0001127602-18-015788.txt : 20180501 0001127602-18-015788.hdr.sgml : 20180501 20180501173408 ACCESSION NUMBER: 0001127602-18-015788 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180501 FILED AS OF DATE: 20180501 DATE AS OF CHANGE: 20180501 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cook Robert S CENTRAL INDEX KEY: 0001615123 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36434 FILM NUMBER: 18796713 MAIL ADDRESS: STREET 1: 631 S BODIN ST CITY: HINSDALE STATE: IL ZIP: 60521 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 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2018-05-01 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001615123 Cook Robert S 1421 CHARLESTON AVE MATTOON IL 61938 1 Common Stock 2018-05-01 4 A 0 8160 A 13814 I By LLC Common Stock 2018-05-01 4 A 0 2880 A 4266 I by 401k Common Stock 2018-05-01 4 A 0 1840 A 1840 I by IRA Common Stock 14122 D Common Stock 1980 I As Custodian for Children Common Stock 244 I By Spouse Received in exchange for 10,200 shares of First BancTrust Corporation ("First Bank") common stock in connection with the merger of First Bank into a wholly owned subsidiary of First Mid-Illinois Bancshares, Inc. ("First Mid") (the "Merger"). On the effective date of the Merger, each share of First Bank common stock was converted into 0.80 shares of First Mid common stock, $5.00 in cash, and cash-in-lieu of any fractional share. Reflects transactions not required to be reported pursuant to Section 16 of the Securities Exchange Act of 1934, as amended. Received in exchange for 3,600 shares of First BancTrust Corporation ("First Bank") common stock in connection with the merger of First Bank into a wholly owned subsidiary of First Mid-Illinois Bancshares, Inc. ("First Mid") (the "Merger"). On the effective date of the Merger, each share of First Bank common stock was converted into 0.80 shares of First Mid common stock, $5.00 in cash, and cash-in-lieu of any fractional share. Received in exchange for 2,300 shares of First BancTrust Corporation ("First Bank") common stock in connection with the merger of First Bank into a wholly owned subsidiary of First Mid-Illinois Bancshares, Inc. ("First Mid") (the "Merger"). On the effective date of the Merger, each share of First Bank common stock was converted into 0.80 shares of First Mid common stock, $5.00 in cash, and cash-in-lieu of any fractional share. /s/ Michael L Taylor, attorney-in-fact for Mr. Cook 2018-05-01