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