-----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, WSg6I4NRh25nujorGPZFqrd6/wVHHMvLNdjYyfChzKmU1NrC1+nM/cDGWVa+2tep 5S3bbjW6npN+S3nt0l3I0g== 0000927797-04-000038.txt : 20040130 0000927797-04-000038.hdr.sgml : 20040130 20040130170011 ACCESSION NUMBER: 0000927797-04-000038 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040130 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: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 04556609 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 5 1 ncbform5singer_12-03ex.xml X0201 5 2003-12-31 0 0 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 Stock option (right to buy) 19.75 1998-01-01 2008-01-01 Common stock 500 500 D Stock option (right to buy) 19.125 1998-01-23 2008-01-23 Common stock 3000 3000 D Stock option (right to buy) 20.59 2002-01-01 2012-01-01 Common stock 2000 2000 D Stock option (right to buy) 31.00 2003-01-01 2013-01-01 Common stock 2000 2000 D Stock option (right to buy) 36.84 2004-01-02 2014-01-02 Common stock 2000 2000 D /s/Robert H. Singer, Jr. 2004-01-13 -----END PRIVACY-ENHANCED MESSAGE-----