0001127602-14-024702.txt : 20140805
0001127602-14-024702.hdr.sgml : 20140805
20140805100831
ACCESSION NUMBER: 0001127602-14-024702
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140804
FILED AS OF DATE: 20140805
DATE AS OF CHANGE: 20140805
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: 0211
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: LUMPKIN RICHARD ANTHONY
CENTRAL INDEX KEY: 0000925184
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36434
FILM NUMBER: 141014913
MAIL ADDRESS:
STREET 1: 121 SOUTH 17TH STREET
CITY: MATTOON
STATE: IL
ZIP: 61938
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2014-08-04
1
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0000925184
LUMPKIN RICHARD ANTHONY
121 SOUTH 17TH STREET
MATTOON
IL
61938
1
8/4/14 ceased as 10% owner
Common Stock
2014-08-04
4
J
0
316947
0
D
0
I
By 1970 Trust Fbo Richard A. Lumpkin
Common Stock
2014-08-04
4
J
0
604
0
D
0
I
By 1976 Trust Fbo Richard A. Lumpkin
Common Stock
2014-08-04
4
J
0
12552
0
D
0
I
By 1970 Trust Fbo Mary Lee Sparks
Common Stock
2014-08-04
4
J
0
605
0
D
0
I
By 1976 Trust Fbo Mary Lee Sparks
Common Stock
2014-08-04
4
J
0
24888
0
D
0
I
By 1970 Trust Fbo Margaret L. Keon
Common Stock
2014-08-04
4
J
0
604
0
D
0
I
By 1976 Trust Fbo Margaret L. Keon
Common Stock
2014-08-04
4
J
0
5874
0
D
0
I
By 2001 Irr Trust Fbo John W. Sparks
Common Stock
46159.493
D
Common Stock
3624
I
By Living Trust Fbo John W. Sparks
Series B 9% Non-cumulative Perpetual Convertible Preferred
2014-08-04
4
J
0
100
0
D
Common Stock
23126.7
0
I
By Trust Fbo Richard A. Lumpkin
Series B 9% Non-cumulative Perpetual Convertible Preferred
2014-08-04
4
J
0
80
0
D
Common Stock
18501.36
0
I
By Trust Fbo Margaret Keon
Series C 8% Non-cumulative Perpetual Convertible Preferred
2014-08-04
4
J
0
80
0
D
Common Stock
19714.16
0
I
By 1970 Trust Fbo Margaret L. Keon
Series C 8% Non-cumulative Perpetual Convertible Preferred
2014-08-04
4
J
0
50
0
D
Common Stock
12321.35
0
I
By 1970 Trust Fbo Mary Lee Sparks
On August 4, 2014 Mr. Lumpkin ceased being the trustee of these trusts.
Mr. Lumpkin is trustee of this trust.
Each share of the Series B Convertible Preferred Stock (i) is convertible at any time into 231.267 shares of common stock and cash in lieu of any fractional share of common stock, subject to certain adjustments, (ii) is convertible at First Mid-Illinois Bancshares' option under certain circumstances, and (iii) has no expiration date.
Each share of Series C Convertible Preferred Stock (i) is convertible at any time into 246.427 shares of common stock and cash in lieu of any fractional share of common stock, subject to certain adjustments, (ii) is convertible at First Mid-Illinois Bancshares' option under certain circumstances, (iii) has no expiration date.
/s/ Michael L. Taylor, attorney-in-fact for Mr. Lumpkin
2014-08-05