UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 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 this box if no longer subject to Section 16. Form 4 or
Form 5 obligations may continue. See Instructions 1(b).
1. Name and Address of Reporting Person:
Grissom, Steven L.
21 S. Country Club Road
Mattoon, IL 61938
U.S.A.
2. Issuer Name and Ticker or Trading Symbol:
First Mid-Illinois Bancshares, Inc. (FMBH.OB)
3. I.R.S. Identification Number of Reporting Person, if an
entity (voluntary):
4. Statement for Month/Day/Year:
November 1, 2002
5. If Amendment, Date of Original (Month/Day/Year):
6. Relationship of Reporting Person(s) to Issuer (Check all
applicable):
(x) Director ( ) 10% Owner ( ) Officer (give title below)
( ) Other (specify below):
7. Individual or Joint/Group Filing (Check Applicable Line):
(x) Form filed by One Reporting Person
( ) Form filed by More than One Reporting Person
Table I -- Non-Derivative Securities Acquired,
Disposed of, or Beneficially Owned
5.
Amount of 6.
2A. Securities Ownership
Deemed Beneficially Form: 7.
2. Trans- Execution 3. Owned Direct Nature of
action Date, if Trans- 4. Securities Following (D) or Indirect
1. Title of Date any action Acquired (A) or Reported Indirect Beneficial
Security (Month/ (Month/ Code Disposed of (D) Transaction(s) (I) Ownership
(Instr. 3) Day/Year) Day/Year (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr. 4) (Instr.4)
----------- --------- -------- ---------- ------------------- ---------------- ---------- ----------
Code V Amount (A)or(D) Price
---- - ------ -------- -----
Common Stock 16,848.860 D
Common Stock 11/1/02 J(1) 82,500 A $27.50 82,500 I (2)
Common Stock 11/1/02 J(1) 82,500 A $27.50 82,500 I (3)
Table II -- Derivative Securities Acquired,
Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
9.
Number
of
5. deriv-
Number ative 10.
of Secur- Owner-
2. Deriv- ities ship
Conver- ative Benefi- Form of 11.
sion 3A. Secur- cially Deriv- Nature
1. or Deemed ities 8. Owned ative of
Title Exer- Execu- Acquired Price Follow- Secur- In-
of cise 3. tion (A) or 6. 7. of ing ities: direct
Deriv- Price Trans- Date, 4. Dis- Date Title and Deriv- Re- Direct Bene-
ative of action if Trans- posed Exercisable Amount of ative ported (D) or ficial
Secur- Deriv- Date any, action of (D) and Underlying Secur- Transac- Indirect Owner-
ity ative (Month/ (Month/ Code (Instr. Expiration Securities ity tion(s) (I) ship
(Instr. Secur- Day/ Day/ (Instr. 3, 4 Date (Month/ (Instr. (Instr. (Instr. (Instr. (Instr.
3) ity Year) Year) 8) and 5) Day/Year) (3 and 4) 5) 4) 4) 4)
------- ------ ------ ------- ------- -------- ----------- ---------- ------- ------- -------- -------
Amount
or
Exer- Expir- Number
cis- ation of
Code V (A) (D) able Date Title Shares
---- - --- --- ---- ----- ----- ------
Stock
Option 1,750 D
Reminder: Report on a separate line for each class of securities beneficially owned directly of indirectly.
* If the form is filed by more than one reporting person, SEE Instruction 4(b)(v).
** 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 is insufficient, SEE Instruction 6 for procedure.
________________________________________ ____________________
**Signature of Reporting Person Date
Attorney-in-Fact
Explanation of Responses:
(1) The following shares were transferred by Mr. Richard A. Lumpkin: (a) 82,500 shares to the Richard Anthony Lumpkin
1990 Personal Income Trust for the Benefit of Benjamin Iverson Lumpkin dated 4/20/90, under which Mr. Grissom
serves as co-trustee; and (b) 82,500 shares to the Richard Anthony Lumpkin 1990 Personal Income Trust for the
Benefit of Elizabeth Arabella Lumpkin dated 4/20/90, under which Mr. Grissom serves as co-trustee.
(2) By Mr. Grissom as co-trustee of the Richard Anthony Lumpkin 1990 Personal Income Trust for the Benefit of Benjamin
Iverson Lumpkin dated 4/20/90. Mr. Grissom disclaims beneficial ownership of these shares.
(3) By Mr. Grissom as co-trustee of the Richard Anthony Lumpkin 1990 Personal Income Trust for the Benefit of Elizabeth
Arabella Lumpkin dated 4/20/90. Mr. Grissom disclaims beneficial ownership of these shares.