-----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, AJKac2edkEa3BCPSDVk9PkZAjQCvTMHeFrUvZLqFKOqfSUT6xy6CS1MUbfpDxtDF lAWt7UFTyAVydykWMUHCHg== 0001140361-09-003665.txt : 20090212 0001140361-09-003665.hdr.sgml : 20090212 20090212152127 ACCESSION NUMBER: 0001140361-09-003665 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: Lumpkin Benjamin I. CENTRAL INDEX KEY: 0001454931 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 09594404 BUSINESS ADDRESS: BUSINESS PHONE: 312-819-0232 MAIL ADDRESS: STREET 1: 340 E. RANDOLPH STREET UNIT 5403 CITY: CHICAGO STATE: IL ZIP: 60601 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 0001454931 Lumpkin Benjamin I. 340 E. RANDOLPH ST, UNIT 5403 CHICAGO IL 60601 1 0 0 0 Series B 9% Non-cumulative perpetual convertible preferred 2009-02-11 4 P 0 150 5000 A Common Stock 150 D 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 upder certain circumstances, and (iii) has no expiration date. Michael L. Taylor, pursuant to a power of attorney filed 01/29/09. 2009-02-12 -----END PRIVACY-ENHANCED MESSAGE-----