-----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, Ts3iq9RWNbgDkLVGAGJ24fAvy4+M3MAWdkzrUbnsGbtG7Bgm+oQTzUbQZZ98krs9 PgiPTenWz94Ogvo1agumVg== 0000700565-05-000085.txt : 20050314 0000700565-05-000085.hdr.sgml : 20050314 20050314105203 ACCESSION NUMBER: 0000700565-05-000085 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050311 FILED AS OF DATE: 20050314 DATE AS OF CHANGE: 20050314 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: Dively Joseph R CENTRAL INDEX KEY: 0001301318 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 05677366 BUSINESS ADDRESS: BUSINESS PHONE: 217-348-1800 MAIL ADDRESS: STREET 1: 13179 E. COUNTY ROAD 720N CITY: CHARLESTON STATE: IL ZIP: 61920 4 1 form4_dively-031105ex.xml JOSEPH DIVELY X0202 4 2005-03-11 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001301318 Dively Joseph R 13179 E. COUNTY ROAD 720N CHARLESTON IL 61920 1 0 0 0 Common Stock 600 D Common Stock 2005-03-11 4 P 0 122.297 41.00 A 122.297 I By Deferred Comp Stock Option 41.00 2004-12-14 2014-12-14 Common Stock 2250 2250 D Michael L. Taylor, pursuant to a Power of Attorney filed on 8/25/04. 2005-03-14 -----END PRIVACY-ENHANCED MESSAGE-----