-----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, QynHgHZ47TBn79gDDV0csn59i/eCDh/EgGmya2GJ9xyBuxRpVspt33xuGYPcuKXv uM/KMaiJ1uUPlg2NjKhdfA== 0000927797-06-000161.txt : 20060523 0000927797-06-000161.hdr.sgml : 20060523 20060523151914 ACCESSION NUMBER: 0000927797-06-000161 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20060522 FILED AS OF DATE: 20060523 DATE AS OF CHANGE: 20060523 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: CHALSTROM C THOMAS CENTRAL INDEX KEY: 0001195964 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 06861298 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-form4chalstrom_052206ex.xml X0202 4 2006-05-22 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195964 CHALSTROM C THOMAS C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVE PO BOX 1237 FORT DODGE IA 50501 1 1 0 0 Executive Vice President Common stock, par value $0.01 2006-05-22 4 M 0 2000 19.25 A 4710 D Common stock, par value $0.01 2006-05-22 4 S 0 2000 38.85 D 2710 D Common stock, par value $0.01 671 I 401(k) Trust Common stock, par value $0.01 9515 I ESOP Stock option (right to buy) 19.25 2006-05-22 4 M 0 2000 0 D 2003-01-30 2008-01-30 Common stock 4000 2000 D Stock option (right to buy) 38.67 2016-02-24 Common stock 5000 5000 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 March 31, 2006, rather than specific transactions, are reported. Options vest over five years, at an annual rate of 20%, with the first vesting scheduled on February 24, 2007 and each anniversary thereafter. /s/C. Thomas Chalstrom 2006-05-23 -----END PRIVACY-ENHANCED MESSAGE-----