0001140361-11-048535.txt : 20111006 0001140361-11-048535.hdr.sgml : 20111006 20111006093457 ACCESSION NUMBER: 0001140361-11-048535 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111004 FILED AS OF DATE: 20111006 DATE AS OF CHANGE: 20111006 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: 111128347 MAIL ADDRESS: STREET 1: 21 ST. ANDREWS PLACE CITY: MATTOON STATE: IL ZIP: 61938 4 1 doc1.xml FORM 4 X0304 4 2011-10-04 0 0000700565 FIRST MID ILLINOIS BANCSHARES INC FMBH 0001185704 ADAMS CHARLES A /TX 1020 N 13TH STREET MATTOON IL 61938 1 0 0 0 Common Stock 2011-10-04 4 P 0 5000.00 18.70 A 74872.348 I By Spouse Common Stock 2011-10-04 4 S 0 5000.00 18.70 D 276146.351 I By Howell Paving, Inc. Michael L. Taylor, pursuant to power of attorney filed 11/01/02. 2011-10-06