0001127602-16-040503.txt : 20160211
0001127602-16-040503.hdr.sgml : 20160211
20160211102010
ACCESSION NUMBER: 0001127602-16-040503
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160210
FILED AS OF DATE: 20160211
DATE AS OF CHANGE: 20160211
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: MELVIN GARY W
CENTRAL INDEX KEY: 0001185506
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36434
FILM NUMBER: 161408773
MAIL ADDRESS:
STREET 1: RR1, BOX 226
CITY: SULLIVAN
STATE: IL
ZIP: 61951
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2016-02-10
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0001185506
MELVIN GARY W
1134 CR 1650 E
SULLIVAN
IL
61951
1
Common Stock
2016-02-10
4
P
0
4574.4381
26.00
A
451126.8781
D
Common Stock
44504.201
I
By Deferred Comp Plan
Series C 8% Non-cumulative Perpetual Convertible Preferred
2016-02-10
4
P
0
50
6407.10
A
Common Stock
12321.35
539
D
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 Gary W. Melvin
2016-02-10