTKyb6tRrl8QtJQusmAL/Q== 0000700565-04-000220.txt : 20041216 0000700565-04-000220.hdr.sgml : 20041216 20041216150643 ACCESSION NUMBER: 0000700565-04-000220 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: DOWNS KELLY A CENTRAL INDEX KEY: 0001233427 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 041207968 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172580487 MAIL ADDRESS: STREET 1: 1 HANCE DRIVE CITY: CHARLESTON STATE: IL ZIP: 61920 4 1 form4_downs-121404ex.xml KELLY DOWNS X0202 4 2004-12-14 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001233427 DOWNS KELLY A 1 HANCE DRIVE CHARLESTON IL 61920 0 1 0 0 VP, Director of Human Resource Common Stock 231.418 I By 401K Stock Options 18.17 2004-01-01 2012-12-16 Common Stock 1500 1500 D Stock Options 31.00 2005-01-01 2013-12-16 Common Stock 2250 3750 D Stock Options 41.00 2004-12-14 4 A 0 2250 A 2006-01-01 2014-12-14 Common Stock 2250 6000 D 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 Share balance has been adjusted to reflect a 3 for 2 stock split that ocurred on July 16, 2004. Michael L. Taylor, pursuant to a Power of Attorney filed on 05/29/2003. 2004-12-16 -----END PRIVACY-ENHANCED MESSAGE-----