-----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, STWHGq/qog6pcL2rxMAaddL2EUzVSGBw/CMC8jgvm7dk4F1KS1mPJ4cKtcd96mwU ghgRIHVENmUPo880mhSeaA== 0000700565-05-000203.txt : 20050920 0000700565-05-000203.hdr.sgml : 20050920 20050920144553 ACCESSION NUMBER: 0000700565-05-000203 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050919 FILED AS OF DATE: 20050920 DATE AS OF CHANGE: 20050920 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: SPARKS RAY A CENTRAL INDEX KEY: 0001012163 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 051093393 BUSINESS ADDRESS: STREET 1: 30 S COUNTY CLUB ROAD CITY: MATTOON STATE: IL ZIP: 61938 BUSINESS PHONE: 2172588741 MAIL ADDRESS: STREET 1: 30 S COUNTRY CLUB RD CITY: MATTOON STATE: IL ZIP: 61938 4 1 form4_sparks-091905ex.xml RAY A. SPARKS X0202 4 2005-09-19 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH.OB 0001012163 SPARKS RAY A 30 S COUNTY CLUB ROAD MATTOON IL 61938 1 0 0 0 Common Stock 2005-09-19 4 G 0 270 40.25 A 6000 I By Wife Common Stock 2005-09-19 4 G 0 270 40.25 D 5730 I By Wife Common Stock 57682.000 I By Sparks Investment Group Common Stock 2005-09-19 4 G 0 4040 40.25 D 103308 D Common Stock 12002.034 I By Deferred Comp Common Stock 2005-09-19 4 G 0 270 40.25 A 945 I By Child Common Stock 2005-09-19 4 G 0 270 40.25 A 1215 I By Child Common Stock 2005-09-19 4 G 0 3500 40.25 A 6100 I By The Sparks Foundation Stock Option 41.00 2004-12-14 2014-12-14 Common Stock 2250 2250 D On September 19, 2005 Debra Sparks gifted 270 shares of First Mid-Illinois Bancshares common stock to her minor child. On September 19, 2005 Ray Sparks gifted 3,500 shares of First Mid-Illinois Bancshares common stock to The Sparks Foundation: 270 shares to his minor child and 270 shares to his wife. Michael L. Taylor, pursuant to a power of attorney filed 09/06/2002 2005-09-20 -----END PRIVACY-ENHANCED MESSAGE-----