-----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, RKVYyXFLKBrKPNgFeLkiQJYnNE8MwoR/GqUM9kTQZmYTkpKwmnQxYcLD8SdJaHCa mgVi1EUaZpXyZRBAvbNi0w== 0000700565-05-000014.txt : 20050103 0000700565-05-000014.hdr.sgml : 20041231 20050103141942 ACCESSION NUMBER: 0000700565-05-000014 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: MELVIN GARY W CENTRAL INDEX KEY: 0001185506 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05501854 BUSINESS ADDRESS: STREET 1: 4216 DEWITT AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172357101 MAIL ADDRESS: STREET 1: RR1, BOX 226 CITY: SULLIVAN STATE: IL ZIP: 61951 4 1 form4_melvin-123104ex.xml X0202 4 2004-12-31 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185506 MELVIN GARY W RR 1, BOX 226 SULLIVAN IL 61951 1 0 0 0 Common Stock 152686.459 D Common Stock 2004-12-31 4 P 0 158.856 37.00 A 23860.731 I By Deferred Comp Stock Option 10.45 1997-10-21 2007-10-21 Common Stock 1125 1125 D Stock Option 14.99 1997-12-15 2008-01-12 Common Stock 1125 2250 D Stock Option 15.55 1998-12-15 2008-12-22 Common Stock 1125 3375 D Stock Option 15.33 1999-12-13 2009-12-13 Common Stock 1125 4500 D Stock Option 12.55 2000-12-18 2010-12-18 Common Stock 1125 5625 D Stock Option 16.00 2001-12-18 2011-12-18 Common Stock 1500 7125 D Stock Option 18.17 2002-12-16 2012-12-16 Common Stock 1500 8625 D Stock Option 31.00 2003-12-16 2013-12-16 Common Stock 2250 10875 D Stock Option 41.00 2004-12-14 2014-12-14 Common Stock 2250 13125 D Michael L. Taylor, pursuant to a power of attorney 11/1/02 2005-01-03 -----END PRIVACY-ENHANCED MESSAGE-----