-----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, Oy+iwM6GtriexH+w99rRkqwvSqNfBdxDKlTcJYMHKc4RUOI+jMiwwiZVpDHhHUiV PyUtSWFpZOqkZnzP+3Qoaw== 0000912057-97-029259.txt : 19970828 0000912057-97-029259.hdr.sgml : 19970828 ACCESSION NUMBER: 0000912057-97-029259 CONFORMED SUBMISSION TYPE: 11-K PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 19970228 FILED AS OF DATE: 19970827 SROS: NASD FILER: COMPANY DATA: COMPANY CONFORMED NAME: ROCKY MOUNTAIN CHOCOLATE FACTORY INC CENTRAL INDEX KEY: 0000785815 STANDARD INDUSTRIAL CLASSIFICATION: SUGAR & CONFECTIONERY PRODUCTS [2060] IRS NUMBER: 840910696 STATE OF INCORPORATION: CO FISCAL YEAR END: 0228 FILING VALUES: FORM TYPE: 11-K SEC ACT: 1934 Act SEC FILE NUMBER: 000-14749 FILM NUMBER: 97671100 BUSINESS ADDRESS: STREET 1: 265 TURNER DR CITY: DURANGO STATE: CO ZIP: 81301 BUSINESS PHONE: 3032590554 MAIL ADDRESS: STREET 1: 265 TURNER DRIVE CITY: DURANGO STATE: CO ZIP: 81301 11-K 1 FORM 11-K UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ---------------------- FORM 11-K ---------------------- (Mark One) [X] ANNUAL REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED FEBRUARY 28, 1997 OR [ ] TRANSITION REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 FOR THE TRANSITION PERIOD FROM __________ TO __________ COMMISSION FILE NO. 0-14749 ROCKY MOUNTAIN CHOCOLATE FACTORY, INC.401(K) PLAN (FULL TITLE OF PLAN AND ADDRESS OF PLAN IF DIFFERENT FROM THAT OF ISSUER NAMED BELOW) ---------------------- ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 265 Turner Drive Durango, Colorado 81301 (NAME OF ISSUER OF SECURITIES HELD PURSUANT TO THE PLAN AND THE ADDRESS OF ITS PRINCIPAL EXECUTIVE OFFICE) REQUIRED INFORMATION The report filed as Exhibit 1 hereto (the "Plan Information") is incorporated by reference herein in satisfaction of the financial statement requirements of Form 11-K pursuant to Item 4 of Form 11-K. The Plan Information has been prepared in accordance with the financial reporting requirements of ERISA. ERISA (without regard to the limited scope exemption contained in Section 103(a)(3)(C) thereof) does not require the Plan Information to be examined by an independent accountant. EXHIBITS Exhibit Number Description ------- ----------- 1 Return/Report of the Plan on Form 5500-R for the year ended February 28, 1997 2 Form of Rocky Mountain Chocolate Factory, Inc. 401(k) Plan (incorporated by reference to Exhibit 4.1 to the Company's Registration Statement on Form S-8 (Registration No. 33- 79342) filed on May 25, 1994). 2 SIGNATURES Pursuant to the requirements of the Securities Exchange Act of 1934, the Administrator of the Rocky Mountain Chocolate Factory, Inc. 401(k) Plan has duly caused this annual report to be signed on its behalf by the undersigned hereunto duly authorized. ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN By: Rocky Mountain Chocolate Factory, Inc., Plan Administrator Date: August 27, 1997 By: /s/ LAWRENCE C. REZENTES --------------------------------------------- Lawrence C. Rezentes, Vice President-Finance 3 INDEX TO EXHIBITS Exhibit Number Description ------ ----------- 1 Return/Report of the Plan on Form 5500-R for the year ended February 28, 1997 2 Form of Rocky Mountain Chocolate Factory, Inc. 401(k) Plan (incorporated by reference to Exhibit 4.1 to the Company's Registration Statement on Form S-8 (Registration No. 33- 79342) filed on May 25, 1994). 4 EX-1 2 EXHIBIT 1
Form 5500-C/R RETURN/REPORT OF EMPLOYEE BENEFIT PLAN OMD NOS. 1210-0016 (WITH FEWER THAN 100 PARTICIPANTS) 1210-0089 Department of the Treasury THIS FORM IS REQUIRED TO BE FILED UNDER SECTIONS 104 AND 4065 OF THE 1996 Internal Revenue Service EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 AND SECTIONS 6039D, 6047(e), ----------- 6057(b), AND 6058(a) OF THE INTERNAL REVENUE CODE. THIS FORM IS OPEN Department of Labor TO PUBLIC Pension and Welfare Benefits INSPECTION. Administration ----------- Pension Benefit Guaranty Corporation See separate instructions. - ---------------------------------------------------------------------------------------------------------------------------------- FOR THE CALENDAR PLAN YEAR 1996 OR FISCAL PLAN YEAR BEGINNING MARCH 1, 1996, AND ENDING FEBRUARY 28, 1997 - ---------------------------------------------------------------------------------------------------------------------------------- If A(1) through A(4), B, C, and/or D do not apply to this year's return/report, FOR IRS USE ONLY leave the boxes unmarked. EP-ID ------------------------------------------ YOU MUST CHECK EITHER BOX A(5) OR A(6), WHICHEVER IS APPLICABLE. SEE INSTRUCTIONS. A This return/report is: (5) FORM 5500-C FILER CHECK HERE....../ / (1) / / The first return/report filed for the plan; (Complete only pages 1 and 3 through (2) / / an amended return/report; 6.) (Code Section 6039D (3) / / the final return/report filed for the plan; or filers see instructions on page 5.) (4) / / a short plan year return/report (less than 12 months). (6) FORM 5500-R FILER CHECK HERE....../X/ (Complete only pages 1 and 2. Detach pages 3 through 6 before filing.) If you checked box (1) or (3), you must file a Form 5500-C. (See page 6 of the instructions.) IF ANY INFORMATION ON A PREPRINTED PAGE 1 IS INCORRECT, CORRECT IT. IF ANY INFORMATION IS MISSING, ADD IT. PLEASE USE RED INK WHEN MAKING THESE CHANGES AND INCLUDE THE PREPRINTED PAGE 1 WITH YOUR COMPLETED RETURN/REPORT. B Check here if any information reported in 1a, 2a, 2b, or 5a changed since the last return/report for this plan............../ / C If your plan year changed since the last return/report, check here........................................................../ / D If you filed for an extension of time to file this return/report, check here and attach a copy of the approved extension..../ / - ---------------------------------------------------------------------------------------------------------------------------------- 1a Name and address of plan sponsor (employer, if for a single-employer plan) 1b Employer identification number (EIN) (Address should include room or suite no.) 84 0910696 ---------------------------------------- ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 1c Sponsor's telephone number 265 TURNER DRIVE (303) 247-4943 DURANGO, CO 81301-0000 ---------------------------------------- 1d Business code (see instructions, page 17) 2060 ---------------------------------------- 1e CUSIP issuer number N/A - ---------------------------------------------------------------------------------------------------------------------------------- 2a Name and address of plan administrator (if same as plan sponsor, enter "Same") 2b Administrator's EIN SAME ---------------------------------------- 2c Administrator's telephone number - ---------------------------------------------------------------------------------------------------------------------------------- 3 If you are filing this page without the preprinted historical plan information and the name, address, and EIN of the plan sponsor or plan administrator has changed since the last return/report filed for this plan, enter the information from the last return/report on lines 3a and/or 3b and complete line 3c. a Sponsor EIN Plan number ------------------------------------------------------------------------------ ------------- -------------- b Administrator EIN ------------------------------------------------------------------------ -------------------------------------- c If line 3a indicates a change in the sponsor's name, address, and EIN, is this a change in sponsorship only? (See line 3c on page 8 of the instructions for the definition of sponsorship.) Enter "Yes" or "No." - ---------------------------------------------------------------------------------------------------------------------------------- 4 ENTITY CODE. (If not shown, enter applicable code from page 8 of the instructions.) A - ---------------------------------------------------------------------------------------------------------------------------------- 5a Name of plan ROCKY MOUNTAIN CHOCOLATE 5b Effective date of plan (mo., day, yr.) ----------------------------------------------------------------------- FACTORY, INC. 401(K) PLAN June 1, 1994 - --------------------------------------------------------------------------------------- ----------------------------------------- 5c Three-digit - --------------------------------------------------------------------------------------- ALL FILERS MUST COMPLETE 6a THROUGH 6d, AS APPLICABLE. plan number 0 0 1 ----------------------------------------- 6a / / Welfare benefit plan 6b /x/ Pension benefit plan 2 ----------------------------------------- (If the correct codes are not preprinted below, enter the applicable codes from page 8 of the instructions in the boxes.) ----------------------------------------- 6c Pension plan features. (If the correct codes are not preprinted below, enter the ----------------------------------------- applicable pension plan feature codes from page 8 of the instructions in the boxes.) C G ----------------------------------------- 6d / / Fringe benefit plan. Attach Schedule F (Form 5500). See instructions. - ---------------------------------------------------------------------------------------------------------------------------------- CAUTION: A PENALTY FOR THE LATE OR INCOMPLETE FILING OF THIS RETURN/REPORT WILL BE ASSESSED UNLESS REASONABLE CAUSE IS ESTABLISHED. - ---------------------------------------------------------------------------------------------------------------------------------- Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this return/report, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of employer/plan sponsor Date -------------------------------------------------------------- ------------------------------ Type or print name of individual signing above ------------------------------------------------------------------------------------ Signature of plan administrator Date ----------------------------------------------------------------- ------------------------------ Type or print name of individual signing above - ---------------------------------------------------------------------------------------------------------------------------------- FOR PAPERWORK REDUCTION ACT NOTICE, SEE PAGE 1 OF THE INSTRUCTIONS. Cat. No. 10957K Form 5500-C/R (1996)
Form 5500-C/R(1996) FORM 5500-R FILERS, COMPLETE PAGES 1 AND 2 ONLY. PAGE 2 FORM 5500-C FILERS, COMPLETE PAGE 1, SKIP PAGE 2, AND COMPLETE PAGE 3 THROUGH 6. - -------------------------------------------------------------------------------- 6 e Check investment arrangement(s): (1) / / Master trust (2)/ / Common/Collective trust (3) /X/ Pooled separate account YES NO - ---------------------------------------------------------------------------------------------------------------------------------- 7 a Total participants: (1) At the beginning of plan year > 98 (2) At the end of plan year > 108 ---------- ------- b Enter the number of participants with account balances at the end of the plan year (defined benefit plans do not complete this item) 73 ----- c (1) Were any participants in the pension benefit plan separated from service with a deferred vested benefit for which a Schedule SSA (Form 5500) is required to be attached? (See instructions.)...........................................7c(1) X (2) If "Yes," enter the number of separated participants required to be reported > - ---------------------------------------------------------------------------------------------------------------------------------- 8 a Was this plan terminated during this plan year or any prior plan year? If "Yes," enter the year > 8a X b Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of PBGC? 8b X c If line 8a is "Yes" and the plan is covered by PBGC, is the plan continuing to file PBGC Form 1 and pay premiums until the end of the plan year in which assets are distributed or brought under the control of PBGC? ......................................................................................................... 8c - ---------------------------------------------------------------------------------------------------------------------------------- 9 Is this a plan established or maintained pursuant to one or more collective bargaining agreements?.............. 9 X - ---------------------------------------------------------------------------------------------------------------------------------- 10 If any benefits are provided by an insurance company, insurance service, or similar organization, enter the number of Schedules A (Form 5500), Insurance Information, that are attached. If none, enter -0-. > 1 - ---------------------------------------------------------------------------------------------------------------------------------- 11 a (1) Were any plan amendments adopted during this plan year?..................................................11a(1) X (2) Enter the date the most recent amendment was adopted > Month 05 Day 27 Year 94 ---- ---- ---- b If line 11a is "Yes," did any amendment result in a retroactive reduction of accrued benefits for any participant?.................................................................................................11b c If line 11a is "Yes," did any amendment change the information contained in the latest summary plan description or summary description of modifications available at the time of the amendment?..................11c d If line 11c is "Yes," has a summary plan description or summary description of modifications that reflects the plan amendments referred to on line 11c been both furnished to participants and filed with the Department of Labor?....................................................................................................11d - ---------------------------------------------------------------------------------------------------------------------------------- 12 a If this is a pension benefit plan subject to the minimum funding standards, has the plan experienced a funding deficiency for this plan year? (See instructions.)...................................................12a X b If line 12a is "Yes," have you filed form 5330 to pay the exercise tax?......................................12b c Is the plan administrator making an election under section 412(c)(8) for an amendment adopted after the end of the plan year? (See instructions.)....................................................................12c X d If a change in the actuarial funding method was made for the plan year pursuant to a Revenue Procedure providing automatic approval for the change, indicate whether the plan sponsor/administrator agrees to the change................................................................................................12d - ---------------------------------------------------------------------------------------------------------------------------------- 13 a Total plan assets as of the beginning 198,682 and end 287,770 of the plan year ---------- -------- b Total liabilities as of the beginning 0 and end 0 of the plan year ---------- -------- c Net assets as of the beginning 198,682 and end > 287,770 of the plan year ---------- -------- - ---------------------------------------------------------------------------------------------------------------------------------- 14 For this plan year, enter: a Plan income 102,292 d Plan contributions 137,473 ----------- ----------- b Expenses 13,204 e Total benefits paid 13,193 ----------- ----------- c Net income (loss)(subtract 14b from 14a) 89,088 -------- - ---------------------------------------------------------------------------------------------------------------------------------- 15 You may NOT use N/A in response to lines 15a through 15o. If you check "Yes," you must enter a YES NO AMOUNT dollar amount in the amount column. DURING THIS PLAN YEAR: a Was this plan covered by a fidelity bond?.....................................................15a X 50,000 b If line 15a is "Yes," enter the name of the surety company > HARTFORD FIRE INSURANCE CO. c Was there any loss to the plan, whether or not reimbursed, caused by fraud or dishonesty?.....15c X d Was there any sale, exchange, or lease of any property between the plan and the employer, any fiduciary, any of the five most highly paid employees of the employer, any owner of a 10% or more interest in the employer, or relatives of any such persons?.....................15d X e Was there any loan or extension of credit by the plan to the employer, any fiduciary, any of the five most highly paid employees of the employer, any owner of a 10% or more interest in the employer, or relatives of any such persons?............................................15e X f Did the plan acquire or hold any employer security or employer real property?.................15f X g Has the plan granted an extension on any delinquent loan owed to the plan?...................15g X h Were any participant contributions transmitted to the plan more than 31 days after receipt or withholding by the employer?...............................................................15h X i Were any loans by the plan or fixed income obligations due the plan classified as uncollectible or in default as of the close of the plan year?.................................15i X j Has any plan fiduciary had a financial interest in excess of 10% in any party providing services to the plan or received anything of value from any such party?.......................15j X k Did the plan at any time hold 20% or more of its assets in any single security, debt, mortgage, parcel of real estate, or partnership/joint venture interests?......................15k X 76,997 l Did the plan at any time engage in any transaction or series of related transactions involving 20% or more of the current value of plan assets?....................................15l X 77,087 m Were there any noncash contributions made to the plan the value of which was set without an appraisal by an independent third party?...................................................15m X n Were there any purchases of nonpublicly traded securities by the plan the value of which was set without an appraisal by an independent third party?...................................15n X o Has the plan reduced or failed to provide any benefit when due under the plan because of insufficient assets?.......................................................................15o X - ---------------------------------------------------------------------------------------------------------------------------------- 16 a Is the plan covered under the Pension Benefit Guaranty Corporation termination insurance program? / / Yes / / No / / Not determined b If line 16a is "Yes" or "Not determined," enter the employer identification number and the plan number used to identify it. Employer identification number > Plan number > - ----------------------------------------------------------------------------------------------------------------------------------
[LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- MONEY MARKET BALANCE SHEET
- ------------------------------------------------------------------------- ASSETS Bonds $1,157,636,689 Bank Deposits 2,722,936 Receivable From Principal Mutual Life Insurance Co. 47,894,506 -------------- Total Assets $1,208,254,131 -------------- -------------- LIABILITIES & SURPLUS Unallocated Reserves $1,205,625,266 Remitted & Items Not Allocated 2,628,865 -------------- Total Liabilities 1,208,254,131 Surplus 0 -------------- Total Liabilities and Surplus $1,208,254,131 -------------- --------------
SUMMARY OF OPERATIONS
- ------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 386,878,049 Interest Income 59,058,382 -------------- Total Receipts $ 445,936,431 DISBURSEMENTS Benefit Payments $ 174,892,793 Funds Withdrawn 166,925,829 Investment Management, Mortality, and Administration Charges 8,003,079 Investment Expenses 862,874 -------------- Total Disbursements 350,684,575 -------------- Increase in Reserves $ 95,251,856 -------------- --------------
[LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- GOVERNMENT SECURITIES BALANCE SHEET
- ------------------------------------------------------------------------- ASSETS Bonds $ 196,903,413 Bank Deposits 789 Adjustment to Investments to Reflect Market Value 544,173 Investment Income Due & Accrued 1,097,233 Receivable From Principal Mutual Life Insurance Co. 3,242,084 Remitted & Items Not Allocated 153 -------------- Total Assets $ 201,787,845 -------------- -------------- LIABILITIES & SURPLUS Unallocated Reserves $ 198,831,244 Payable For Investments Purchased 2,956,601 -------------- Total Liabilities 201,787,845 Surplus 0 -------------- Total Liabilities and Surplus $ 201,787,845 -------------- --------------
SUMMARY OF OPERATIONS
- ------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 72,190,961 Gross Investment Income: Interest Income 11,770,045 Change In: Investment Income Earned But Not Collected 341,940 Accrued Interest Receivable (257,385) 11,854,600 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments (4,048,223) Realized Capital Gain 374,733 -------------- Total Receipts $ 80,372,071 DISBURSEMENTS Funds Withdrawn $ 13,176,335 Benefit Payments 10,136,799 Investment Management, Mortality, and Administration Charges 1,179,221 Investment Expenses 133,628 -------------- Total Disbursements 24,625,983 -------------- Increase in Reserves $ 55,745,500 Contributed Surplus 588 -------------- $ 55,746,088 -------------- --------------
[LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- BOND EMPHASIS BALANCED BALANCE SHEET
- ------------------------------------------------------------------------- ASSETS Investment in Principal Mutual Life Insurance Company Separate Account: Bond and Mortgage $ 65,476,329 Government Securities 44,301,931 U.S. Stock 24,141,652 International Stock 17,489,272 Real Estate 18,135,887 Large Company Value 1,110,664 Small Company Value 246,849 Large Company Growth 740,415 Small Company Growth 123,411 Remitted and Items Not Allocated 4,444,006 Adjustment to Investments to Reflect Market Value 21,396,753 -------------- Total Assets $ 197,607,169 -------------- -------------- LIABILITIES & SURPLUS Unallocated Reserves $ 197,607,169 -------------- Total Liabilities 197,607,169 Surplus 0 -------------- Total Liabilities and Surplus $ 197,607,169 -------------- --------------
SUMMARY OF OPERATIONS
- ------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 65,818,615 Change in Net Unrealized Appreciation/Depreciation of Investments 7,205,810 Realized Capital Gain 9,361,046 -------------- Total Receipts $ 82,385,471 -------------- -------------- DISBURSEMENTS Funds Withdrawn $ 24,523,164 Benefit Payments 10,722,706 Investment Management, Mortality, and Administration Charges 320,034 -------------- Total Disbursements 35,565,904 -------------- Increase in Reserves $ 46,819,567 -------------- --------------
[LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- STOCK EMPHASIS BALANCED BALANCE SHEET - -------------------------------------------------------------------------------- ASSETS Investment in Principal Mutual Life Insurance Company Separate Account: Bond and Mortgage $ 68,701,241 Government Securities 39,887,632 U.S. Stock 159,984,815 International Stock 61,237,702 Real Estate 60,726,163 Large Company Value 3,427,828 Small Company Value 791,180 Large Company Growth 2,241,170 Small Company Growth 263,690 Remitted and Items Not Allocated 11,380,208 Adjustments to Investments to Reflect Market Value 22,886,684 ------------ Total Assets $431,528,313 ------------ ------------ LIABILITIES & SURPLUS Unallocated Reserves $431,528,313 ------------ Total Liabilities 431,528,313 Surplus 0 ------------ Total Liabilities & Surplus $431,528,313 ------------ ------------ SUMMARY OF OPERATIONS - ------------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $154,974,610 Change in Net Unrealized Appreciation/Depreciation of Investments (6,588,723) Realized Capital Gain 58,270,814 ------------ Total Reciepts $206,656,701 DISBURSEMENTS Funds Withdrawn $ 17,432,293 Benefit Payments 20,656,000 Investment Management, Mortality, and Administration Charges 693,802 ------------ Total Disbursements 38,782,095 ------------ Increase in Reserves $167,874,606 ------------ ------------ Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001. [LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- STOCK INDEX 500 BALANCE SHEET - -------------------------------------------------------------------------------- ASSETS Bonds $ 24,906,211 Common Stock 936,737,449 Bank Deposits 55,076 Adjustment to Investments to Reflect Market Value 382,979,288 Investment Income Due & Accrued 2,246,871 Receivable From Principal Mutual Life Insurance Co. 3,782,141 -------------- $1,350,707,036 -------------- -------------- LIABILITIES Unallocated Reserves $1,325,794,256 Remitted & Items Not Allocated 824 Payable for Investments Purchased 24,911,956 -------------- Total Liabilities 1,350,707,036 Surplus 0 -------------- Total Liabilities & Surplus $1,350,707,036 -------------- -------------- SUMMARY OF OPERATIONS - ------------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 397,820,438 Gross Investment Income: Dividend Income 22,551,121 Interest Income 152,983 Charge in Investment Income Earned But Not Collected 876,502 23,580,606 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 183,764,903 Realized Capital Gain 11,584,688 -------------- Total Receipts $ 616,750,635 DISBURSEMENTS Benefit Payments $ 64,560,629 Funds Withdrawn 56,963,996 Investment Management, Mortality, and Administration Charges 5,494,123 Investment Expenses 843,076 -------------- Total Disbursements 127,861,824 -------------- Increase in Reserves 488,274,450 Contributed Surplus 614,361 -------------- $ 488,888,811 -------------- -------------- Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001. [LOGO] 12/31/96 FUND STATEMENT POOLED SEPARATE ACCOUNT- U.S. STOCK BALANCE SHEET - -------------------------------------------------------------------------------- ASSETS Bonds $ 97,804,829 Common Stock 5,842,967,334 Bank Deposits 57,822 Adjustment to Investments to Reflect Market Value 1,109,052,797 Investment Income Due & Accrued 12,663,762 Receivable From Principal Mutual Life Insurance Co. 81,874,989 Remitted & Items Not Allocated 29,221,499 -------------- Total Assets $7,173,643,032 -------------- -------------- LIABILITIES & SURPLUS Allocated Annuities Reserve $ 100,268,907 Unallocated Reserves 7,007,191,337 Payable for Investments Purchased 66,182,788 -------------- Total Liabilities 7,173,643,032 Surplus 0 -------------- Total Liabilities & Surplus $7,173,643,032 -------------- -------------- SUMMARY OF OPERATIONS - ------------------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 690,456,067 Gross Investment Income: Dividend Income 140,608,715 Interest Income 4,299,495 Investment Fee Income 2,379 Change in Investment Income Earned But Not Collected 4,377,248 149,287,837 ----------- Change in Net Unrealized Appreciation/Depreciation of Investments (64,082,654) Realized Capital Gain 1,318,852,405 -------------- Total Receipts $2,094,513,655 DISBURSEMENTS Funds Withdrawn $ 459,957,577 Benefit Payments 294,378,717 Annuity Payments 20,670,246 Investment Management, Mortality, and Administration Charges 36,723,947 Investment Expenses 5,066,705 -------------- Total Disbursements 816,797,192 -------------- Increase in Reserves $1,277,716,463 -------------- -------------- Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001. 12/31/96 FUND STATEMENT [LOGO OF THE PRINCIAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT- MEDIUM COMPANY VALUE BALANCE SHEET ASSETS Bonds $ 7,698,610 Common Stock 441,975,904 Bank Deposits 73,584 Adjustment to Investments to Reflect Market Value 36,400,920 Investment Income Due & Accrued 1,383,397 Receivable From Principal Mutual Life Insurance Co. 8,257,874 Remitted & Items Not Allocated 1,210,355 ------------ Total Assets $497,000,644 ------------ ------------ LIABILITIES & SURPLUS Unallocated Reserves $493,482,774 Payable for Investments Purchased 3,517,870 ------------ Total Liabilities 497,000,644 Surplus 0 ------------ Total Liabilities & Surplus $497,000,644 ------------ ------------ SUMMARY OF OPERATIONS RECEIPTS Deposits and Net Transfers $205,630,242 Gross Investment Income: Dividend Income 14,752,299 Interest Income 519,369 Change in Investment Income Earned But Not Collected 978,807 16,250,475 ------------ Change in Net Unrealized Appreciation/Depreciation of Investments 14,132,133 Realized Capital Gain 29,611,230 ------------ Total Receipts $265,624,080 ------------ ------------ DISBURSEMENTS Benefit Payments $ 17,708,077 Funds Withdrawn 12,382,760 Investment Management, Mortality, and Administration Charges 2,541,384 Investment Expenses 303,448 ------------ Total Disbursements 32,935,669 ------------ Increase in Reserves $232,688,411 ------------ ------------ Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001 12/31/96 FUND STATEMENT [LOGO OF THE PRINCIAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT- MEDIUM COMPANY BLEND BALANCE SHEET ASSETS Bonds $ 18,434,058 Preferred Stock 81,400 Common Stock 404,112,973 Bank Deposits 58,359 Adjustment to Investments to Reflect Market Value 109,814,810 Investment Income Due & Accrued 856,480 Receivable From Principal Mutual Life Insurance Co. 11,329,069 ------------ Total Assets $544,687,149 ------------ ------------ LIABILITIES & SURPLUS Unallocated Reserves $544,687,149 ------------ Total Liabilities 544,687,149 Surplus 0 ------------ Total Liabilities & Surplus $544,687,149 ------------ ------------ SUMMARY OF OPERATIONS RECEIPTS Deposits and Net Transfers $203,981,012 Gross Investment Income: Dividend Income 6,681,024 Interest Income 737,184 Change in Investment Income Earned But Not Collected 352,957 7,771,165 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 63,894,046 Realized Capital Gain 1,929,059 ------------ Total Receipts $277,575,282 ------------ ------------ DISBURSEMENTS Benefit Payments $ 22,729,456 Funds Withdrawn 17,195,973 Investment Management, Mortality, and Administration Charges 2,987,872 Investment Expenses 340,237 ------------ Total Disbursements 43,253,538 ------------ Increase in Reserves $234,321,744 ------------ ------------ Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001 12/31/96 FUND STATEMENT [LOGO OF THE PRINCIAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT- SMALL COMPANY BLEND BALANCE SHEET ASSETS Bonds $ 44,201,240 Common Stock 824,124,196 Bank Deposits 1,753,840 Adjustment to Investments to Reflect Market Value 117,226,995 Investment Income Due & Accrued 321,114 Receivable for Investments Sold 2,031,061 Receivable From Principal Mutual Life Insurance Co. 35,762,079 -------------- Total Assets $1,025,420,525 -------------- -------------- LIABILITIES & SURPLUS Unallocated Reserves $1,022,696,239 Remitted & Items Not Allocated 2,724,286 -------------- Total Liabilities 1,025,420,525 Surplus 0 -------------- Total Liabilities & Surplus $1,025,420,525 -------------- -------------- SUMMARY OF OPERATIONS RECEIPTS Deposits and Net Transfers $453,859,262 Gross Investment Income: Dividend Income 4,467,215 Interest Income 1,609,242 Change in Investment Income Earned But Not Collected 40,326 6,116,783 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 60,600,980 Realized Capital Gain 53,745,061 ------------ Total Receipts $574,322,086 ------------ ------------ DISBURSEMENTS Benefit Payments $ 39,126,957 Funds Withdrawn 29,664,424 Investment Management, Mortality, and Administration Charges 5,322,260 Investment Expenses 611,137 ------------ Total Disbursements 74,724,778 ------------ Increase in Reserves $499,597,308 ------------ ------------ Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001 SCHEDULE A (FORM 5500) Department of the Treasury Internal Revenue Service ------------------- Department of Labor Pension and Welfare Benefits Administration ------------------- Pension Benefit Guaranty Corporation INSURANCE INFORMATION This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974. - FILE AS AN ATTACHMENT OF FORM 5500 OR 5500-C/R. - Insurance companies are required to provide this information as per ERISA section 103(a)(2). OMB No. 1210-0016 - -------------------------------------------------------------------------------- 1996 - -------------------------------------------------------------------------------- THIS FORM IS OPEN TO PUBLIC INSPECTION - -------------------------------------------------------------------------------- For calendar year 1996 or fiscal plan year beginning March 1, 1996, and ending February 28, 1997. - -------------------------------------------------------------------------------- - - PART I MUST BE COMPLETED FOR ALL PLANS REQUIRED TO FILE THIS SCHEDULE. - - PART II MUST BE COMPLETED FOR ALL INSURED PENSION PLANS. - - PART III MUST BE COMPLETED FOR ALL INSURED WELFARE PLANS. - - ENTER MASTER TRUST OR 103-12 IE NAME IN PLACE OF "SPONSOR" AND SPECIFY INVESTMENT ACCOUNT OR 103-12 IE IN PLACE OF "PLAN" IF FILING WITH DOL FOR A MASTER TRUST OR 103-12 IE. - -------------------------------------------------------------------------------- Name of plan sponsor as shown on line 1a of Form 5500 or 5500-C/R ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. - -------------------------------------------------------------------------------- Employer identification number 84 0910696 - -------------------------------------------------------------------------------- Name of plan ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN - -------------------------------------------------------------------------------- Three-digit plan number - - -------------------------------------------------------------------------------- 0 0 1 - -------------------------------------------------------------------------------- PART I SUMMARY OF ALL INSURANCE CONTRACTS INCLUDED IN PARTS II AND III Group all contracts in the same manner as in Parts II and III. - -------------------------------------------------------------------------------- 1 Check appropriate box: a / / Welfare plan b /X/ Pension Plan c / / Combination pension and welfare plan
- ----------------------------------------------------------------------------------------------------------------------------------- 2 Coverage: (a) Name of insurance carrier (b) Contract (c) Approximate number Policy or contract year or identification of persons covered at and ----------------------- number of policy or contract year (d) From (e) To - ----------------------------------------------------------------------------------------------------------------------------------- PRINCIPAL MUTUAL LIFE INSURANCE CO 4-12731 108 03/01/96 2/28/97
- ----------------------------------------------------------------------------------------------------------------------------------- 3 Insurance fees and commissions paid to agents and brokers: (d) Fees paid (a) Contract or (b) Name and address of the agents or brokers to (c) Amount of --------------------------------- Identification number whom commissions or fees were paid commissions paid Amount Purpose - ----------------------------------------------------------------------------------------------------------------------------------- 4-12731 JOHNSON & HIGGINS OF COLORA 1,800 25 - PRORATED INCENTIVE 1225 17TH ST STE 2100 AMOUNT NOT CHARGED DENVER CO 80202-5534 TO YOUR PLAN - ----------------------------------------------------------------------------------------------------------------------------------- TOTAL 1,800 25
- -------------------------------------------------------------------------------- 4 Premiums due and unpaid at the end of the plan year - $ : Contract or identification number - 4-12731 - -------------------------------------------------------------------------------- PART II INSURED PENSION PLANS Provide information for each contract on a separate Part II. Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. - -------------------------------------------------------------------------------- - - Contract or identification number - 4-12731
- ----------------------------------------------------------------------------------------------------------------------------------- 5 Contracts with allocated funds, (for example, individual policies or group deferred annuity contracts): a State the basis of premium rates - -------------------------------------------------------------------------------------------- b Total premiums paid to carrier...................................................................................... 0 ---------- c If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in 3 above, enter amount................................ ---------- Specify nature of costs - - ----------------------------------------------------------------------------------------------------------------------------------- 6 Contracts with unallocated funds, (for example, deposit administration or immediate participation guarantee contracts). Do not include portions of these contracts maintained in separate accounts: a Balance at the end of the previous policy year...................................................................... 24,956 ---------- b Additions: (i) Contributions deposited during year....................................................... 11,594 ---------- (ii) Dividends and credits.............................................................................. 0 ---------- (iii) Interest credited during the year.................................................................. 2,026 ---------- (iv) Transferred from separate account.................................................................. 0 ---------- (v) Other (specify) - Rollover 5,019 --------------------------------------------------------------------------------- ---------- (vi) Total additions............................................................................................... 18,639 ---------- c Total of balance and additions (and a and b(vi)).................................................................... 43,595 ---------- d Deductions: (i) Disbursed from fund to pay benefits or purchase annuities during year.............................. 5,567 ---------- (ii) Administration charge made by carrier.............................................................. 11 ---------- (iii) Transferred to separate account.................................................................... 19 ---------- (iv) Other (specify) - Mkt Value Change 84 --------------------------------------------------------------------------------- ---------- (v) Total deductions.............................................................................................. 5,681 ---------- e Balance at end of current policy year (subtract d(v) from c) 37,914 - ----------------------------------------------------------------------------------------------------------------------------------- 7 Separate accounts: Current value of plan's interest in separate accounts at year end.................................. 167,963 - -----------------------------------------------------------------------------------------------------------------------------------
FOR PAPERWORK REDUCTION ACT NOTICE, SEE PAGE 1 OF THE INSTRUCTIONS FOR FORM 5500 OR 5500-C/R Cat. No. 135051 SCHEDULE A (FORM 5500) 1996 GROUP CONTRACT 4-12731 SCHEDULE A (FORM 5500) SUPPLEMENT PLAN NAME ROCKY MOUNTAIN CHOCOLATE PLAN SPONSOR FACTORY, INC. 401(K) PLAN EIN 84 0910696 PLAN NO. 001 CERTIFICATION This Schedule A and supplement which is provided by Principal Mutual Life Insurance Company, is certified to be complete and accurate according to the best of our knowledge. 6-17-97 /s/ JULIE C. HUDSON - ------------ --------------------- DATE SIGNATURE
| OMB No. 1210-0016 SCHEDULE P | ANNUAL RETURN OF FIDUCIARY |---------------------- (FORM 5500) | OF EMPLOYEE BENEFIT TRUST | 1996 | |---------------------- Department of the Treasury | FILE AS AN ATTACHMENT TO FORM 5500, 5500-C/R, or 5500-EZ. | This Form is Open to Internal Revenue Service | FOR THE PAPERWORK REDUCTION NOTICE, SEE PAGE 1 OF THE FORM 5500 INSTRUCTIONS. | Public Inspection - ---------------------------------------------------------------------------------------------------------------------------------- For trust calendar year 1996 or fiscal year beginning March 1, 1996, and ending February 28, 1997. - ---------------------------------------------------------------------------------------------------------------------------------- P | 1a Name of trustee or custodian L | TRUSTEE OF ROCKY MOUNTAIN CHOCOLATE E | FACTORY, INC. 401(K) PLAN A |----------------------------------------------------------------------------------------------------------------------------- S | b Number, street, and room or suite no. (if a P.O. box, see the instructions for Form 5500, 5500-C/R, or 5500-EZ.) E | | 265 TURNER DRIVE T |----------------------------------------------------------------------------------------------------------------------------- Y | c City or town, state, and ZIP code P | E | DURANGO, CO 81301-0000 |----------------------------------------------------------------------------------------------------------------------------- O | 2a Name of trust b Trust's employer identification number R | TRUST FOR ROCKY MOUNTAIN CHOCOLATE | FACTORY, INC. 401(K) PLAN 42|0127290 P |----------------------------------------------------------------------------------------------------------------------------- R | 3 Name of plan if different from name of trust I | ROCKY MOUNTAIN CHOCOLATE N | FACTORY, INC. 401(K) PLAN T | - ---------------------------------------------------------------------------------------------------------------------------------- 4 Have you furnished the participating employee benefit plan(s) with the trust financial information required to be reported by the plan(s)?................................................ /X/ Yes No / / - ---------------------------------------------------------------------------------------------------------------------------------- 5 Enter the plan sponsor's employer identification number as shown on | Form 5500, 5500-C/R, or 5500-EZ........................................ | 84|0910696 - ---------------------------------------------------------------------------------------------------------------------------------- Under penalties of perjury, I declare that I have examined this schedule, and to the best of my knowledge and belief it is true, correct, and complete. SIGNATURE OF FIDUCIARY > DATE > - ---------------------------------------------------------------------------------------------------------------------------------- INSTRUCTIONS SECTION REFERENCES ARE TO THE INTERNAL REVENUE CODE. PURPOSE OF FORM You may use this schedule to satisfy the requirements under section 6033(a) for an annual information return from every section 401(a) organization exempt from tax under section 501(a). Filing this form will start the running of the statute of limitations under section 6501(a) for any trust described in section 401(a), which is exempt from tax under section 501(a). WHO MAY FILE 1. Every trustee of a trust created as part of an employee benefit plan as described in section 401(a). 2. Every custodian of a custodial account described in section 401(f). HOW TO FILE File Schedule P (Form 5500) for the trust year ending with or within any participating plan's plan year. Attach it to the Form 5500, 5500-C/R, or 5500-EZ filed by the plan for that plan year. A separately filed Schedule P (Form 5500) will not be accepted. If the trust or custodial account is used by more than one plan, file one Schedule P (Form 5500). If a plan uses more than one trust or custodial account for its funds, file one Schedule P (Form 5500) for each trust or custodial account. TRUST'S EMPLOYER IDENTIFICATION NUMBER Enter the trust employer identification number (EIN) assigned to the employee benefit trust or custodial account, if one has been issued to you. The trust EIN should be used for transactions conducted for the trust. If you do not have a trust EIN, enter the EIN you would use on Form 1099-R to report distributions from employee benefit plans and on Form 945 to report withheld amounts of income tax from those payments. NOTE: TRUSTEES WHO DO NOT HAVE AN EIN MAY APPLY FOR ONE ON FORM SS-4, APPLICATION FOR EMPLOYER IDENTIFICATION NUMBER. YOU MUST BE CONSISTENT AND USE THE SAME EIN FOR ALL TRUST REPORTING PURPOSES. SIGNATURE The fiduciary (trustee or custodian) must sign this schedule. If there is more than one fiduciary, the fiduciary authorized by the others may sign. OTHER RETURNS AND FORMS THAT MAY BE REQUIRED - - FORM 990-T--For trusts described in section 401(a), a tax is imposed on income derived from business that is unrelated to the purpose for which the trust received a tax exemption. Report this income and tax on FORM 990-T, Exempt Organization Business Income Tax Return. (See sections 511 through 514 and the related regulations.) - - FORM 1099-R--If you made payments or distributions to individual beneficiaries of a plan, report those payments on Form 1099-R. (See the instructions for Forms 1099, 1098, 5498, and W-2G.) - - FORM 945--If you made payments or distributions to individual beneficiaries of a plan, you may be required to withhold income tax from those payments. Use FORM 945, Annual Return of Withheld Federal Income Tax, to report taxes withheld from nonpayroll items. (See CIRCULAR E, Employer's Tax Guide (Pub. 15), for more information.) - ---------------------------------------------------------------------------------------------------------------------------------- D132 Cat. No. 13504X SCHEDULE P (FORM 5500) 1996
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