0001140361-12-004985.txt : 20120202 0001140361-12-004985.hdr.sgml : 20120202 20120202143523 ACCESSION NUMBER: 0001140361-12-004985 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100916 FILED AS OF DATE: 20120202 DATE AS OF CHANGE: 20120202 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: SINGER ROBERT H JR CENTRAL INDEX KEY: 0001195969 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 12565556 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/A 1 doc1.xml FORM 4/A X0304 4/A 2010-09-16 2010-09-20 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001195969 SINGER ROBERT H JR 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 2010-09-16 4 P 0 500 13.00 A 9583 D This Form 4/A is being filed to correct the transaction amount, which was incorrectly reported as 600 in the original Form 4 that was filed on 9/20/2010. The figure in Column 5 of Table I is corrected in this Form 4/A to reflect an updated total beneficial ownership amount based on the corrected transaction amount described in footnote (1). The adjustment to the total beneficial ownership amount also affects the cumulative total beneficial ownership amount reported in one Form 4 that was filed by the reporting person after his original Form 4 referenced in footnote (1) was filed. The amount reported in this Column 5 of Table I reflects the total beneficial ownership amount of the reporting person as of the date of the filing of this amendment and includes 725 shares of restricted stock which will vest on April 22, 2012. /s/ Robert H. Singer, Jr. 2012-02-02