-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Q3QUzayEWJneGNslmvSQc+KjEiiHJ4JrRUAsWScgEPvhv6xTuJJ2sVB5ZhfwvRI2 lGm96GKler9ershGaG94KA== 0001140361-09-003664.txt : 20090212 0001140361-09-003664.hdr.sgml : 20090212 20090212152056 ACCESSION NUMBER: 0001140361-09-003664 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090211 FILED AS OF DATE: 20090212 DATE AS OF CHANGE: 20090212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dively Joseph R CENTRAL INDEX KEY: 0001301318 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 09594396 BUSINESS ADDRESS: BUSINESS PHONE: 217-348-1800 MAIL ADDRESS: STREET 1: 13179 E. COUNTY ROAD 720N CITY: CHARLESTON STATE: IL ZIP: 61920 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: 0211 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 doc1.xml FORM 4 X0303 4 2009-02-11 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001301318 Dively Joseph R 13179 E. COUNTY ROAD 720N CHARLESTON IL 61920 1 0 0 0 Common Stock 2009-01-05 5 J 0 23.315 23.00 A 2845.695 D Common Stock 2009-01-05 5 J 0 30.491 23.00 A 3721.477 I By Deferred Compensation Plan Series B 9% Non-cumulative perpetual convertible preferred 2009-02-11 4 P 0 40 5000 A Common Stock 40 D Shares acquired through the Company's dividend reinvestment plan with dividends being paid on shares of common stock held. Each share of the Series B Convertible Preferred Stock (i) is convertible at any time into 227 shares of common stock and cash in lieu of any fractional share of common stock, subject to certain adjustments, (ii) is convertible at First Mid-Illinois Bancshares' option under certain circumstances, and (iii) has no expiration date. Michael L. Taylor, pursuant to a power of attorney filed 08/25/04. 2009-02-12 -----END PRIVACY-ENHANCED MESSAGE-----