-----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, VZwK1rDm9vBnGMdr/Rc38LWNFHE0KAZo13UIKE7AOSFp/OHUgulHfNgsW3xgLIPk p7POwutaIRMX/eE0eEX2mA== 0000700565-05-000016.txt : 20050112 0000700565-05-000016.hdr.sgml : 20050112 20050112120201 ACCESSION NUMBER: 0000700565-05-000016 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041231 FILED AS OF DATE: 20050112 DATE AS OF CHANGE: 20050112 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: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05525212 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 5 1 form5_downs-123104ex.xml X0202 5 2004-12-31 0 0 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 2004-01-30 5 J 0 1.991 46.55 A 233.409 I By 401K Common Stock 2004-03-09 5 P 0 10.158 47.09 A 243.567 I By 401K Common Stock 2004-05-20 5 P 0 3.675 48.44 A 247.242 I By 401K Common Stock 2004-05-25 5 S 0 97.167 49.00 D 150.075 I By 401K Common Stock 2004-06-25 5 J 0 .984 48.75 A 151.059 I By 401K Common Stock 2004-08-23 5 P 0 6.704 32.97 A 233.292 I By 401K Common Stock 2004-11-19 5 P 0 4.377 36.95 A 237.669 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 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. Shares acquired through the Company's dividend reinvestment plan with dividends paid on shares of common stock held. Shares balance has been adjusted to reflect a 3 for 2 stock split that occurred on July 16, 2004. Michael L. Taylor, pursuant to a Power of Attorney filed on 05/29/2003. 2005-01-12 -----END PRIVACY-ENHANCED MESSAGE-----