| FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | ||||||||||||||||
| Form 3 Holdings Reported. | |||||||||||||||||
| Form 4 Transactions Reported. | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
KANSAS CITY LIFE INSURANCE CO [ KCLI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2003 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
| Amount | (A) or (D) | Price | |||||||||||||
| Common Stock, $1.25 par value | 07/28/2003 | S | 25,900 | D | (1) | 0 | D | ||||||||
| Common Stock, $1.25 par value | 07/28/2003 | J | 324 | D | (2) | 0 | D | ||||||||
| Common Stock, $1.25 par value | 12/31/2003 | J(3) | 7 | D | (3) | 1,552 | I | See Footnotes(4) | |||||||
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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 (Instr. 3) | 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 (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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| Explanation of Responses: |
| 1. Effective July 28, 2003, Margie Morris Bixby as trustee of the Margie Morris Bixby Revocable Trust dated December 18, 1997 ("MMB Trust") transferred all of her general partnership interest in JRB Interests, Ltd. (the "Partnership"), including the shared power to vote 2,966,312 shares of common stock, $1.25 par value of the Kansas City Life Insurance Company ("Common Stock") and a pecuniary interest in 25,900 shares of Common Stock, to Nancy Bixby Hudson in her capacity as co-trustee of the GST Nancy Bixby Hudson Trust and the Issue Trust for Nancy Bixby Hudson and to Lee M. Vogel in his capacity as co-trustee of the Issue Trust for Lee M. Vogel for an aggregate price of $592,552.50 |
| 2. Effective July 28, 2003, the Partnership redeemed from Mrs. Bixby her Class A limited partnership interests in the Partnership, including the sole voting power and indirect pecuniary interest in 324 shares of Common Stock |
| 3. Effective on December 31, 2003, pursuant to the mandatory provisions of the agreement of the Partnership, the sole voting power in 7 shares of Common Stock, owned by the Partnership was transferred from Margie M. Bixby, a Class A limited partner, to the Class B limited partners |
| 4. includes 252 shares of Common Stock held by the Partnership, which Mrs. Bixby as a Class C partner, in her capacity as Trustee of the MMB Trust has the shared power to vote and a pecuniary interest and 1,300 shares of Common B Stock held in joint tenancy with right of survivorship with Mr. Vogel for which Mrs. Bixby has shared voting and investment power. |
| Remarks: |
| signed by William A. Schalekamp as Power of Attorney |
| Margie Morris Bixby | 02/17/2004 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| 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. | ||