0001127602-16-062504.txt : 20160914
0001127602-16-062504.hdr.sgml : 20160914
20160914135616
ACCESSION NUMBER: 0001127602-16-062504
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160908
FILED AS OF DATE: 20160914
DATE AS OF CHANGE: 20160914
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: Westerhold Mary
CENTRAL INDEX KEY: 0001522064
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36434
FILM NUMBER: 161884821
MAIL ADDRESS:
STREET 1: 6814 GOSHEN ROAD
CITY: EDWARDSVILLE
STATE: IL
ZIP: 62025
3
1
form3.xml
PRIMARY DOCUMENT
X0206
3
2016-09-08
0
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0001522064
Westerhold Mary
2 SUGAR CREEK LANE
EDWARDSVILLE
IL
61938
1
Common Stock
960
I
By IRA
Common Stock
20236
I
By LLC 1
Common Stock
29224
I
By LLC 2
Common Stock
49
I
By Spouse's IRA
Common Stock
75893
I
By Trusts 1
Common Stock
16455
I
By Trusts 2
Reflects transactions not required to be reported pursuant to Section 16 of the Securities Exchange Act of 1934, as amended
The reporting person is a co-trustee of these trusts, and the members of her immediate family are beneficiaries of the trusts. The reporting person disclaims beneficial ownership of the common stock held by the trusts except to the extent of her pecuniary interest therein.
/s/ Michael L. Taylor, attorney-in-fact for Mary J Westerhold
2016-09-14