-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DlarxA2UqTkO6qbayGuWOQxRmBOX8I1IKx0IEr7N+pGLVUqRTicuzbsvbxqvZ9Sr 1PaRpu3dHikWzUXdg31ehg== 0001144204-09-060923.txt : 20091119 0001144204-09-060923.hdr.sgml : 20091119 20091119161345 ACCESSION NUMBER: 0001144204-09-060923 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091117 FILED AS OF DATE: 20091119 DATE AS OF CHANGE: 20091119 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: 091196048 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 v167152_ex.xml X0303 4 2009-11-17 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 2009-11-17 4 M 0 2000 15.000 A 6950 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) 15.000 2009-11-17 4 M 0 2000 0 D 2000-01-01 2010-01-01 Common Stock 2000 0 D Includes 2,150 shares held in a self-directed IRA. These shares are being held in a family limited partnership for which the reporting person, Mark 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 power. /s/ Mark M. Thompson 2009-11-19 -----END PRIVACY-ENHANCED MESSAGE-----