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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 ANGELINE I |
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X |
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Angeline I. Bixby |
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02/12/2007 |
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**Signature of Reporting Person |
Date |
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(1) Effective on December
31, 2006, pursuant to the mandatory provisions of the agreement of WEB
Interests, Ltd., a Texas |
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(1)(c) an indirect
pecuniary interest in 15,416 shares were transferred to Ms. Bixby in her
capacity as the sole trustee of |
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(2) As a general partner of
the Partnership, Ms. Bixby shares with the WEB Trust (a general partner of
the Partnership) and |
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(2)(c) 135,740 shares for
which Ms. Bixby as a limited partner, in her capacity as the sole trustee of
each of the AIO |
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(3) As a co-trustee of the
Walter E. Bixby Descendants Trust with Walter E. Bixby and Robert Philip
Bixby, Ms. Bixby shares |
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(4) 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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