0001127602-19-000225.txt : 20190102
0001127602-19-000225.hdr.sgml : 20190102
20190102155532
ACCESSION NUMBER: 0001127602-19-000225
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181215
FILED AS OF DATE: 20190102
DATE AS OF CHANGE: 20190102
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TAYLOR MICHAEL L
CENTRAL INDEX KEY: 0001185497
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36434
FILM NUMBER: 19501590
MAIL ADDRESS:
STREET 1: 19 CAMBRIDGE DRIVE
CITY: MATTOON
STATE: IL
ZIP: 61938
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/A
1
form4a.xml
PRIMARY DOCUMENT
X0306
4/A
2018-12-15
2018-12-18
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0001185497
TAYLOR MICHAEL L
1421 CHARLESTON AVE
MATTOON
IL
61938
1
Chief Operating Officer
Common Stock
2018-12-15
2018-12-17
4
F
0
169
32.58
D
11365.7837
D
Common Stock
6608.291
I
By 401k Plan
Common Stock
368
I
by Deferred Compensation Plan
Revised to reflect the correct number of shares withheld to satisfy income tax withholding obligations in connection with shares of restricted stock that vested.
/s/ Matthew K. Smith, attorney-in-fact for Mr. Taylor
2019-01-02