SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Westerhold Mary

(Last) (First) (Middle)
2 SUGAR CREEK LANE

(Street)
EDWARDSVILLE IL 61938

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/08/2016
3. Issuer Name and Ticker or Trading Symbol
FIRST MID ILLINOIS BANCSHARES INC [ FMBH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 960 I By IRA
Common Stock 20,236 I(1) By LLC 1
Common Stock 29,224 I By LLC 2
Common Stock 49 I By Spouse's IRA
Common Stock 75,893 I(1) By Trusts 1
Common Stock 16,455 I(2) By Trusts 2
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Reflects transactions not required to be reported pursuant to Section 16 of the Securities Exchange Act of 1934, as amended
2. 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 09/14/2016
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.