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