0001140361-12-030910.txt : 20120622 0001140361-12-030910.hdr.sgml : 20120622 20120622124351 ACCESSION NUMBER: 0001140361-12-030910 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120622 FILED AS OF DATE: 20120622 DATE AS OF CHANGE: 20120622 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ruhland Russell J. CENTRAL INDEX KEY: 0001511949 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 12921719 MAIL ADDRESS: STREET 1: 825 CENTRAL AVENUE CITY: FORT DODGE STATE: IA ZIP: 50501 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 4 1 doc1.xml FORM 4 X0305 4 2012-06-22 0 0001005188 NORTH CENTRAL BANCSHARES INC FFFD 0001511949 Ruhland Russell J. C/O NORTH CENTRAL BANCSHARES, INC. 825 CENTRAL AVENUE FORT DODGE IA 50501 0 1 0 0 SVP of subsidiary Common Stock, par value $0.01 per share 2012-06-22 4 D 0 498 30.58 D 0 I By KSOP 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. /s/ Russell J. Ruhland 2012-06-22