-----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, VMYXyHaHzKeOyunqww0ZIbYuDxz4AN/Kko5EvyhIbPjjDPO6kzpFm9oaKm+9uk2d 09sCK/SMJW0I203DAd/kwA== 0000700565-05-000008.txt : 20050103 0000700565-05-000008.hdr.sgml : 20041231 20050103141534 ACCESSION NUMBER: 0000700565-05-000008 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041231 FILED AS OF DATE: 20050103 DATE AS OF CHANGE: 20050103 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: ADAMS CHARLES A /TX CENTRAL INDEX KEY: 0001185704 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05501816 BUSINESS ADDRESS: STREET 1: 1020 N 13TH STREET CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 217234-8877 MAIL ADDRESS: STREET 1: 21 ST. ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_adams-123104ex.xml X0202 4 2004-12-31 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185704 ADAMS CHARLES A /TX 1020 N 13TH STREET MATTOON IL 61938 1 0 0 0 Common Stock 83541.047 D Common Stock 5171.615 I By Wife Common Stock 252006.077 I Howell Paving, Inc. Common Stock 2004-12-31 4 P 0 165.782 37.00 A 28446.455 I By Deferred Compensation Plan Stock Options 31.00 2003-12-16 2013-12-16 Common Stock 2250 2250 D Stock Options 41.00 2004-12-14 2014-12-14 Common Stock 2250 4500 D Michael L. Taylor, Pursuant to a Power of Attorney filed 11/1/02 2005-01-03 -----END PRIVACY-ENHANCED MESSAGE-----