-----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, Q/9Czvn2pAk/xzORxq8FKnG+3wCZDT6wiWwFE2YvRHFHv+TK3V8IvEZXoepl6Ml7 AuLAM0vAkylv90Ijx/ibtw== 0000700565-05-000028.txt : 20050112 0000700565-05-000028.hdr.sgml : 20050112 20050112121255 ACCESSION NUMBER: 0000700565-05-000028 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: SWIFT ROBERT J CENTRAL INDEX KEY: 0001185504 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05525243 BUSINESS ADDRESS: STREET 1: 1515 CHARLESTON AVE CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172580652 MAIL ADDRESS: STREET 1: 6807 N COUNTRY CLUB ROAD CITY: MATTOON STATE: IL ZIP: 61938 5 1 form5_swift-123104ex.xml X0202 5 2004-12-31 0 0 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001185504 SWIFT ROBERT J 6807 N COUNTRY CLUB ROAD MATTOON IL 61938 0 1 0 0 EVP for Trust Common Stock 2004-01-30 5 J 0 5.521 46.55 A 647.247 I By 401K Common Stock 2004-03-09 5 P 0 104.531 47.07 A 751.778 I By 401K Common Stock 2004-05-20 5 P 0 18.164 48.37 A 769.942 I By 401K Common Stock 2004-06-25 5 J 0 5.054 48.75 A 774.996 I By 401K Common Stock 2004-08-23 5 P 0 28.824 32.99 A 1191.318 I By 401K Common Stock 2004-11-19 5 P 0 19.945 36.96 A 1211.263 I By 401K Common Stock 1284.023 I By Deferred Comp Stock Options 12.56 2005-01-01 2010-12-18 Common Stock 843.75 843.75 D Stock Options 16.00 2005-01-01 2011-12-18 Common Stock 1687.50 2531.25 D Stock Options 18.17 2005-01-01 2012-12-16 Common Stock 2531.25 5062.5 D Stock Options 31.00 2005-01-01 2013-12-16 Common Stock 3375 8437.5 D Stock Options 41.00 2006-01-01 2014-12-14 Common Stock 3375 11812.5 D Options become exercisable on 1/1/2005. Options become exercisable in 2 equal annual installments beginning on 1/1/2005. Options become exercisable in 3 equal annual installments beginning on 1/1/2005. 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 dividned 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 11/1/2002. 2005-01-12 -----END PRIVACY-ENHANCED MESSAGE-----