-----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, F9r7yqu0IBMBWDNI8vHgpyiNSW+8SUPGSbY/7xL7txcGuNjjCcT9eeQJjAs0s+Q4 //7uofQaDbQoUkO17gvG6Q== 0001140361-11-013438.txt : 20110302 0001140361-11-013438.hdr.sgml : 20110302 20110302154226 ACCESSION NUMBER: 0001140361-11-013438 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110302 FILED AS OF DATE: 20110302 DATE AS OF CHANGE: 20110302 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADAMS CHARLES A /TX CENTRAL INDEX KEY: 0001185704 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13368 FILM NUMBER: 11656132 MAIL ADDRESS: STREET 1: 21 ST. ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 4 1 doc1.xml FORM 4 X0303 4 2011-03-02 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001185704 ADAMS CHARLES A /TX 1020 N 13TH STREET MATTOON IL 61938 1 0 0 0 Series C 8% Non-Cumulative perpetual convertible preferred 2011-03-02 4 P 0 300 5000 A Common Stock 300 D Series C 8% Non-Cumulative perpetual convertible preferred 2011-03-02 4 P 0 125 5000 A Common Stock 125 I By Wife Each share of Series C Convertible Preferred Stock (i) is convertible at any time into 246.427 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, (iii) has no expiration date. Michael L. Taylor, pursuant to a power of attorney filed 11/01/02. 2011-03-02 -----END PRIVACY-ENHANCED MESSAGE-----