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