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