0001140361-12-031648.txt : 20120629 0001140361-12-031648.hdr.sgml : 20120629 20120629122459 ACCESSION NUMBER: 0001140361-12-031648 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120628 FILED AS OF DATE: 20120629 DATE AS OF CHANGE: 20120629 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: 12934888 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 X0305 4 2012-06-28 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 C 8% Non-Cumulative perpetual convertible preferred 2012-06-28 4 P 0 500 5000 A Common Stock 500 D 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 01/29/09. 2012-06-29