-----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, Oq/ex48HCqYATyCBguhHXf4Vs6KEb6RKQa9xEbIxHwNgRT87HxAaBfHMzBEC4OIX Ss4ZD2s1ay+aUwHMdUgJGQ== 0000927797-05-000037.txt : 20050210 0000927797-05-000037.hdr.sgml : 20050210 20050210150809 ACCESSION NUMBER: 0000927797-05-000037 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: SINGER ROBERT H JR CENTRAL INDEX KEY: 0001195969 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 05592596 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-singer_123104ex.xml X0202 5 2004-12-31 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 2004-12-31 5 J 0 29 0 A 5154 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 Shares acquired pursuant to the North Central Bancshares, Inc. Automatic Dividend Reinvestment and Stock Purchase Plan, dated September 22, 2000. /s/ Robert H. Singer, Jr. 2005-02-09 -----END PRIVACY-ENHANCED MESSAGE-----