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