-----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, S0i/HhZ4n3+uViuBMROhTDO7o9ZeSMb4cTn1KNczh5vgAkep07VnnChfO/1Tr4se F5ldZ9QXOxaeeNJb0U7xgA== 0000927797-04-000011.txt : 20040105 0000927797-04-000011.hdr.sgml : 20040105 20040105160021 ACCESSION NUMBER: 0000927797-04-000011 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20040105 FILED AS OF DATE: 20040105 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: SINGER ROBERT H JR CENTRAL INDEX KEY: 0001195969 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 04504936 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 ncbform4robtsingerjr_01-04ex.xml X0201 4 2004-01-05 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195969 SINGER ROBERT H JR C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVE. PO BOX 1237 FORT DODGE IA 50501 1 0 0 0 Common Stock, par Value $0.01 per share 5125 D Employee stock option (right to buy) 19.75 1998-01-01 2008-01-01 Common stock 500 500 D Employee stock option (right to buy) 19.25 1998-01-23 2008-01-23 Common stock 3000 3000 D Employee stock option (right to buy) 20.59 2002-01-01 2012-01-01 Common stock 2000 2000 D Employee stock option (right to buy) 31.00 2003-01-01 2013-01-01 Common stock 2000 2000 D Employee stock option (right to buy) 36.84 2004-01-02 4 A 0 2000 0 A 2004-01-02 2014-01-02 Common stock 2000 2000 D Power of Attorney is included with this filing. John L. Pierschbacher as Power of Attorney for Robert H. Singer, Jr. 2004-01-05 EX-24 4 ncbform4poasinger_01-04.txt FORM 4 POA ROBERT H. SINGER, JR. EXHIBIT 24 ---------- NORTH CENTRAL BANCSHARES, INC. SECTION 16 POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of John L. Pierschbacher and David M. Bradley, signing singly, the undersigned's true and lawful attorney-in-fact to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of North Central Bancshares, Inc. (the "Company"), Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules 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 Form 3, 4, or 5 and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) 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 such 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 substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such 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 attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended. 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 the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 20th day of December, 2002. /s/Robert H. Singer, Jr. -----END PRIVACY-ENHANCED MESSAGE-----