-----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, FvCAIsRSx9ciEC66U8EYnyqa/TYZlcI199HIpYVUCXxT6kv84oorzga/E7wTYcQ2 i5SS0iSkSq/sLbDoc2b+aQ== 0000927797-05-000265.txt : 20051114 0000927797-05-000265.hdr.sgml : 20051111 20051114164121 ACCESSION NUMBER: 0000927797-05-000265 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051111 FILED AS OF DATE: 20051114 DATE AS OF CHANGE: 20051114 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: BRADLEY DAVID M CENTRAL INDEX KEY: 0001195965 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 051202193 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 ncb-form4bradley_111105ex.xml X0202 4 2005-11-11 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195965 BRADLEY DAVID M C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVE PO BOX 1237 FORT DODGE IA 50501 1 1 0 0 Chairman, President & CEO Common stock, par value $0.01 2005-11-11 4 M 0 4000 19.25 A 14893 D Common stock, par value $0.01 2005-11-11 4 S 0 4000 37.79 D 10893 D Common stock, par value $0.01 200 I Spouse and minor child Common stock, par value $0.01 3225 I 401(k) Trust Stock option (right to buy) 19.25 2005-11-11 4 M 0 4000 0 D 2003-01-30 2008-01-30 Common stock 20000 16000 D Stock option (right to buy) 17.375 2011-01-01 Common stock 11500 11500 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 as of August 31, 2005, rather than specific transactions, are reported. Options vest over five years, at an annual rate of 20%, with the first vesting scheduled on January 1, 2002 and each anniversary thereafter. /s/David M. Bradley 2005-11-14 -----END PRIVACY-ENHANCED MESSAGE-----