0001127602-16-052354.txt : 20160516
0001127602-16-052354.hdr.sgml : 20160516
20160516171326
ACCESSION NUMBER: 0001127602-16-052354
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160516
FILED AS OF DATE: 20160516
DATE AS OF CHANGE: 20160516
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: Dively Joseph R
CENTRAL INDEX KEY: 0001301318
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36434
FILM NUMBER: 161655094
MAIL ADDRESS:
STREET 1: 13179 E. COUNTY ROAD 720N
CITY: CHARLESTON
STATE: IL
ZIP: 61920
4
1
form4.xml
PRIMARY DOCUMENT
X0306
4
2016-05-16
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0001301318
Dively Joseph R
12732 E CR 700N
CHARLESTON
IL
61920
1
1
CEO
Common Stock
2016-05-16
4
C
0
4928
20.29
A
37000.375
D
Common Stock
29223.444
I
By Deferred Compensation Plan
Series C 8% Non-cumulative Perpetual Convertible Preferred
2016-05-16
4
C
0
20
0
D
Common Stock
4928.54
0
D
On May 16, 2016 the Company caused the conversion of the Series C 8% Non-cumulative Perpetual Convertible Preferred stock. Each shares was converted into 246.4268 shares of common stock, cash in lieu of fractional shares.
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. Dively
2016-05-16