0001140361-11-058831.txt : 20111223 0001140361-11-058831.hdr.sgml : 20111223 20111223133237 ACCESSION NUMBER: 0001140361-11-058831 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111223 FILED AS OF DATE: 20111223 DATE AS OF CHANGE: 20111223 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 111279898 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 doc1.xml FORM 4 X0304 4 2011-12-23 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195970 THOMPSON MARK M C/O NORTH CENTRAL BANCSHARES INC 825 CENTRAL AVENUE FORT DODGE IA 50501 1 0 0 0 Common Stock, par value $0.01 per share 2011-12-23 4 M 0 2000 20.59 A 11625 D Common Stock, par value $0.01 per share 2000 I By Limited Partnership Common Stock, par value $0.01 per share 3213 I By Limited Partnership Employee stock option (right to buy) 20.59 2011-12-23 4 M 0 2000 0 A 2002-01-01 2012-01-01 Common Stock 2000 0 D Includes 2,500 shares held in a self-directed IRA and 725 shares of restricted stock which will vest on April 22, 2012. These shares are being held in a family limited partnship for which the reporting person, Mark M. Thompson, is the general partner. These shares are being held in a family limited partnership for which the reporting person, Mark M. Thompson, is a limited partner and as of July 28, 2006, the acting general partner under a power of attorney granted by the general partner. /s/ Mark M. Thompson 2011-12-23