-----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, APWjOg15VTJeZVZOpcA/9+StblYFzCAPuB/iVbNM2IGh1XD0EtnIyQaBFCSOW73J lQGmFewbFEGMzXrdNdb5fQ== 0000927797-05-000033.txt : 20050210 0000927797-05-000033.hdr.sgml : 20050210 20050210145200 ACCESSION NUMBER: 0000927797-05-000033 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041231 FILED AS OF DATE: 20050210 DATE AS OF CHANGE: 20050210 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: IA 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: LAKE JEAN CENTRAL INDEX KEY: 0001195962 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 05592456 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 ncbform5-lake_123104ex.xml X0202 5 2004-12-31 0 0 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195962 LAKE JEAN C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVE. PO BOX 1237 FORT DODGE IA 50501 0 1 0 0 Corporate Secretary Common stock, par value $0.01 per share 2021 D Common stock, par value $0.01 per share 1133 I 401(k) Trust Stock option (right to buy) 19.25 2003-01-30 2008-01-30 Common stock 4000 4000 D Reflects total shares allocable to the reporting person of the 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)(i)(B) under the Securities and Exchange Act of 1934, as amended, only end of period holdings, rather than specific transactions, are reported. /s/ Jean L. Lake 2005-02-09 -----END PRIVACY-ENHANCED MESSAGE-----