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FORM 5
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION ANNUAL STATEMENT
OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to
Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the
Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment
Company Act of 1940 |
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(Print or Type Responses)
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Table II - Derivative Securities Acquired, Disposed
of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative
Security |
2. Conversion or Exercise
Price of Derivative Security |
3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date,
if any (Month/Day/Year) |
4. Transaction Code |
5. Number of Derivative
Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable and
Expiration Date |
7. Title and Amount of
Securities Underlying Derivative Security |
8. Price of Derivative
Security |
9. Number of Derivative
Securities Beneficially Owned at End of Issuer's Fiscal Year |
10. Ownership Form of
Derivative Security: Direct (D) or Indirect (I) |
11. Nature of Indirect
Beneficial Ownership |
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(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
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Reporting Owner Name / Address |
Relationships |
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Director |
10% Owner |
Officer |
Other |
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BIXBY WALTER E |
X |
X |
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Walter E. Bixby, signed by William A. Schalekamp as power
of attorney |
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02/10/2006 |
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**Signature of Reporting Person |
Date |
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(1) |
(1) Effective on December
31, 2005, pursuant to the mandatory provisions of the agreement of WEB
Interests, Ltd., a Texas |
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(2) |
(1)(c) an indirect
pecuniary interest in 12,817 shares were transferred to Mr. Bixby in his
capacity as the sole trustee of |
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(3) |
(2) As a general partner of
the Partnership, Mr. Bixby shares with the WEB Jr. Trust (a general partner
of the Partnership) |
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(4) |
(3) As custodian for each
of Walter E. Bixby, IV, Adam J. Bixby, and Kai M. Bixby under the Missouri
Transfer to Minors law, |
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(5) |
(4) As a co-trustee of the
Walter E. Bixby Descendants Trust with Angeline I. O'Connor and Robert Philip
Bixby, Mr. Bixby |
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(6) |
(5) These shares do not
include beneficial ownership in any of Kansas City Life Insurance Company's
benefit plans; and |
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(7) |
(6) As reported on a
Schedule 13D filed by the Bixby family group with the Securities and Exchange
Commission on November 2, |
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Reminder: Report on a
separate line for each class of securities beneficially owned directly or
indirectly. |
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* |
If the form is filed by
more than one reporting person, see Instruction 4(b)(v). |
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** |
Intentional misstatements
or omissions of facts constitute Federal Criminal Violations. See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a). |
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Note: File three copies of
this Form, one of which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
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Persons who respond to
the collection of information contained in this form are not required to
respond unless the form displays a currently valid OMB Number. |
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