U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
LUMPKIN RICHARD A.
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(Last) (First) (Middle)
121 SOUTH 17TH STREET, P.O. BOX 1234
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(Street)
MATTOON IL 61938
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
FIRST MID-ILLINOIS BANCSHARES, INC. (FMBH.OB)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
March 28, 2003
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5. If Amendment, Date of Original (Month/Year)
August 2002
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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COMMON STOCK 01/04/02 J(1) V(7) 1,063.063 A $23.70 D
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COMMON STOCK 06/14/02 J(1) V(7) 2,979.338 A $25.25 330,058.866 (2) D
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COMMON STOCK 01/04/02 J(1) V(7) 2,215.930 A $23.70 (2) I (4)
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COMMON STOCK 01/04/02 J(1) V(7) 2,215.930 A $23.70 I (5)
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COMMON STOCK 02/26/02 J(3) 221,038.993 D I (5)
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COMMON STOCK 01/04/02 J(1) V(7) 670.722 A $23.70 I (6)
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COMMON STOCK 06/14/02 J(1) V(7) 609.428 A $25.25 67,513.984 I (6)
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COMMON STOCK 01/04/02 J(1) V(7) 187.642 A $23.70 I DEF COMP
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COMMON STOCK 03/31/02 P V(7) 166.365 A $23.70 I DEF COMP
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COMMON STOCK 06/30/02 P V(7) 146.223 A $25.28 19,029.8631 I DEF COMP
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Response) (Over)
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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COMMON STOCK 4,750 D
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Explanation of Responses:
(1) SHARES PURCHASED THROUGH COMPANY'S DIVIDEND REINVESTMENT PLAN WITH DIVIDENDS
PAID ON SHARES OF COMMON STOCK HELD.
(2) DUE TO THE TERMINATION OF THE RICHARD A LUMPKIN TRUST UNDER ARTICLE V OF THE
MARY G LUMPKIN TRUST DATED 1/31/84, 221,038.993 SHARES WERE TRANSFERRED TO
MR. LUMPKIN ON 2/5/02 AND ARE NOW HELD DIRECTLY BY MR. LUMPKIN AND ARE
INCLUDED AS PART OF HIS 330,058.866 SHARES.
(3) DUE TO THE TERMINATION OF THE MARY LEE SPARKS TRUST UNDER ARTICLE V OF THE
MARY G. LUMPKIN TRUST DATED 1/31/84, MR. LUMPKIN IS NO LONGER TRUSTEE OF
THESE SHARES. THE SHARES WERE TRANSFERRED DIRECTLY TO MS. SPARKS ON 2/26/02
AND ARE NO LONGER REPORTABLE BY MR. LUMPKIN.
(4) BY SELF AS TRUSTEE OF RICHARD A. LUMPKIN TRUST
(5) BY SELF AS TRUSTEE OF THE MARY LEE SPARKS TRUST
(6) SKL INVESTMENT GROUP R.A.LUMPKIN VOTING MEMBER
(7) THE REPORTING PERSON FILED A FORM 4 ON AUGUST 2002 THAT INADVERTENTLY
OMITTED THE "V" TRANSACTION CODE. THIS FORM 4 HAS BEEN AMENDED TO INCLUDE
THE "V" TRANSACTION CODE TO INDICATE THAT THE TRANSACTION WAS VOLUNTARILY
REPORTED EARLIER THAN REQUIRED.
/S/ WILLIAM S. ROWLAND, PURSUANT TO A POWER
OF ATTORNEY FILED CONTEMPORANEOUSLY HEREWITH 03/28/03
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
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