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