0001127602-14-032455.txt : 20141117 0001127602-14-032455.hdr.sgml : 20141117 20141117173932 ACCESSION NUMBER: 0001127602-14-032455 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141117 FILED AS OF DATE: 20141117 DATE AS OF CHANGE: 20141117 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: LeFebvre Charles Allen CENTRAL INDEX KEY: 0001398841 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36434 FILM NUMBER: 141228920 MAIL ADDRESS: STREET 1: RR 1, BOX 301A CITY: SULLIVAN STATE: IL ZIP: 61951 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2014-11-17 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001398841 LeFebvre Charles Allen 689 N CO RD 1600E SADORIS IL 61872 1 EVP-Wealth Management Common Stock 2014-11-17 4 C 0 1156 0 A 1156 I By IRA Common Stock 1010 D Common Stock 4898.473 I By Deferred Compensation Plan Series B 9% Non-cumulative Perpetual Convertible Preferred 2014-11-17 4 C 0 5 0 D Common Stock 1156.335 0 I By Ira On November 17, 2014 the Company caused the conversion of the Series B 9% Non-cumulative Perpetual Convertible Preferred stock. Each share was converted into 231.267 shares of common stock, cash in lieu of fractional shares. 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 curcumstances, and (iii) has no expiration date. /s/ Michael L Taylor, attorney-in-fact for Mr. LeFebvre 2014-11-17