SEC Form 4 · accession 0001127602-16-052360

FIRST MID BANCSHARES, INC. · FMBH

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

May 16, 2016

Accepted (ET)

May 16, 2016 · 5:30 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000700565

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock	May 16, 2016	C	17,249	$20.29	A	32,782	I	By Spouse
Common Stock	May 16, 2016	C	2,464	$20.29	A	92,113	I	By Sparks Investment Group Lp
Common Stock	May 16, 2016	C	54,213	$20.29	A	282,858	D
Common Stock	holding	—	—		—	1,822	I	By Child
Common Stock	holding	—	—		—	24,154	I	By Deferred Compensation Plan
Common Stock	holding	—	—		—	18,880	I	By Sparks Foundation

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series C 8% Non-cumulative Perpetual Convertible Preferred^F2	—	May 16, 2016	C	70	D	—	—	Common Stock	17,250	I
Series C 8% Non-cumulative Perpetual Convertible Preferred^F2	—	May 16, 2016	C	10	D	—	—	Common Stock	2,464	I
Series C 8% Non-cumulative Perpetual Convertible Preferred^F2	—	May 16, 2016	C	220	D	—	—	Common Stock	54,214	D

F1On May 16, 2016 the Company caused the conversion of the Series C 8% Non-cumulative Perpetual Convertible Preferred stock. Each shares was converted into 246.4268 shares of common stock, cash in lieu of fractional shares.
F2Each 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.