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FORM 3
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Washington, D.C. 20549 |
OMB APPROVAL
OMB Number: 3235-0104 Expires: January 31, 2008 Estimated average burden hours per response... 0.5 |
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| 1. Name and Address of Reporting Person * GRISSOM STEVEN L |
2. Date of Event Requiring Statement (MM/DD/YYYY)
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3. Issuer Name and Ticker or Trading Symbol Consolidated Communications Illinois Holdings, Inc. [CNSL] |
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
___ X ___ Officer (give title below) _____ Other (specify below) Treasurer and Secretary / |
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
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X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
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1.Title of Security
(Instr. 4) |
2. Amount of Securities Beneficially Owned
(Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) |
4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common Stock | 0 | D | |
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Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) |
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1. Title of Derivate Security
(Instr. 4) |
2. Date Exercisable and Expiration Date
(MM/DD/YYYY) |
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) |
6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
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| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Call Equivalent Position | (1) | (1) | Common Stock | 40292 | (1) | D | |
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Reporting Owners
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| Reporting Owner Name / Address |
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| Director | 10% Owner | Officer | Other | ||
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GRISSOM STEVEN L
121 SOUTH 17TH STREET MATTOON, IL 61938-3987 |
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Treasurer and Secretary |
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Signatures
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| James N. Pepin, Power of Attorney | 7/21/2005 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
| * | If the form is filed by more than one reporting person, see Instruction 5(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. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | |
Power of Attorney
The undersigned hereby constitutes and appoints
each of Steven L.
Grissom and Alexander A. Gendzier and James N. Pepin,
of King & Spalding LLP,
the Company's counsel, as the undersigned's true
and lawful attorney-in-fact to:
(1) execute for and on behalf of the underhsigned, in the undersigned's capacity as an officer, director and/or a stockholder owning more than 10% of Consolidated
Communications Holdings, Inc.'s (the "Company") common stock,
Forms 3, 4 and 5 in accordance with Section 16 of the
Securities
Exchange Act of 1934, as amended (the "Exchange
Act"), and the rules
and regulations promulgated thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Forms 3, 4 or 5 and timely file such forms with the U.S. Securities and Exchange Commission and any stock exchange or similar authority; and
take any other action of any type whatsoever in connection
with the
foregoing which, in the opinion of such
attorney-in-fact, may be of
benefit to, in the best interest
of, or legally required by, the
undersigned, it being
understood that the documents executed by such
attorney-in-fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such
terms
and conditions as such attorney-in-fact may approve in
such
attorney-in-fact's discretion.
The undersigned hereby grants to
each attorney-in-fact full power and
authority to do and perform any and
every act and thing whatsoever requisite,
necessary, or proper to be done
in the exercise of any of the rights and powers
herein granted, as fully
to all intents and purposes as the undersigned might or
could do if
personally present, with full power of such substitution or
revocation,
hereby ratifying and confirming all that each attorney-in-fact, or
each
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to
be done by virtue of this Power of Attorney and the rights and powers
herein
granted. The undersigned acknowledges that the foregoing
attorney-in-fact, in
serving in such capacity at the request of the
undersigned, is not assuming, nor
is the Company assuming, any of the
undersigned's responsibilities to comply
with Section 16 of the Exchange
Act.
This Power of Attorney shall remain in full force and effect
until the
undersigned is no longer required to file Forms 3, 4 and 5 with
respect to the
undersigned's holdings of and transactions in securities
issued by the Company,
unless earlier revoked by the undersigned in a
signed writing delivered to
either of the foregoing attorneys -in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney
to be executed as of this 12th day of July, 2005.
By: /s/ Steven L. Grissom
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Name: Steven L. Grissom
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