0001140361-12-030892.txt : 20120622
0001140361-12-030892.hdr.sgml : 20120622
20120622122733
ACCESSION NUMBER: 0001140361-12-030892
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120622
FILED AS OF DATE: 20120622
DATE AS OF CHANGE: 20120622
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: 12921640
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
X0305
4
2012-06-22
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
2012-06-22
4
D
0
11625
30.58
D
0
D
Common Stock, par value $0.01 per share
2012-06-22
4
D
0
2000
30.58
D
0
I
By Limited Partnership
Common Stock, par value $0.01 per share
2012-06-22
4
D
0
3213
30.58
D
0
I
By Limited Partnership
Each share has been converted into the right to receive $30.58 per share merger consideration pursuant to the Agreement and Plan of Merger, dated March 12, 2012 by and among Great Western Bancorporation, Inc., 150, Inc. and North Central Bancshares, Inc.
Thse shares were held in a family limited partnership for which the reporting person, Mark Thompson, is the general partner.
These shares were held in a family limited partnership for which the reporting person, Mark 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
2012-06-22