-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, TfqiefoZvkFCd/uDQP6caoKW2k2eHlWrrEBVWpjWKAgR5xB9uqfvheHoIYufK0SW dGshxS6MhiIjUJKQMSfvgg== 0000927797-03-000128.txt : 20030806 0000927797-03-000128.hdr.sgml : 20030806 20030806160519 ACCESSION NUMBER: 0000927797-03-000128 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030805 FILED AS OF DATE: 20030806 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NORTH CENTRAL BANCSHARES INC CENTRAL INDEX KEY: 0001005188 STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035] IRS NUMBER: 421449849 STATE OF INCORPORATION: IA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 825 CENTRAL AVE STREET 2: C/O FIRST FED SAVINGS BANK OF FT DODGE CITY: FORT DODGE STATE: I0 ZIP: 50501 BUSINESS PHONE: 5155767531 MAIL ADDRESS: STREET 1: 825 CENTRAL AVENUE CITY: FORT DODGE STATE: IA ZIP: 50501 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CHALSTROM C THOMAS CENTRAL INDEX KEY: 0001195964 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 03826355 BUSINESS ADDRESS: STREET 1: C/O NORTH CENTRAL BANCSHARES INC STREET 2: 825 CENTRAL AVE. PO BOX 1237 CITY: FORT DODGE STATE: IA ZIP: 50501 BUSINESS PHONE: 5155767531 MAIL ADDRESS: STREET 1: C/O NORTH CENTRAL BANCSHARES INC STREET 2: 825 CENTRAL AVE PO BOX 1237 CITY: FORT DODGE STATE: IA ZIP: 50501 4 1 form4tchalstrom08-06_03ex.xml X0201 4 2003-08-05 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195964 CHALSTROM C THOMAS C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVE. PO BOX 1237 FORT DODGE IA 50501 0 1 0 0 Executive Vice President Common Stock, par value $0.01 per share 2003-08-05 4 M 0 1000 12.375 A 2710 D Common Stock, par value $0.01 per share 2003-08-05 4 S 0 1000 34.928 D 334 I 401 (k) Trust Employee stock option plan (right to buy) 12.375 2003-08-05 4 M 0 1000 0 D 2006-09-21 Common stock 1000 3500 D Reflects total shares allocable to the reporting person pursuant to shares of stock held by the Bank of New York, as trustee of the North Central Bancshares, Inc. stock fund of the First Federal Savings Bank of Iowa 401(k) plan. Pursuant to rule 16a-3(f)(1)(B) under the Securities Exchange Act of 1934, as amended, only end-of-period holdings, rather than specific transactions are reported. The options vest in five annual installments, at a rate of 20%, with the first vesting scheduled on September 21, 1997 and each year thereafter. Previously filed Power of Attorney is still in effect. John Pierschbacher 2003-08-06 -----END PRIVACY-ENHANCED MESSAGE-----