0001193125-12-293619.txt : 20120703 0001193125-12-293619.hdr.sgml : 20120703 20120703151701 ACCESSION NUMBER: 0001193125-12-293619 CONFORMED SUBMISSION TYPE: 15-12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20120703 DATE AS OF CHANGE: 20120703 EFFECTIVENESS DATE: 20120703 FILER: 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 FILING VALUES: FORM TYPE: 15-12G SEC ACT: 1934 Act SEC FILE NUMBER: 000-27672 FILM NUMBER: 12944345 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 15-12G 1 d376055d1512g.htm FORM 15 Form 15

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 15

CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER SECTION 12(g)

OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF DUTY TO FILE REPORTS

UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.

Commission File Number 000-27672

NORTH CENTRAL BANCSHARES, INC.

(Exact name of registrant as specified in its charter)

 

Iowa    42-1449849

(State or other jurisdiction of

incorporation or organization)

   

(I.R.S. Employer

Identification No.)

825 Central Avenue

Fort Dodge, Iowa

    50501
(Address of Principal Executive Offices)    (Zip Code)

Common Stock, par value $0.01 per share

(Title of each class of securities covered by this Form)

Not Applicable

(Titles of all other classes of securities for which a duty to file reports under section 13(a) or 15(d) remains)

Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:

 

Rule 12g-4(a)(1)   x
Rule 12g-4(a)(2)   ¨
Rule 12h-3(b)(1)(i)   x
Rule 12h-3(b)(1)(ii)   ¨
Rule 15d-6   ¨

Approximate number of holders of record as of the certification or notice date: None (see “Explanatory Note”).

Explanatory Note: On June 22, 2012, North Central Bancshares, Inc. (“North Central”) was acquired via merger by Great Western Bancorporation, Inc. (“Great Western”) pursuant to the Agreement and Plan of Merger (the “Merger Agreement”), dated March 12, 2012. Under the terms of the Merger Agreement, a subsidiary of Great Western merged into North Central (the “Merger”) and North Central became wholly-owned by Great Western. Upon the effectiveness of the Merger, each share of common stock of North Central outstanding immediately prior to the effective time of the Merger was converted into the right to receive $30.58 per share, without interest and subject to withholding. Following the Merger, North Central was merged with and into Great Western, which was the surviving corporation in the merger.

 

 

 

Pursuant to the requirements of the Securities Act of 1934, Great Western Bancorporation, Inc. has caused this certification/notice to be signed on its behalf by the undersigned duly authorized person.

 

    North Central Bancshares, Inc.
Date: July 3, 2012   By:   /s/ Timothy D. Kaiser
   

Timothy D. Kaiser

Corporate Secretary of Great Western Bancorporation, Inc. (successor by merger to North Central Bancshares, Inc.)