-----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, HUDxxXm1LUcGpQMNQYexuClwbYrYqZ/w++82bTShMcMQu7/udxI7Ku0bV5NMlb+d s9t2l7XllaCsuxajQzxJ3g== 0000700565-05-000020.txt : 20050112 0000700565-05-000020.hdr.sgml : 20050112 20050112120601 ACCESSION NUMBER: 0000700565-05-000020 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: HEDGES JOHN W CENTRAL INDEX KEY: 0001185494 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05525228 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172580670 MAIL ADDRESS: STREET 1: 4 PINEHURST DRIVE CITY: MATTOON STATE: IL ZIP: 61938 5 1 form5_hedges-123104ex.xml X0202 5 2004-12-31 0 0 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185494 HEDGES JOHN W 4 PINEHURST DRIVE MATTOON IL 61938 0 1 0 0 Pres First Mid-Illinois Bank Common Stock 375 D Common Stock 2004-01-30 5 J 0 4.946 46.55 A 579.929 I By 401K Common Stock 2004-03-09 5 P 0 .037 45.67 A 579.966 I By 401K Common Stock 2004-05-20 5 P 0 .001 30.00 A 579.967 I By 401K Common Stock 2004-06-25 5 J 0 3.807 48.75 A 583.774 I By 401K Common Stock 2004-08-23 5 P 0 .001 30.00 A 875.661 I By 401K Common Stock 2029.181 I By Deferred Comp Stock Option 15.33 2001-01-01 2009-12-13 Common Stock 4500 4500 D Stock Option 12.56 2002-01-01 2010-12-18 Common Stock 3375 7875 D Stock Option 16.00 2003-01-01 2011-12-18 Common Stock 3375 11250 D Stock Option 18.17 2004-01-01 2012-12-16 Common Stock 4875 16125 D Stock Option 31.00 2005-01-01 2013-12-16 Common Stock 4875 21000 D Stock Option 41.00 2006-01-01 2014-12-14 Common Stock 4875 25875 D Options become exercisable in 4 equal annual installments beginning on 1/1/2001. Options become exercisable in 4 equal annual installments beginning on 1/1/2002. Options become exercisable in 4 equal annual installments beginning on 1/1/2003. 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. Share 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 11/01/2002. 2005-01-12 -----END PRIVACY-ENHANCED MESSAGE-----