-----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, Iyzdpf7HnxQQUph02JhNMqbu3uME0MOyMjaKncRTaLOCHX1nLXIciWZs9gvdUGKW uuH/rzI64i4fmGC4PLbqdQ== 0000927797-05-000038.txt : 20050210 0000927797-05-000038.hdr.sgml : 20050210 20050210151011 ACCESSION NUMBER: 0000927797-05-000038 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: THOMPSON MARK M CENTRAL INDEX KEY: 0001195970 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 05592612 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-thompson_123104ex.xml X0202 5 2004-12-31 0 0 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195970 THOMPSON MARK M 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 1750 I IRA Common stock, par value $0.01 per share 2000 I By Partnership Common stock, par value $0.01 per share 100 D Stock option (right to buy) 15.00 2000-01-01 2010-01-01 Common stock 2000 2000 D Stock option (right to buy) 17.375 2001-01-01 2011-01-01 Common stock 2000 2000 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 Shares are held in a family limited partnership of which Mark Thompson is general partner. /s/ Mark M. Thompson 2005-02-09 -----END PRIVACY-ENHANCED MESSAGE-----