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