0001140361-12-016962.txt : 20120321
0001140361-12-016962.hdr.sgml : 20120321
20120321170350
ACCESSION NUMBER: 0001140361-12-016962
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120320
FILED AS OF DATE: 20120321
DATE AS OF CHANGE: 20120321
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: GRISSOM STEVEN L
CENTRAL INDEX KEY: 0001073304
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13368
FILM NUMBER: 12706501
MAIL ADDRESS:
STREET 1: CONSOLIDATED COMMUNICATIONS INC
STREET 2: 121 S 17TH ST
CITY: MATTOON
STATE: IL
ZIP: 61938
4
1
doc1.xml
FORM 4
X0304
4
2012-03-20
0
0000700565
FIRST MID ILLINOIS BANCSHARES INC
FMBH
0001073304
GRISSOM STEVEN L
C/O SKL INVESTMENT GROUP
121 S. 17TH STREET
MATTOON
IL
61938
1
0
0
0
Common Stock
2012-03-20
4
J
0
6122
0
A
198096
I
By Trust FBO Benjamin I. Lumpkin
Common Stock
2012-03-20
4
J
0
6122.00
0
A
198096
I
By Trust FBO Elizabeth L. Celio
Common Stock
2012-03-20
4
J
0
300.00
0
A
300.00
I
By 1978 Trust FBO Mary Lee Sparks
Common Stock
43142.50
D
Common Stock
2298.412
I
By Deferred Comp Plan
Shares acquired through a distribution of common stock held by SKL Investment Group, LLC.
Shares acquired by Mr. Grissom as co-trustee of the trust. Mr. Grissom disclaims beneficial ownership of these shares.
Shares include 48.937 shares acquired through the Company's dividend reinvestment plan with dividends being paid on shares of common stock held.
Michael L. Taylor, pursuant to a power of attorney filed 12/19/02.
2012-03-21