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