-----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, Pr9AsFM0BUMvLHGWeJNUfmaKvVNVFKBJJz7gFiWAKMiUNik50X/WwFvqboIdgtSd UJ94U7i2BhwR25SFG4TAPg== 0001047469-98-033267.txt : 19980901 0001047469-98-033267.hdr.sgml : 19980901 ACCESSION NUMBER: 0001047469-98-033267 CONFORMED SUBMISSION TYPE: 11-K PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 19980228 FILED AS OF DATE: 19980831 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: SEC FILE NUMBER: 000-14749 FILM NUMBER: 98701787 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 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, 1998 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 for the year ended February 28, 1998 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 31, 1998 By: /s/ Bryan J. Merryman --- -------------------------------------------- Bryan J. Merryman, Vice President-Finance 3 INDEX TO EXHIBITS
Exhibit Number Description - -------- ----------- 1 Return/Report of the Plan on Form 5500 for the year ended February 28, 1998 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 EX-1 Form 5500 ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN OMB Nos. 1210-0016 1210-0089 Department of the Treasury (WITH 100 OR MORE PARTICIPANTS) ------------------- Internal Revenue Service THIS FORM IS REQUIRED TO BE FILED UNDER SECTIONS 1997 ___________ 104 AND 4065 OF THE EMPLOYEE RETIREMENT INCOME -------------------- SECURITY ACT OF 1974 AND SECTIONS 6039D, 6047(e), Department of Labor 6057(b), AND 6058(a) OF THE INTERNAL REVENUE CODE, THIS FORM IS OPEN TO Pension and Welfare Benefits REFERRED TO AS THE CODE. PUBLIC INSPECTION Administration -------------------- ___________ Pension Benefit SEE SEPARATE INSTRUCTIONS. Guaranty Corporation - --------------------------------------------------------------------------------------------------------------------- FOR THE CALENDAR PLAN YEAR 1997 OR FISCAL PLAN YEAR BEGINNING MARCH 1, 1997, AND ENDING FEBRUARY 28, 1998 - --------------------------------------------------------------------------------------------------------------------- If A(1) through A(4), B, C, and/or D, do not apply to this year's FOR IRS USE ONLY return/report, leave the boxes unmarked. EP-ID A This return/report is: (1)/ / the first return/report filed for the plan; (3)/ / the final return/report filed for the plan; or (2)/ / an amended return/report; (4)/ / a short plan year return/report (less than 12 months). 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............................................................................................... /X/ - ------------------------------------------------------------------------------------------------------------------------- 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 81301-7941 --------------------------------------------- 1d Business code (see instructions, page 20) 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 in line 3a and/or line 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 the applicable code from page 8 of the instructions.) A - ---------------------------------------------------------------------------------------------------------------------------------- 5a Name of plan ROCKY MOUNTAIN CHOCOLATE 5b Effective date of plan (mo., day, yr.) ---------------------------------------------------------------- June 1, 1994 FACTORY, INC. 401(K) PLAN - ------------------------------------------------------------------------------------- ------------------------------------------- 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 -------------------------------------------- (If the correct codes are not preprinted below, enter the applicable ) 2 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 THE INSTRUCTIONS FOR FORM 5500. Cat. No. 13500F Form 5500 (1997)
Form 5500 (1997) Page 2 - ------------------------------------------------------------------------------------------------------------------------------------ 6e Check all applicable investment arrangements below (see instructions on page 9): (1) / / Master trust (2) / / 103-12 investment entity (3) / / Common/collective trust (4) /X/ Pooled separate account ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- f Single-employer plans enter the tax year end of the employer in which this plan year ends Month 2 Day 28 Year 98 g Is any part of this plan funded by an insurance contract described in Code section 412(i)?...................... / / YES /X/ NO h If line 6g is "Yes," was the part subject to the minimum funding standards for either of the prior 2 plan years? / / YES / / NO - ------------------------------------------------------------------------------------------------------------------------------------ 7 Number of participants as of the end of the plan year (welfare plans complete only lines 7a(4), 7b, 7c, and 7d): a Active participants: (1) Number fully vested ................................ a(1) 44 ------------------------------- (2) Number partially vested ............................ a(2) 58 ------------------------------- (3) Number nonvested ................................... a(3) 10 ------------------------------- (4) Total ......................................................................... a(4) 112 -------------------- b Retired or separated participants receiving benefits ..................................................... b 0 -------------------- c Retired or separated participants entitled to future benefits ............................................ c 0 -------------------- d Subtotal. Add lines 7a(4), 7b, and 7c .................................................................... d 112 -------------------- e Deceased participants whose beneficiaries are receiving or are entitled to receive benefits .............. e 0 -------------------- f Total. Add lines 7d and 7e ............................................................................... f 112 -------------------- g Number of participants with account balances. (Defined benefit plans do not complete this line item.)..... g 89 -------------------- h Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested .................................................................................... h 4 -------------------- YES NO i (1) Was any participant(s) separated from service with a deferred vested benefit for which a Schedule SSA -------------------- (Form 5500) is required to be attached? (See instructions.) ................................................ i(1) X (2) If "Yes," enter the number of separated participants required to be reported - ------------------------------------------------------------------------------------------------------------------------------------ 8a Was this plan ever amended since its effective date? If "Yes," complete line 8b ................................ 8a X If the amendment was adopted in this plan year, complete lines 8c through 8e. -------------- b If line 8a is "Yes," enter the date the most recent amendment was adopted Month 05 Day 27 Year 94 c Did any amendment during the current plan year result in the retroactive reduction of accrued benefits for any participants? .......................................................................................... c -------------- d During this plan year did any amendment change the information contained in the latest summary plan descriptions or summary description of modifications available at the time of amendment? ....................... d -------------- e If line 8d is "Yes," has a summary plan description or summary description of modifications that reflects the plan amendments referred to on line 8d been both furnished to participants? (see instructions) ................. e - ------------------------------------------------------------------------------------------------------------------------------------ 9a Was this plan terminated during this plan year or any prior plan year? If "Yes," enter the year _____________ 9a X -------------- b Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of PBGC? ............................................................................. b X -------------- c Was a resolution to terminate this plan adopted during this plan year or any prior plan year? .................. c X -------------- d If line 9a or line 9c is "Yes," have you received a favorable determination letter from the IRS for the termination? ............................................................................................... d -------------- e If line 9d is "No," has a determination letter been requested from the IRS? .................................... e -------------- f If line 9a or line 9c is "Yes," have participants and beneficiaries been notified of the termination or the proposed termination? ...................................................................................... f -------------- g If line 9a is "Yes" and the plan is covered by PBGC, is the plan continuing to file a 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? .. g -------------- h During this plan year, did any trust assets revert to the employer for which the Code section 4980 excise tax is due? .................................................................................................... h X -------------- i If line 9h is "Yes," enter the amount of tax paid with Form 5330 $ - ------------------------------------------------------------------------------------------------------------------------------------ 10a In this plan year, was this plan merged or consolidated into another plan(s), or were assets or liabilities transferred to another plan(s)? If "Yes," complete lines 10b through 10e ....................... / / YES /X/ NO If "Yes," identify the other plan(s) c Employer identification number(s) d Plan number(s) b Name of plan(s) ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- e If required, has a Form 5310-A been filed? ................................................................. / / YES / / NO - ------------------------------------------------------------------------------------------------------------------------------------ 11 Enter the plan funding arrangement code from page 10 of the 12 Enter the plan benefit arrangement code from page 10 of instructions.................... 2 the instructions 2 - ------------------------------------------------------------------------------------------------------------------------------------ YES NO 13a Is this a plan established or maintained pursuant to one or more collective bargaining agreements? ............. 13a X b If line 13a is "Yes," enter the appropriate six-digit LM number(s) of the sponsoring labor organization(s)(see instructions): (1) (2) (3) - ------------------------------------------------------------------------------------------------------------------------------------ 14 If any benefits are provided by an insurance company, insurance service, or similar organization, enter the number of SCHEDULES A (FORM 5500), Insurance Information, attached. If none, enter "-0-." 1
Form 5500 (1997) Page 3 ------------------------------------------------------------------------------------------------------------------------------- WELFARE PLANS DO NOT COMPLETE LINES 15 THROUGH 24. GO TO LINE 25 ON PAGE 4 ------------------------------------------------------------------------------------------------------------------------------- 15 a If this is a defined benefit plan subject to the minimum funding standards for this plan year, is SCHEDULE B YES NO ----------- (Form 5500) required to be attached? (if this is a defined contribution plan leave blank.).................. 15a ----------- b If this is a defined contribution plan (i.e., money purchase or target benefit), is it subject to the minimum funding standards? (If a waiver was granted, see instructions.)(If this is a defined benefit plan, leave blank.)............................................................................................... b X ----------- If "Yes," complete (1),(2), and (3) below: (1) Amount of employer contribution required for the plan year under Code section 412 b(1) $ -------------------- (2) Amount of contribution paid by the employer for the new plan year................ b(2) $ -------------------- Enter date of last payment by employer Month____ Day___ Year______ (3) If (1) is greater than (2), subtract (2) from (1) and enter the funding deficiency here; otherwise, enter -0-. (If you have a funding deficiency, file Form 5330.) b(3) $ ------------------------------------------------------------------------------------------------------------------------------- 16 Has the annual compensation of each participant taken into account under the current plan year been limited as required by section 401(a)(17)? (See instructions.)............................................. 16 X ------------------------------------------------------------------------------------------------------------------------------- 17 a (1) Did the plan distribute any annuity contracts this year? (See instructions.)........................... a(1) X (2) If (1) is "Yes," did these contracts contain a requirement that the spouse consent before any distributions under the contract are made in a form other than a qualified joint and survivor annuity?..... a(2) X ----------- b Did the plan make distributions or loans to married participants and beneficiaries without the required consent of the participant's spouse?....................................................................... b X ----------- c Upon plan amendment or termination, do the accrued benefits of every participant include the subsidized benefits that the participant may become entitled to receive subsequent to the plan amendment or termination?............................................................................................... c X ------------------------------------------------------------------------------------------------------------------------------- 18 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.).................................................................. 18 X ----------- 19 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 agrees to the change........ 19 ----------- 20 Is the employer electing to compute minimum funding for the plan year using the Transition rule of Code section 412(I)(11)?........................................................................................ 20 ------------------------------------------------------------------------------------------------------------------------------- 21 Check if you are applying the substantiation guidelines from Revenue Procedure 93-42, in completing lines 21a through 21o (see instructions).................................................................. / / If you checked the box, enter the first day of the plan year for which data is being submitted Month____ Day___ Year______ a Does the employer apply the separate line of business rules of Code section 414(r) when testing this plan for the coverage and discrimination tests of Code sections 410(b) and 401(a)(4)?...................... 21a X ----------- b If line 21a is "Yes," enter the total number of separate lines of business claimed by the employer ________ If more than one separate line of business, see instructions for additional information to attach. c Does the employer apply the mandatory disaggregation rules under Income Tax Regulations section 1.410(b)-7(c)?............................................................................................. c X ----------- If "Yes," see instructions for additional information to attach. d In testing whether this plan satisfies the coverage and discrimination tests of Code sections 410(b) and 401(a), does the employer aggregate plans?............................................................. d X ----------- e Does the employer restructure the plan into component plans to satisfy the coverage and discrimination tests of Code sections 410(b) and 401(a)(4)?............................................................... e X ----------- f If you meet either of the following exceptions, check the applicable box to tell us which exception you meet and do NOT complete the rest of question 21: (1) / / No highly compensated employee benefited under the plan at any time during the plan year; (2) / / This is a collectively bargained plan that benefits only collectively bargained employees, no more than 2% of whom are professional employees. g Did any leased employee perform services for the employer at any time during the plan year?................ g X ----------- h Enter the total number of employees of the employer. Employer includes entities aggregated with the NUMBER employer under code section 414(b), (c) or (m). Include leased employees and self-employed individuals..... h 1107 ----------- i Enter the total number of employees excludable because of: (1) failure to meet requirements for minimum age and years of service; (2) collectively bargained employees; (3) nonresident aliens who receive no earned income from U.S. sources; and (4) 500 hours of service/last day rule................................ i 993 ----------- j Enter the number of nonexcludable employees. Subtract line 21i from line 21h................................ j 114 ----------- k Do 100% of the nonexcludable employees entered on line 21j benefit under the plan?.......... /X/ YES / / NO If line 21k is "Yes," do NOT complete lines 21l through 21o. l Enter the number of nonexcludable employees (line 21j) who are highly compensated employees................ l ----------- m Enter the number of nonexcludable employees (line 21j) who benefit under the plan.......................... m ----------- n Enter the number of employees entered on line 21m who are highly compensated employees..................... n ----------- o This plan satisfies the coverage requirements on the basis of (check one): (1) / / The average benefits test (2) / / The ratio percentage test - Enter percentage / / / /. / / % ------------------------------------------------------------------------------------------------------------------------------- TEST FOR 401(k) PROVISION
Form 5500 (1997) Page ------------------------------------------------------------------------------------------------------------------------------- WELFARE PLANS GO TO LINE 25 ON THIS PAGE. ------------------------------------------------------------------------------------------------------------------------------- 22 a Is it or was it ever intended that this plan qualify under Code section 401(a)? If "Yes," complete lines YES NO 22b and 22c................................................................................................. 22a X ----------- b Enter the date of the most recent IRS determination letter......................... Month____ Year_______ c Is a determination letter request pending with the IRS?..................................................... c X ------------------------------------------------------------------------------------------------------------------------------- 23 a Does the plan hold any assets that have a fair market value that is not readily determinable on an established market?......................................................................................... (If "Yes," complete line 23b) (See instructions) ........................................................... 23a X ----------- b Were all the assets referred to in line 23a valued for the 1997 plan year by an independent third-party appraiser?.................................................................................................. b ----------- c If line 23b in "No," enter the value of the assets that were not valued by an independent third-party appraiser for the 1997 plan year. ____________________________ d Enter the most recent date the assets on line 23c were valued by an independent third-party appraiser. (If more than one asset, see instructions.) Month____ Day___ Year______ (If this plan does not have ESOP features leave line 23e blank and go to line 24.) e If dividends paid on employer securities held by the ESOP were used to make payments on ESOP loans, enter the amount of the dividends used to make the payments................................................ [23e] ------------------------------------------------------------------------------------------------------------------------------- 24 Does the employer/sponsor listed on line 1a of this form maintain other qualified pension benefit plans?.... 24 X ----------- If "Yes," enter the total number of plans, including this plan ------------------------------------------------------------------------------------------------------------------------------- 25 a Did any person who rendered services to the plan receive directly or indirectly $5,000 or more in compensation from the plan during the plan year (except for employees of the plan who were paid less than $1,000 in each month)?...................................................................................... 25a X ----------- If "Yes," complete Part I of SCHEDULE C (Form 5500). b Did the plan have any trustees who must be listed in Part II of SCHEDULE C (Form 5500)?..................... b X ----------- c has there been a termination in the appointment of any person listed on line 25d below?..................... c X ----------- d If line 25c is "Yes," check the appropriate box(es), answer lines 25e and 25f, and complete Part III of SCHEDULE C (Form 5500): (1) / / Accountant (2) / / Enrolled actuary (3) / / Insurance carrier (4) / / Custodian (5) / / Administrator (6) / / Investment manager (7) / / Trustee e Have there been any outstanding material disputes or matters of disagreement concerning the above termination?................................................................................................ e ----------- f If an accountant or enrolled actuary has been terminated during the plan year, has the terminated accountant/actuary been provided a copy of the explanation required by Part III of SCHEDULE C (Form 5500) with a notice advising them of their opportunity to submit comments on the explanation directly to the DOL?.. f ----------- g Enter the number of SCHEDULES C (Form 5500) that are attached. If none, enter -0- 1 ------------------------------------------------------------------------------------------------------------------------------- 26 a Is this plan exempt from the requirement to engage an independent qualified public accountant? (see instructions).......................................................................................... 26a X ----------- b If line 26a is "No," attach the accountant's opinion to this return/report and check the appropriate box. This opinion is: (1) / / Unqualified (2) / / Qualified/disclaimer per Department of Labor Regulations 29 CFR 2520.103-8 and /or 2520.103-12(d) (3) / / Qualified/disclaimer other (4) / / Adverse (5) / / Other (explain)__________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ c If line 26a is "No," does the accountant's report, including the financial statements and/or notes required to be attached to this return/report disclose (1) errors or irregularities; (2) illegal acts; (3) material internal control weaknesses; (4) a loss contingency indicating that assets are impaired or a liability incurred; (5) significant real estate or other transactions in which the plan and (A) the sponsor, (B) the plan administrator, (C) the employer(s), or (D) the employee organization(s) are jointly involved; (6) that the plan has participated in any related party transactions; or (7) any unusual or infrequent events or transactions occurring subsequent to the plan year end that might significantly affect the usefulness of the financial statements in assessing the plan's present or future ability to pay benefits?................. c ----------- d If line 26c is "Yes," provide the total amount involved in such disclosure ------------------------------------------------------------------------------------------------------------------------------- 27 If line 26a is "No," complete the following questions. (You may NOT use "N/A" in response to lines 27a through 27i): If line 27a, 27b, 27c, 27d, 27e, or 27f is checked "Yes," schedules of these items in the format set forth in the instructions are required to be attached to this return/report. SCHEDULE G (Form 5500) may be used as specified in the instructions. During the plan year: a Did the plan have assets held for investment?............................................................... 27a X ----------- b Were any loans by the plan or fixed income obligations due the plan in default as of the close of the plan year or classified during the year as uncollectible?................................................... b X ----------- c Were any leases to which the plan was a party in default or classified during the year as uncollectible?.... c X ----------- d Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets?... d X ----------- e Do the notes to the financial statements accompanying the accountant's opinion disclose any nonexempt transactions with parties-in-interest?...................................................................... e ----------- f Did the plan engage in any nonexempt transactions with parties-in-interest not reported on line 27e?........ f X ----------- g Did the plan hold qualifying employer securities that are not publicly traded?............................... g X ----------- h Did the plan purchase or receive any nonpublicly traded securities that were not appraised in writing by an unrelated third party within 3 months prior to their receipt?............................................ h X ----------- i Did any person manage plan assets who had a financial interest worth more than 10% in any party providing services to the plan or receive anything of value from any party providing services to the plan?............ i X
Form 55000(1997) Page 5
- --------------------------------------------------------------------------------------------------------------------- Yes No -------------------- 28 Did the plan acquire individual whole life insurance contracts during the plan year?. . 28 X - --------------------------------------------------------------------------------------------------------------------- 29 During the plan year: a (1) Was this plan covered by a fidelity bond? If "Yes," complete lines 29a(2) and 29a(3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29a(1) X (2) Enter amount of bond $ 50,0000 ---------------------------------------------------------- (3) Enter the name of the surety company HARTFORD FIRE INSURANCE CO. ------------------------------------------- b (1) Was there any loss to the plan, whether or not reimbursed, caused by fraud or dishonesty?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29b(1) X (2) If line 29b(1) is "Yes", enter amount of loss $ - --------------------------------------------------------------------------------------------------------------------- 30 a Is the plan covered under the Pension Benefit Guaranty Corporation termination insurance program? / / YES / / NO / / NOT DETERMINED b If line 30a is "Yes" or "Not determined," enter the employer identification number and the plan number used to identify it. Employer identification number Plan number - ---------------------------------------------------------------------------- 31 Current value of plan assets and liabilities at the beginning and end of the plan year. Combine the value of plan assets held in more than one trust. Allocate the value of the plan's interest in a commingled trust containing the assets of more than one plan on a line-by-line basis unless the trust meets one of the specific exceptions described in the instructions. Do not enter the value of that portion of an insurance contract that guarantees, during this plan year, to pay a specific dollar benefit at a future date. ROUND OFF AMOUNTS TO THE NEAREST DOLLAR, ANY OTHER AMOUNTS ARE SUBJECT TO REJECTION. Plans with no assets at the beginning and at the end of the plan year, enter -0- on line 31f. - ----------------------------------------------------------------------------------------------------------------------- (a) Beginning of year (b) End of Year --------------------- ---------------- ASSETS a Total noninterest-bearing cash. . . . . . . . . . . . . . . . . . a 0 0 --------------------------------------------- b Receivables: (1) Employer contributions . . . . . . . . . . . . . b(1) 1,041 582 --------------------------------------------- (2) Participant contributions . . . . . . . . . . . . . . . . . (2) 3,855 3,087 --------------------------------------------- (3) Income. . . . . . . . . . . . . . . . . . . . . . . . . . . (3) 0 0 --------------------------------------------- (4) Other . . . . . . . . . . . . . . . . . . . . . . . . . . . (4) 0 0 --------------------------------------------- (5) Less allowance for doubtful accounts. . . . . . . . . . . . (5) 0 0 --------------------------------------------- (6) Total. Add lines 31b(1) through 31b(4) and subtract 31b(5). . . . . . . . . . . . . . . . . . . . . . (6) 4,896 3,669 --------------------------------------------- c General Investments: (1) Interest-bearing cash (including money market funds). . . . . . . . . . . . . . . . . . . . . . . . . . c(1) 0 0 --------------------------------------------- (2) Certificates of deposit . . . . . . . . . . . . . . . . . . (2) 0 0 --------------------------------------------- (3) U.S. Government securities. . . . . . . . . . . . . . . . . (3) 0 0 --------------------------------------------- (4) Corporate debt instruments: (A) Preferred . . . . . . . . . (4)(A) 0 0 --------------------------------------------- (B) All other . . . . . . . . . . . . . . . . . . . . . . . (4)(B) 0 0 --------------------------------------------- (5) Corporate stocks: (A) Preferred . . . . . . . . . . . . . . (5)(A) 0 0 --------------------------------------------- (B) Common. . . . . . . . . . . . . . . . . . . . . . . . . (5)(B) 0 0 --------------------------------------------- (6) Partnership/joint venture interests. . . . . . . . . . . . (6) 0 0 --------------------------------------------- (7) Real estate: (A) Income-producing . . . . . . . . . . . . . (7)(A) 0 0 --------------------------------------------- (B) Nonincome-producing . . . . . . . . . . . . . . . . . . (7)(B) 0 0 --------------------------------------------- (8) Loans (other than to participants) secured by mortgages: (A) Residential . . . . . . . . . . . . . . . . . . . . . . (8)(A) 0 0 --------------------------------------------- (B) Commercial . . . . . . . . . . . . . . . . . . . . . . (8)(B) 0 0 --------------------------------------------- (9) Loans to participants: (A) Mortgages . . . . . . . . . . . (9)(A) 0 0 --------------------------------------------- (B) Other . . . . . . . . . . . . . . . . . . . . . . . . . (9)(B) 0 0 --------------------------------------------- (10) Other loans . . . . . . . . . . . . . . . . . . . . . . . . (10) 0 0 --------------------------------------------- (11) Value of interest in common/collective trusts . . . . . . . (11) 0 0 --------------------------------------------- (12) Value of interest in pooled separate accounts . . . . . . . (12) 167,963 318,656 --------------------------------------------- (13) Value of interest in master trusts. . . . . . . . . . . . . (13) 0 0 (14) Value of interest in 103-12 investment entities . . . . . . (14) 0 0 --------------------------------------------- (15) Value of interest in registered investment companies. . . . (15) 0 0 --------------------------------------------- (16) Value of funds held in insurance company general account (unallocated contracts) . . . . . . . . . . . . . . . . . (16) 37,914 54,707 --------------------------------------------- (17) Other . . . . . . . . . . . . . . . . . . . . . . . . . . . (17) 0 0 --------------------------------------------- (18) Total. Add lines 31c(1) through 31c(17) . . . . . . . . . . (18) 205,877 373,363 --------------------------------------------- d Employer-related investments: (1) Employer securities . . . . . . d(1) 76,997 118,302 --------------------------------------------- (2) Employer real property. . . . . . . . . . . . . . . . . . . (2) 0 0 --------------------------------------------- e Buildings and other property used in plan operation . . . . . . . e 0 0 --------------------------------------------- f TOTAL assets. Add lines 31a, 31b(6), 31c(18), 31d(1), 31d(2), and 31e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . f 287,770 495,334 --------------------------------------------- --------------------------------------------- LIABILITIES g Benefit claims payable. . . . . . . . . . . . . . . . . . . . . . g 0 0 --------------------------------------------- h Operation payables . . . . . . . . . . . . . . . . . . . . . . . h 0 0 --------------------------------------------- i Acquisition indebtedness. . . . . . . . . . . . . . . . . . . . . i 0 0 --------------------------------------------- j Other liabilities . . . . . . . . . . . . . . . . . . . . . . . . j 0 0 --------------------------------------------- k TOTAL liabilities. Add lines 31g through 31j . . . . . . . . . . k 0 0 --------------------------------------------- --------------------------------------------- NET ASSETS l Subtract line 31k from line 31f . . . . . . . . . . . . . . . . . l 287,770 495,334 - ----------------------------------------------------------------------------------------------------------------------- Form 55000(1997) Page 6 - -------------------------------------------------------------------------------- 32 Plan income, expenses, and changes in net assets for the plan year, INCLUDE ALL INCOME AND EXPENSES OF THE PLAN, INCLUDING ANY TRUST(S) OR SEPARATELY MAINTAINED FUND(S), AND ANY PAYMENTS/RECEIPTS TO/FROM INSURANCE CARRIERS. ROUND OFF AMOUNTS TO THE NEAREST DOLLAR; ANY OTHER AMOUNTS ARE SUBJECT TO REJECTION. - ----------------------------------------------------------------------------------------------------------------------- (a) Amount (b) Total --------------------------------- INCOME a CONTRIBUTIONS: (1) Received or receivable from: (A) Employers . . . . . . . . . . . . . . . . . . . . . . . a(1)(A) 32,314 -------------------------- (B) Participants. . . . . . . . . . . . . . . . . . . . . . (B) 148,379 -------------------------- (C) Others. . . . . . . . . . . . . . . . . . . . . . . . . (C) 46 -------------------------- (2) Noncash contributions. . . . . . . . . . . . . . . . . . . . (2) 0 ---------------------------------------------- (3) Total contributions. Add lines 32a(1)(A), (B), (C) and line 32a(2) . . . . . . . . . . . . . . . . . . . . . . . . (3) 180,739 --------- ---------------- b EARNINGS ON INVESTMENTS: (1) Interest (A) Interest-bearing cash (including money market funds). . b(1)(A) 0 -------------------------- (B) Certificates of deposit . . . . . . . . . . . . . . . . (B) 0 -------------------------- (C) U.S. Government securities. . . . . . . . . . . . . . . (C) 0 -------------------------- (D) Corporate debt instruments. . . . . . . . . . . . . . . (D) ( 8,993) -------------------------- (E) Mortgage loans. . . . . . . . . . . . . . . . . . . . . (E) 0 -------------------------- (F) Other loans . . . . . . . . . . . . . . . . . . . . . . (F) 0 -------------------------- (G) Other interest. . . . . . . . . . . . . . . . . . . . . (G) 2,793 ---------------------------------------------- (H) Total interest. Add lines 32b(1)(A) through (G). . . . (H) ( 6,200) --------- ---------------- (2) Dividends: (A) Preferred stock . . . . . . . . . . . . . . . b(2)(A) 0 -------------------------- (B) Common stock. . . . . . . . . . . . . . . . . . . . . . (B) 0 ---------------------------------------------- (C) Total dividends. Add lines 32b(A) and (B) . . . . . . . (C) 0 ---------------------------------------------- (3) Rents. . . . . . . . . . . . . . . . . . . . . . . . . . . . (3) 0 --------- ---------------- (4) Net gain (loss) on sale of assets: (A) Aggregate proceeds. . (4)(A) 0 -------------------------- (B) Aggregate carrying amount (see instructions). . . . . . (B) 0 -------------------------- (C) Subtract (B) from (A) and enter result. . . . . . . . . (C) 0 --------- ---------------- (5) Unrealized appreciation (depreciation) of assets . . . . . . (5) 0 --------- ---------------- (6) Net investment gain (loss) from common/collective trust. . . (6) 0 --------- ---------------- (7) Net investment gain (loss) from pooled separate accounts . . (7) 50,207 --------- ---------------- (8) Net investment gain (loss) from master trusts. . . . . . . . (8) 0 --------- ---------------- (9) Net investment gain (loss) from 103-12 investment entities . (9) 0 --------- ---------------- (10) Net investment gain (loss) from registered investment companies . . . . . . . . . . . . . . . . . . . . . . . . . (10) 0 --------- ---------------- c Other income. . . . . . . . . . . . . . . . . . . . . . . . . . . c 87 --------- ---------------- d Total income. Add all amounts in column (b) and enter total . . . d 224,833 --------- ---------------- EXPENSES e Benefit payment and payments to provide benefits: (1) Directly to participants or beneficiaries. . . . . . . . . . e(1) 17,266 -------------------------- (2) To insurance carriers for the provision of benefits. . . . . (2) 0 -------------------------- (3) Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . (3) 0 ---------------------------------------------- (4) Total payments. Add lines 32e(1) through 32e(3). . . . . . . (4) 17,266 --------- ---------------- f Interest expense. . . . . . . . . . . . . . . . . . . . . . . . . f 0 --------- ---------------- g Administrative expenses: (1) Salaries and allowances. . . . . . . g(1) 0 -------------------------- (2) Account fees . . . . . . . . . . . . . . . . . . . . . . . . (2) 0 -------------------------- (3) Actuarial fees . . . . . . . . . . . . . . . . . . . . . . . (3) 0 -------------------------- (4) Contract administrator fees. . . . . . . . . . . . . . . . . (4) 0 -------------------------- (5) Investment advisory and management fees. . . . . . . . . . . (5) 0 -------------------------- (6) Legal fees . . . . . . . . . . . . . . . . . . . . . . . . . (6) 0 -------------------------- (7) Valuation/appraisal fees . . . . . . . . . . . . . . . . . . (7) 0 -------------------------- (8) Trustees fees/expenses (including travel, seminars, meetings, etc.) . . . . . . . . . . . . . . . . . . . . . . (8) 0 -------------------------- (9) Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . (9) 3 ---------------------------------------------- (10) Total administrative expenses. Add lines 32g(1) through 32g(9). . . . . . . . . . . . . . . . . . . . . . . . . . . (10) 3 --------- ---------------- h Total expenses. Add lines 32e(4), 32f, and 32g(10) . . . . . . . h 17,269 --------- ---------------- i Net income (loss). Subtract line 32h from line 32d. . . . . . . . i 207,564 --------- ---------------- j Transfers to (from) the plan (see instructions) . . . . . . . . . j 0 --------- ---------------- k Net assets at beginning of year (line 31l, column (a)). . . . . . k 287,770 --------- ---------------- l Net assets at end of year (line 31l column (b)) . . . . . . . . . l 495,334 - -----------------------------------------------------------------------------------------------------------------------
Yes No ------- 33 Did any employer sponsoring the plan pay any of the administrative expenses of the plan that were not reported on line 32g? X - -------------------------------------------------------------------------------
1997 - ------------------------------------------------------------------------------------------------------------------------------- 21 Check if you are applying the substantiation guidelines from Revenue Procedure 93-42, in completing YES NO lines 21a through 21o (see instructions).......................................................... / / If you checked the box, enter the first day of the plan year for which data is being submitted Month __ Day__Year__ a Does the employer apply the separate line of business rules of Code section 414(r) when testing this plan for the coverage and discrimination tests of Code sections 410(b) and 401(a)(4)?............. 21a X ----------------- b If line 21a is "Yes," enter the total number of separate lines of business claimed by the employer ______________ If more than one separate line of business, see instructions for additional information to attach. c Does the employer apply the mandatory disaggregation rules under Income Tax Regulations section 1.410(b)-7(c)?......................................................................................... c X If "Yes," see instructions for additional information to attach. ----------------- d In testing whether this plan satisfies the coverage and discrimination tests of Code sections 410(b) and 401(a), does the employer aggregate plans?............................................................. d X ----------------- e Does the employer restructure the plan into component plans to satisfy the coverage and discrimination tests of Code sections 410(b) and 401(a)(4)?............................................................ e X ----------------- f If you meet either of the following exceptions, check the applicable box to tell us which exception you meet and do NOT complete the rest of question 21: (1) / / No highly compensated employee benefited under the plan at any time during the plan year; (2) / / This is a collectively bargained plan that benefits only collectively bargained employees, no more than 2% of whom are professional employees. g Did any leased employee perform services for the employer at any time during the plan year?............ g X ----------------- h Enter the total number of employees of the employer. Employer includes entities aggregated with the employer under Code section 414(b), (c), or (m). Include leased employees and self-employed NUMBER individuals. .......................................................................................... h 1107 ----------------- i Enter the total number of employees excludable because of: (1) failure to meet requirements for minimum age and years of service; (2) collectively bargained employees; (3) nonresident aliens who receive no earned income from U.S. sources; and (4) 500 hours of service/last day rule ................ i 993 ----------------- j Enter the number of nonexcludable employees. Subtract line 21i from 21h ............................... j 114 ----------------- k Do 100% of the nonexcludable employees entered on line 21j benefit under the plan?...... /X/ YES / / NO If line 21k is "Yes," do NOT complete lines 21l through 21o. l Enter the number of nonexcludable employees (line 21j) who are highly compensated employees............ l ----------------- m Enter the number of nonexcludable employees (line 21j) who benefit under the plan..................... m ----------------- n Enter the number of employees entered on line 21m who are highly compensated employees................. n ----------------- o This plan satisfies the coverage requirements on the basis of (check one): (1) / / The average benefits test (2) / / The ratio percentage test - Enter percentage / / / / ./ / % - ---------------------------------------------------------------------------------------------------------------------------------
TEST FOR 401(m) PROVISION [LOGO] 12/31/1997 FUND STATEMENT
POOLED SEPARATE ACCOUNT- MONEY MARKET BALANCE SHEET - --------------------------------------------------- ASSETS Bonds $1,318,085,842 Bank Deposits 881,245 Receivable From Principal Life Insurance Company 15,568,149 -------------- Total Assets $1,334,535,236 -------------- -------------- - --------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $1,333,698,656 Remitted & Items Not Allocated 836,580 -------------- Total Liabilities 1,334,535,236 Surplus 0 -------------- Total Liabilities and Surplus $1,334,535,236 -------------- -------------- SUMMARY OF OPERATIONS - --------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 422,129,509 Interest Income 70,362,679 -------------- Total Receipts $ 492,492,188 - --------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 153,071,545 Benefit Payments 200,999,451 Investment Management, Mortality, and Administration Charges 9,343,356 Investment Expenses 1,004,447 -------------- Total Disbursements 364,418,799 -------------- Increase in Reserves $ 128,073,389 -------------- --------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT
FINANCIAL POOLED SEPARATE ACCOUNT- GROUP GOVERNMENT SECURITIES BALANCE SHEET - --------------------------------------------------------------- ASSETS Bonds $294,362,383 Bank Deposits 2,394 Adjustment to Investments to Reflect Market Value 8,633,027 Investment Income Due & Accrued 1,623,793 Receivable From Principal Life Insurance Company 6,604,123 ------------ Total Assets $311,225,720 ------------ ------------ - --------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $302,363,564 Payable For Investments Purchased 8,862,156 ------------ Total Liabilities 311,225,720 Surplus 0 ------------ Total Liabilities & Surplus $311,225,720 ------------ ------------ SUMMARY OF OPERATIONS - --------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $106,613,086 Gross Investment Income: Interest Income 16,345,283 Change In: Investment Income Earned But Not Collected 526,560 Accrued Interest Receivable (306,404) 16,565,439 ----------- Change in Net Unrealized Appreciation/Depreciation of Investments 8,088,853 Realized Capital Gain 69,095 ------------ Total Receipts $131,336,473 - --------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 11,376,255 Benefit Payments 14,478,578 Investment Management, Mortality, and Administration Charges 1,758,633 Investment Expenses 190,687 ------------ Total Disbursements 27,804,153 ------------ Increase in Reserves $103,532,320 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT
FINANCIAL POOLED SEPARATE ACCOUNT- GROUP BOND AND MORTGAGE BALANCE SHEET - -------------------------------------------------------------- ASSETS Bonds $1,686,537,305 Preferred Stock 14,365,039 Mortgage Loans 748,434,819 Real Estate 28,911,791 Bank Deposits 5,558,492 Adjustment to Investments to Reflect Market Value 101,738,490 Investment Income Due & Accrued 25,504,528 Prepaid Expense & Taxes 12,233 Foreign Tax Receivable 10 Receivable From Principal Life Insurance Company 15,187,580 -------------- Total Assets $2,626,250,287 -------------- -------------- - -------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $2,525,875,591 Expenses & Taxes Due & Accrued 68,558 Unearned Investment Income 147,716 Remitted & Items Not Allocated 1,179,346 Payable for Investments Purchased 97,276,171 Rental Guarantee Agreement 31,522 Security Deposits Retained by Principal Life Insurance Company 1,671,383 -------------- Total Liabilities 2,626,250,287 Surplus 0 -------------- Total Liabilities & Surplus $2,626,250,287 -------------- -------------- SUMMARY OF OPERATIONS - -------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $366,297,665 Gross Investment Income: Dividend Income 2,344,696 Interest Income 169,249,326 Rental Income 4,435,655 Investment Fee Income 62,361 Change In: Investment Income Earned But Not Collected (1,395,724) Unearned Investment Income 147,716 174,844,030 ----------- Change in Net Unrealized Appreciation/Depreciation of Investments 57,503,373 Realized Capital Gain 4,313,196 ------------ Total Receipts $602,958,264 - -------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $116,131,261 Benefit Payments 145,336,706 Investment Management, Mortality, and Administration Charges 14,134,611 Investment Expenses 3,594,539 ------------ Total Disbursements 279,197,117 ------------ Increase in Reserves $323,761,147 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT
POOLED SEPARATE ACCOUNT- BOND EMPHASIS BALANCED BALANCE SHEET - ------------------------------------------------------------------ ASSETS Investment in Principal Life Insurance Company Separate Account: Bond and Mortgage $ 94,965,913 Government Securities 63,298,179 U.S. Stock 10,229,101 International Stock 35,985,966 Real Estate 34,681,084 Large Company Value 11,213,866 Small Company Value 2,650,794 Large Company Growth 7,627,601 Small Company Growth 1,276,855 Adjustment to Investments to Reflect Market Value 35,005,685 Remitted and Items Not Allocated 9,158,293 ------------ Total Assets $306,093,337 ------------ ------------ - ------------------------------------------------------------------ LIABILITIES & SURPLUS Unallocated Reserves $306,093,337 ------------ Total Liabilities 306,093,337 Surplus 0 ------------ Total Liabilities & Surplus $306,093,337 ------------ ------------ SUMMARY OF OPERATIONS - ------------------------------------------------------------------ RECEIPTS Deposits and Net Transfers $107,967,309 Change in Net Unrealized Appreciation/Depreciation of Investments 13,608,932 Realized Capital Gain 16,351,290 ------------ Total Receipts $137,927,531 DISBURSEMENTS - ------------------------------------------------------------------ Funds Withdrawn $ 13,760,091 Benefit Payments 15,174,759 Investment Management, Mortality, and Administration Charges 506,513 ------------ Total Disbursements 29,441,363 ------------ Increase in Reserves $108,486,168 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT
POOLED SEPARATE ACCOUNT- STOCK EMPHASIS BALANCED BALANCE SHEET - -------------------------------------------------------------------- ASSETS Investment in Principal Life Insurance Company Separate Account: Bond and Mortgage $ 83,339,967 Government Securities 55,664,606 U.S. Stock 66,591,488 International Stock 126,320,948 Real Estate 124,575,935 Large Company Value 75,687,145 Small Company Value 18,650,205 Large Company Growth 51,022,873 Small Company Growth 6,024,975 Adjustments to Investments to Reflect Market Value 75,132,584 Remitted and Items Not Allocated 11,402,228 ------------ Total Assets $694,412,954 ------------ ------------ - -------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $694,412,954 ------------ Total Liabilities 694,412,954 Surplus 0 ------------ Total Liabilities & Surplus $694,412,954 ------------ ------------ SUMMARY OF OPERATIONS - ------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $235,205,548 Change in Net Unrealized Appreciation/Depreciation of Investments 52,245,900 Realized Capital Gain 37,880,132 ------------ Total Receipts $325,331,580 - -------------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 25,989,706 Benefit Payments 35,227,518 Investment Management, Mortality, and Administration Charges 1,229,716 ------------ Total Disbursements 62,446,940 ------------ Increase in Reserves $262,884,640 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT POOLED SEPARATE ACCOUNT- STOCK INDEX 500
BALANCE SHEET - -------------------------------------------------------------------- ASSETS Bonds $ 14,497,583 Common Stock 1,624,456,650 Bank Deposits 141,991 Adjustment to Investments to Reflect Market Value 857,942,125 Investment Income Due & Accrued 3,328,388 Receivable From Principal Life Insurance Company General Account 37,288,030 Remitted & Items not Allocated 39,133 -------------- Total Assets $2,537,693,900 -------------- -------------- - -------------------------------------------------------------------- LIABILITIES Unallocated Reserves $2,515,246,770 Payable for Investments Purchased 13,860,236 Payable to Principal Life Insurance Company 32,537 -------------- Total Liabilities 2,529,139,543 Surplus* 8,554,357 -------------- Total Liabilities & Surplus $2,537,693,900 -------------- -------------- SUMMARY OF OPERATIONS - -------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $885,710,509 Gross Investment Income: Dividend Income 32,425,484 Interest Income 309,980 Investment Fee Income 1,721 Change in Investment Income Earned But Not Collected 1,081,517 33,818,702 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 474,962,837 Realized Capital Gain 5,050,713 -------------- Total Receipts $1,399,542,761 - -------------------------------------------------------------------- DISBURSEMENTS Benefit Payments $ 105,261,020 Funds Withdrawn 87,911,938 Investment Management, Mortality, and Administration Charges 10,544,278 Investment Expenses 1,514,622 -------------- Total Disbursements 205,231,858 -------------- Increase in Reserves 1,189,452,514 Contributed Surplus 4,858,389 -------------- $1,194,310,903 -------------- --------------
* This is Principal Life Insurance Company Surplus Funds used as seed money to the account; it is net of deposits +(-) income and disbursements. Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT POOLED SEPARATE ACCOUNT- U.S. STOCK
BALANCE SHEET - ----------------------------------------------------------------------- ASSETS Bonds $ 34,243,673 Common Stock 6,654,171,221 Bank Deposits 70,779 Adjustment to Investments to Reflect Market Value 1,570,842,203 Investment Income Due & Accrued 11,572,062 Receivable for Investments Sold 19,151,568 Receivable From Principal Life Insurance Company 64,500,535 Remitted & Items Not Allocated 41,739 -------------- Total Assets $8,354,593,780 -------------- -------------- - ----------------------------------------------------------------------- LIABILITIES & SURPLUS Allocated Annuities Reserve $ 110,035,187 Unallocated Reserves 8,244,558,593 -------------- Total Liabilities 8,354,593,780 Surplus 0 -------------- Total Liabilities & Surplus $8,354,593,780 -------------- -------------- SUMMARY OF OPERATIONS - ----------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 283,372,609 Gross Investment Income: Dividend Income 158,921,804 Interest Income 2,934,183 Investment Fee Income 2,733 Change in Investment Income Earned But Not Collected (1,091,699) 160,767,021 Change in Net Unrealized ------------ Appreciation/Depreciation of Investments 461,789,406 Realized Capital Gain 1,144,485,540 -------------- Total Receipts $2,050,414,576 - ----------------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 341,452,981 Benefit Payments 397,991,627 Annuity Payments 10,868,434 Investment Management, Mortality, and Administration Charges 46,807,431 Investment Expenses 6,160,567 -------------- Total Disbursements 803,281,040 -------------- Increase in Reserves $1,247,133,536 -------------- --------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT FINANCIAL POOLED SEPARATE ACCOUNT- GROUP MEDIUM COMPANY VALUE
BALANCE SHEET - ----------------------------------------------------------------------- ASSETS Bonds $ 21,446,038 Common Stock 689,396,926 Bank Deposits 69,258 Adjustment to Investments to Reflect Market Value 168,420,030 Investment Income Due and Accrued 946,709 Receivable From Principal Life Insurance Company 12,336,672 Remitted & Items Not Allocated 940,067 ------------ Total Assets $893,555,700 - ----------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $888,740,833 Payable for Investments Purchased 4,814,867 ------------ Total Liabilities 893,555,700 Surplus 0 ------------ Total Liabilities & Surplus $893,555,700 ------------ ------------ SUMMARY OF OPERATIONS - ----------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $253,069,331 Gross Investment Income: Dividend Income 22,836,524 Interest Income 789,995 Change in Investment Income Earned But Not Collected (436,688) 23,189,831 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 132,019,111 Realized Capital Gain 52,723,100 ------------ Total Receipts $461,001,373 - ----------------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 26,597,541 Benefit Payments 33,718,076 Investment Management, Mortality, and Administration Charges 4,893,032 Investment Expenses 534,664 ------------ Total Disbursements 65,743,313 ------------ Increase in Reserves $395,258,060 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT FINANCIAL POOLED SEPARATE ACCOUNT- GROUP MEDIUM COMPANY BLEND
BALANCE SHEET - ------------------------------------------------------------------- ASSETS Bonds $ 74,235,683 Preferred Stock 55,108 Common Stock 644,621,090 Bank Deposits 69,840 Adjustment to Investments to Reflect Market Value 200,109,622 Investment Income Due & Accrued 912,222 Receivable From Principal Life Insurance Company 13,987,726 ------------ Total Assets $933,991,291 ------------ ------------ - ------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $932,152,449 Payable for Investments Purchased 1,838,842 ------------ Total Liabilities 933,991,291 Surplus 0 ------------ Total Liabilities & Surplus $933,991,291 ------------ ------------ SUMMARY OF OPERATIONS - ------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $301,278,847 Gross Investment Income: Dividend Income 8,991,605 Interest Income 3,228,991 Change in Investment Income Earned But Not Collected 55,742 12,276,338 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 90,294,812 Realized Capital Gain 60,313,154 ------------ Total Receipts $464,163,151 - ------------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 28,401,218 Benefit Payments 42,015,673 Investment Management, Mortality, and Administration Charges 5,677,339 Investment Expenses 603,621 ------------ Total Disbursements 76,697,851 ------------ Increase in Reserves $387,465,300 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT FINANCIAL POOLED SEPARATE ACCOUNT- GROUP SMALL COMPANY BLEND
BALANCE SHEET - --------------------------------------------------------------------- ASSETS Bonds $ 93,515,288 Common Stock 1,260,185,619 Bank Deposits 105,077 Adjustment to Investments to Reflect Market Value 242,731,337 Investment Income Due & Accrued 547,122 Receivable From Principal Life Insurance Company 29,954,570 -------------- Total Assets $1,627,038,953 -------------- -------------- - --------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $1,627,038,872 Remitted & Items Not Allocated 81 -------------- Total Liabilities 1,627,038,953 Surplus 0 -------------- Total Liabilities & Surplus $1,627,038,953 -------------- -------------- SUMMARY OF OPERATIONS - --------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 489,895,774 Gross Investment Income: Dividend Income 7,695,353 Interest Income 4,325,285 Change in Investment Income Earned But Not Collected 226,008 12,246,646 --------- Change in Net Unrealized Appreciation/Depreciation of Investments 125,504,344 Realized Capital Gain 109,931,043 -------------- Total Receipts $ 737,577,807 -------------- -------------- DISBURSEMENTS - --------------------------------------------------------------------- Funds Withdrawn $ 50,390,528 Benefit Payments 71,958,339 Investment Management, Mortality, and Administration Charges 9,829,990 Investment Expenses 1,056,317 -------------- Total Disbursements 133,235,174 -------------- Increase in Reserves $ 604,342,633 -------------- --------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT FINANCIAL POOLED SEPARATE ACCOUNT- GROUP INTERNATIONAL STOCK
BALANCE SHEET - -------------------------------------------------------------------- ASSETS Bonds $ 149,977,548 Common Stock 1,942,232,873 Bank Deposits 336,520 Adjustment to Investments to Reflect Market Value 443,869,110 Investment Income Due & Accrued 5,198,087 Receivable for Investments Sold 4,577,014 Foreign Tax Receivable 1,342,497 Receivable From Principal Life Insurance Company 22,069,242 Remitted & Items Not Allocated 14,677 -------------- Total Assets $2,569,617,568 -------------- -------------- - -------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $2,569,617,568 -------------- Total Liabilities 2,569,617,568 Surplus 0 -------------- Total Liabilities & Surplus $2,569,617,568 -------------- -------------- SUMMARY OF OPERATIONS - -------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $ 636,501,914 Gross Investment Income: Dividend Income 59,710,407 Interest Income 9,844,276 Interest Fee Income 48 Change in: Investment Income Earned But Not Collected 1,279,714 Accrued Interest Receivable (19,244) 70,815,201 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 68,367,521 Realized Capital Gain 135,808,566 -------------- Total Receipts $ 911,493,202 - -------------------------------------------------------------------- DISBURSEMENTS Benefit Payments $ 123,231,959 Funds Withdrawn 96,342,484 Investment Management, Mortality, and Administration Charges 14,056,067 Investment Expenses 9,338,873 -------------- Total Disbursements 242,969,383 -------------- Increase in Reserves $ 668,523,819 -------------- --------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 [LOGO] 12/31/1997 FUND STATEMENT FINANCIAL POOLED SEPARATE ACCOUNT- GROUP REAL ESTATE
BALANCE SHEET - ------------------------------------------------------------------- ASSETS Bonds $ 55,404,831 Common Stock 39,814,922 Real Estate 528,159,878 Bank Deposits 506,107 Notes Receivable 240,743 Adjustment to Investments to Reflect Market Value (3,430,761) Investment Income Due & Accrued 3,197,026 Prepaid Expenses & Taxes 239,457 Receivable From Principal Life Insurance Company 7,808,908 ------------ Total Assets $631,941,111 ------------ ------------ - ------------------------------------------------------------------- LIABILITIES & SURPLUS Unallocated Reserves $614,288,816 Expenses & Taxes Due & Accrued 7,193,058 Unearned Investment Income 103,044 Remitted & Items Not Allocated 600,541 Payable for Investments Purchased 6,773,161 Security Deposits Retained by Principal Life Insurance Company 2,982,491 ------------ Total Liabilities 631,941,111 Surplus 0 ------------ Total Liabilities & Surplus $631,941,111 ------------ ------------ SUMMARY OF OPERATIONS - ------------------------------------------------------------------- RECEIPTS Deposits and Net Transfers $230,352,377 Gross Investment Income: Dividend Income 437,508 Interest Income 5,906,021 Rental Income 48,946,072 Change in: Investment Income Earned But Not Collected 1,508,727 Unearned Investment Income 103,044 56,901,372 ---------- Change in Net Unrealized Appreciation/Depreciation of Investments 26,355,915 Realized Capital Loss (1,853,278) ------------ Total Receipts $311,756,386 - ------------------------------------------------------------------- DISBURSEMENTS Funds Withdrawn $ 16,134,303 Benefit Payments 16,537,084 Investment Management, Mortality, and Administration Charges 2,680,483 Investment Expenses 23,785,153 ------------ Total Disbursements 59,137,023 ------------ Increase in Reserves $252,619,363 ------------ ------------
Principal Life Insurance Company, Des Moines, Iowa 50392-0001 SCHEDULE A OMB NO. 1210-0016 (FORM 5500) INSURANCE INFORMATION --------------------- Department of the Treasury Internal Revenue Service 1997 -------------- Department of Labor This schedule is required to be filed under section 104 of the --------------------- Pension and Welfare Benefits Employee Retirement Income Security Act of 1974. THIS FORM IS Administration FILE AS AN ATTACHMENT TO FORM 5500 OR 5500-C/R. OPEN TO PUBLIC -------------- Insurance companies are required to provide this information INSPECTION Pension Benefit Guaranty Corporation As per ERISA section 103(a)(2). - ------------------------------------------------------------------------------------------------------------------------------------ For calendar year 1997 or fiscal plan year beginning March 1, 1997, and ending February 28, 1998 - ------------------------------------------------------------------------------------------------------------------------------------ PART I MUST BE COMPLETED FOR ALL PLANS REQUIRED TO FILE THIS SCHEDULE. ENTER MASTER TRUST OR 103-13 IE NAME IN PLACE PART II MUST BE COMPLETED FOR ALL INSURED PENSION LOANS. OF "SPONSOR" AND SPECIFY INVESTMENT ACCOUNT OR 103-12 IE IN PLACE OF "PLAN" IF FILING WITH DOL PART III MUST BE COMPLETED FOR ALL INSURED WELFARE PLANS. FOR A MASTER TRUST OR 103-12 IE. - ------------------------------------------------------------------------------------------------------------------------------------ Named of plan sponsor as shown on line 1a of Form 5500 or 5500-C/R EMPLOYER IDENTIFICATION NUMBER ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 84 0910696 - ------------------------------------------------------------------------------------------------------------------------------------ Name of plan ROCKY MOUNTAIN CHOCOLATE Three-digit FACTORY, INC. 401(K) PLAN 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: (b) Contract (c) Approximate number Policy or contract year (a) Name of insurance carrier or identification of persons covered at end ----------------------- number of policy or contract year (d) From (e) To - ------------------------------------------------------------------------------------------------------------------------------------ PRINCIPAL LIFE INSURANCE COMPANY 4-12731 112 03/01/97 02/28/98 - ------------------------------------------------------------------------------------------------------------------------------------ 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 2,346 1225 17TH ST STE 2100 48 - PRORATED INCENTIVE DENVER CO 80202-5534 AMOUNT NOT CHARGED TO YOUR PLAN 4-12731 J & H MARSH & MCLENNAN INC 413 1255 17TH ST STE 2100 DENVER CO 80202-1501 - ------------------------------------------------------------------------------------------------------------------------------------ TOTAL 2,759 48 - ------------------------------------------------------------------------------------------------------------------------------------ 4 Premiums due and unpaid at 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 ........................................................ 37,914 -------------- b Additions: (i) Contributions deposited during year ................................. 19,423 ----------------- (ii) Dividends and credits ........................................................ 0 ----------------- (iii) Interest credited during the year ............................................ 2,793 ----------------- (iv) Transferred from separate account ............................................ 0 ----------------- (v) Other (specify) Mkt Value Change 87 ------------------------------------------------------------- ----------------- (vi) Total additions ................................................................................. 22,303 -------------- c Total or balance and additions (add a and b (vi)) ..................................................... 60,217 -------------- d Deductions: (i) Disbursed from fund to pay benefits or purchase annuities during year ........ 4,220 ----------------- (ii) Administration charge made by carrier ........................................ 3 ----------------- (iii) Transferred to separate account .............................................. 1,287 ----------------- (iv) Other (specify) .............................................................. 0 ----------------- (v) Total deductions ................................................................................ 5,510 -------------- e Balance at end of the current policy year (subtract d(v) from c) ...................................... 54,707 -------------- - ------------------------------------------------------------------------------------------------------------------------------------ 7 Separate accounts: Current value of plan's interest in separate accounts at year end .................... 318,656 - ------------------------------------------------------------------------------------------------------------------------------------
Schedule A (Form 5500) 1997 Page 2 - ------------------------------------------------------------------------------------------------------------------------------------ PART III INSURED WELFARE PLANS PROVIDE INFORMATION FOR EACH CONTRACT ON A SEPARATE PART III. IF MORE THAN ONE CONTRACT COVERS THE SAME GROUP OF EMPLOYEES OF THE SAME EMPLOYER(S) OR MEMBERS OF THE SAME EMPLOYEE ORGANIZATIONS(S), THE INFORMATION MAY BE COMBINED FOR REPORTING PURPOSES IF SUCH CONTRACTS ARE EXPERIENCE-RATED AS A UNIT. 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. - ------------------------------------------------------------------------------------------------------------------------------------ 8 (a) Contract or (b) Type of (c) List gross premium (d) Premium rate or identification number benefit for each contract subscription charge - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 9 Experience-rated contracts: a Premiums: (i) Amount received ........................... ----------------- (ii) Increase (decrease) in amount due but unpaid ................................. ----------------- (iii) Increase (decrease) in unearned premium reserve .............................. ----------------- (iv) Premiums earned, add (i) and (ii), and subtract (iii) .......................................... -------------- b Benefit charges: (i) Claims paid ................................................... ----------------- (ii) Increase (decrease) in claim reserves ........................................ ----------------- (iii) Incurred claims (add (i) and (ii)) ............................................................. -------------- (iv) Claims charged ................................................................................. -------------- c Remainder of premium: (i) Retention charges (on an accrual basis)-- (A) Commissions .............................................................. ----------------- (B) Administrative service or other fees ..................................... ----------------- (C) Other specific acquisition costs ......................................... ----------------- (D) Other expenses ........................................................... ----------------- (E) Taxes .................................................................... ----------------- (F) Charges for risks or contingencies ....................................... ----------------- (G) Other retention charges .................................................. ----------------- (H) Total retention .......................................................... ----------------- (ii) Dividends or retroactive rate refunds. (These amounts were / / paid in cash, or / / credited.).. -------------- d Status of policyholder reserves at end of year: (i) Amount held to provide benefits after retirement... -------------- (ii) Claim reserves ................................................................................. -------------- (iii) Other reserves ................................................................................. -------------- e Dividends or retroactive rate refunds due. (Do not include amount entered in c (ii).) ............... - ------------------------------------------------------------------------------------------------------------------------------------ 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier .................. -------------- b 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, report amount ..... -------------- Specify nature of costs --------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ IF MORE SPACE IS REQUIRED FOR ANY ITEM, ATTACH ADDITIONAL SHEETS THE SAME SIZE AS THIS FORM. - ------------------------------------------------------------------------------------------------------------------------------------
GENERAL INSTRUCTIONS This schedule must be attached to Form 5500 or 5500-C/R for every defined benefit, defined contribution, and welfare benefit plan where any benefits under the plan are provided by an insurance company, insurance service, or other similar organization. SPECIFIC INSTRUCTIONS Information entered on Scheduled A (Form 5500) should pertain to the insurance contract or policy year ending with or within the loan year (for reporting purposes, a year cannot exceed 12 months). For example, if an insurance contract year begins on July 1 and ends on June 30, and the plan year begins on January 1 and ends on December 31, the Schedule A information attached to the 1997 Form 5500 should be for the insurance contract year ending on June 30, 1997. EXCEPTION: If the insurance company maintains record on the basis of a plan year rather than a policy or contract year, the information entered on Schedule A (Form 5500) may pertain to the plan year instead of the policy or contract year. Include only the contracts issued to the plan for which this return/report is being filed. PLANS PARTICIPATING IN MASTER TRUST(S) AND 103-12 IES.-- SEE INVESTMENT ARRANGEMENTS FILING DIRECTLY WITH DOL on page 4 of the instructions for Form 5500 or 5500-C/R. LINE 2(c).-- Since the plan coverage may fluctuate during the year, the administrator should estimate the number of persons that wee covered by the plan at the end of the policy or contract year. Where contracts covering individual employees are grouped, entries should be determined as of the end of the plan year. LINES 2(d) AND (e).-- Enter the beginning and ending dates of the policy year for each contract listed under column (b). Enter "N/A" in column (d) if separate contracts covering individual employees are grouped. LINE 3.-- Report all sales commissions in column (c) regardless of the identity of the recipient. Do not report override commissions, salaries, bonuses, etc., paid to a general agent or manager for managing an agency, or for performing other administrative functions. Fees to be reported in column (d) represent payments by insurance carriers to agents and brokers for items other than commissions (e.g., service fees, consulting fees, and finders fees). NOTE: FOR PURPOSES OF THIS ITEM, COMMISSIONS AND FEES INCLUDE AMOUNTS PAID BY AN INSURANCE COMPANY ON THE BASIS OF THE AGGREGATE VALUE (E.G, POLICY AMOUNTS, PREMIUMS) OF CONTRACTS OR POLICIES (OR CLASSES THEREOF) PLACED OR RETAINED. THE AMOUNT (OR PRO RATA SHARE OF THE TOTAL) OF SUCH COMMISSIONS OR FEES ATTRIBUTABLE TO THE CONTRACT OR POLICY PLACED WITH OR RETAINED BY THE PLAN MUST BE REPORTED IN COLUMN (c) OR (d), AS APPROPRIATE. Fees paid by insurance carriers to persons other than agents and brokers should be reported in Parts II and III on Schedule A (Form 5500) as acquisition costs, administrative charges, etc., as appropriate. For plans with 100 or more participants, fees paid by employee benefit plans to agents, brokers, and other persons are to be reported on Schedule C (Form 5500). LINE 5a.-- The rate information called for here may be furnished by attaching the appropriate schedules of current rates filed with the appropriate state insurance departments or by providing a statement regarding the basis of the rates. LINE 6.-- Show deposit fund amounts rather than experience credit records when both are maintained. LINE 8(d).-- The rate information called for here may be furnished by attaching the appropriate schedules of current rates or a statement as to the basis of the rates. - -------------------------------------------------------------------------------- CERTIFIED SCHEDULE A INFORMATION Principal Life Insurance Company hereby certifies that the information on the Schedule(s) A and supplements is complete and accurate to the best of our knowledge. /s/ Janet Hester - ------------------------------------------------- Signature 8-27-98 - ------------------------------------------------- Date [LOGO] - -------------------------------------------------------------------------------- SCHEDULE C SERVICE PROVIDER AND TRUSTEE INFORMATION OMB NO. 1210-0016 (FORM 5500) THIS SCHEDULE IS REQUIRED TO BE FILED UNDER SECTION 104 OF THE --------------------- Department of the Treasury EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. Internal Revenue Service File as an attachment to Form 5500. 1997 --------------- Additional Schedules C (Form 5500) may be used, if needed, to Department of Labor provide additional information for Parts I, II, and/or III. --------------------- Pension and Welfare Benefits Administration THIS FORM IS --------------- OPEN TO PUBLIC Pension Benefit Guaranty Corporation INSPECTION - ------------------------------------------------------------------------------------------------------------------------------------ For the calendar year 1997 or fiscal plan year beginning March 1, 1997, and ending February 28, 1998 - ------------------------------------------------------------------------------------------------------------------------------------ Name of plan sponsor as shown on line 1a of Form 5500 EMPLOYER IDENTIFICATION NUMBER ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 84 0910696 - ------------------------------------------------------------------------------------------------------------------------------------ Name of plan ROCKY MOUNTAIN CHOCOLATE Three-digit FACTORY, INC. 401(K) PLAN plan number 0 0 1 - ------------------------------------------------------------------------------------------------------------------------------------ PART I SERVICE PROVIDER INFORMATION (SEE INSTRUCTIONS) - ------------------------------------------------------------------------------------------------------------------------------------ 1 Enter the total dollar amount of compensation paid by the plan to all persons receiving less than $5,000 during the plan year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 $3 - ------------------------------------------------------------------------------------------------------------------------------------ 2 (d) Relationship to (b) Employer (c) Official employer, employee (e) Gross salary (f) Fees and (g) Nature (a) Name identification plan organization, or or allowances commissions paid of service number (see position person known to be paid by plan by plan code (see instructions) a party-in-interest instructions) - ------------------------------------------------------------------------------------------------------------------------------------ (1) Contract administrator 12 - 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Cat. No. 13515E SCHEDULE C (FORM 5500) 1997
Schedule C (Form 5500) 1997 Page 2 - ------------------------------------------------------------------------------------------------------------------------------------ PART II TRUSTEE INFORMATION Enter the name and address of all trustees who served during the plan year. If more space is required to supply this information, attach additional Schedules C (Form 5500). - ------------------------------------------------------------------------------------------------------------------------------------ Name BANKERS TRUST Name ------------------------------------------------------------ ---------------------------------------------------------- Address DES MOINES, IA Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Name Name ------------------------------------------------------------ ---------------------------------------------------------- Address Address ------------------------------------------------------------ ------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ PART III TERMINATION INFORMATION (SEE INSTRUCTIONS) - ------------------------------------------------------------------------------------------------------------------------------------ (a) Name (b) EIN (c) Position (d) Address (e) Telephone No. - 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------------------------------------------------------------------------------------------------------------------------------------ (a) Name (b) EIN (c) Position (d) Address (e) Telephone No. - ------------------------------------------------------------------------------------------------------------------------------------ (2) Explanation: ------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - 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Schedule C (Form 5500) 1997 Page 3 - ------------------------------------------------------------------------------- PART I--SERVICE PROVIDER INFORMATION GENERAL INSTRUCTIONS Item 1 of Part I must be completed by all Form 5500 filers required to complete item 2. Item 2 of Part I must be completed to report all persons receiving, directly or indirectly, $5,000 or more in compensation for all services rendered to the plan during the plan year except: 1. Employees of the plan whose only compensation in relation to the plan was less than $1,000 for each month of employment during the pan year, 2. Employees of the plan sponsor who did not receive direct or indirect compensation from the plan, 3. Employees of a business entity (e.g., corporation, partnership, ect.), other than the plan sponsor, who provided services to the plan, or 4. Persons whose only compensation in relation to the plan consists of insurance fees and commissions listed in Schedule A (Form 5500). Generally, indirect compensation would not include compensation that would have been received had the service not been rendered and that cannot be reasonably allocated to the services performed. Indirect compensation includes, among other things, the payment of "finders' fees" or other fees and commissions by a service provider to an independent agent or employee for a transaction or service involving the plan. NOTE: THE COMPENSATION LISTED SHOULD ONLY REFLECT THE AMOUNT OF COMPENSATION RECEIVED BY THE SERVICE PROVIDER FROM THE PLAN FILING THE SCHEDULE C (FORM 5500), NOT THE AGGREGATE AMOUNT RECEIVED BY THE SERVICE PROVIDER FOR PROVIDING SERVICES TO SEVERAL PLANS. SPECIFIC INSTRUCTIONS ITEM 1 Enter the total dollar amount of compensation received by all persons who provided services to the plan who are not listed in item 2 (except for those persons described in 2, 3, or 4 in the General Instructions). EXAMPLE: A plan had four service providers, A, B, C, and D, who received $12,000, $6,000, $4,500 and $430, respectively, from the plan. Service providers A and B must be identified on separate lines in item 2 by name, EIN, official plan position, ect. As service providers C and D each received less than $5,000, the amounts they received must be combined and $4,930 entered in item 1. ITEM 2 On line (1), include any individual, trade or business, (whether incorporated or unincorporated) responsible for managing the clerical operations (e.g., handling membership rosters, claims payments, maintaining books and records) of the plan on a contractual basis, that is required to be reported in item 2, except for salaried staff or employees of the plan or banks or insurance carriers. On the remaining lines ((2) through (40)) and additional Schedules C (Form 5500) if needed, list all other persons required to be reported in item 2 who provided services to the plan in the order of compensation received, starting with the most highly compensated and ending with the lowest compensated. COLUMN (b).--An EIN must be entered in column (b). If an individual is listed in column (a), the EIN to be entered in column (b) should be the EIN of the individual's employer. COLUMN (c).--For example, employee, trustee, accountant, attorney, etc. COLUMN (d).--For example, employee, vice-president, union president, etc. COLUMNS (e) AND (f).--Include the plan's share of amounts of compensation for services paid during the year to a master trust or 103-12 IE trustee, and to persons providing services to the master trust or 103-12 IE, if such compensation is not subtracted from the gross income of the master trust or 103-12 IE in determining the net investment gain (or loss). Amounts of compensation subtracted from gross income in determining the net investment gain (or loss) of the master trust or 103-12 IE must be included as part of the report of the master trust or 103-12 IE filed with DOL. Include brokerage commissions or fees only if the broker is grated some discretion (see 29 CFR 2510.3-21, paragraph (d), regarding "discretion"). Include all other commissions and fees on investments, whether or not they are capitalized as investment costs. COLUMN (g).--From the list below, select the code that best describes the nature of services provided to the plan, and enter the number. If more than one service was provided, enter only the code of the primary service.
CODE SERVICE 10 Accounting (including auditing) 11 Actuarial 12 Contract administrator 13 Administration 14 Brokerage (real estate) 15 Brokerage (stocks, bonds, commodities) 16 Computing, tabulating, ADP, ect. 17 Consulting (general) 18 Custodial (securities) 19 Insurance agents and brokers 20 Investment advisory 21 Investment management 22 Legal 23 Printing and duplicating 24 Recordkeeping 25 Trustee (individual) 26 Trustee (corporate) 27 Pension insurance adviser 28 Valuation services (appraisals, asset valuations, ect.) 29 Investment evaluations 30 Medical 31 Legal services to participants 99 Other (specify)
NOTE: DO NOT LIST PBGC OR IRS AS A SERVICE PROVIDER ON PART I OF SCHEDULE C (FORM 5500). PART III--TERMINATION INFORMATION Explain the reason for the change in appointment and provide the name, EIN position, address, and telephone number of the persons(s) listed in item 25d of Form 5500 whose appointment has been terminated. List them in the order of the boxes that are checked in item 25d, (i.e., accountants first, enrolled actuaries next, ect.). Include in this explanation a description of any disagreement for which item 25e of the Form 5500 is marked "Yes," even if the disagreement was resolved prior to the termination. If an individual is listed, the EIN to be entered should be the EIN of the individual's employer. Use additional Schedules C (Form 5500), if needed, to list additional persons. SCHEDULE G FINANCIAL SCHEDULES OMB NO. 1210-0016 (FORM 5500) ------------------ This schedule may be filed as an attachment to the Annual 1997 Department of the Treasury Return/Report Form 5500 under Section 104 of the Employee ------------------ Internal Revenue Service Retirement Income Security Act of 1974, referred to as ERISA. THIS FORM IS ----------- SEE THE INSTRUCTIONS FOR ITEM 27 OF THE FORM 5500. OPEN TO PUBLIC INSPECTION Department of Labor ATTACH TO FORM 5500. Pension and Welfare Benefits Administration - ---------------------------------------------------------------------------------------------------------------------------------- For calendar plan year 1997 or fiscal plan year beginning March 1, 1997, and ending February 28, 1998 - ---------------------------------------------------------------------------------------------------------------------------------- Name of plan sponsor as shown on line 1a of Form 5500 EMPLOYER IDENTIFICATION NUMBER ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 84 0910696 - ---------------------------------------------------------------------------------------------------------------------------------- Name of plan ROCKY MOUNTAIN CHOCOLATE Three-digit FACTORY, INC. 401(K) PLAN plan number 0 0 1 - ---------------------------------------------------------------------------------------------------------------------------------- PART I SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES--SEE FORM 5500, ITEM 27a. - ---------------------------------------------------------------------------------------------------------------------------------- (c) (a) (b) DESCRIPTION OF INVESTMENT INCLUDING (d) (e) IDENTITY OF ISSUE, BORROWER, MATURITY DATE, RATE OF INTEREST, COST CURRENT VALUE LESSOR, OR SIMILAR PARTY COLLATERAL, PAR OR MATURITY VALUE - 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Cat. No. 14739A SCHEDULE G (FORM 5500) 1997
Schedule G (Form 5500) 1997 Page 2 - ------------------------------------------------------------------------------------------------------------------------------------ Part II SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES THAT WERE BOTH ACQUIRED AND DISPOSED OF WITHIN THE PLAN YEAR--SEE FORM 5500, ITEM 27a. - ------------------------------------------------------------------------------------------------------------------------------------ (a) (b) IDENTITY OF ISSUE, BORROWER, DESCRIPTION OF INVESTMENT INCLUDING MATURITY DATE, (c) (d) LESSOR, OR SIMILAR PARTY RATE OF INTEREST, COLLATERAL, PAR OR MATURITY VALUE COSTS OF ACQUISITIONS PROCEEDS OF DISPOSITIONS - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - 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------------------------------------------------------------------------------------------------------------------------------------ Part III SCHEDULE OF LOANS OR FIXED INCOME OBLIGATIONS--SEE FORM 5500, ITEM 27b - ------------------------------------------------------------------------------------------------------------------------------------ AMOUNT RECEIVED (g) (b) (c) DURING REPORTING YEAR (f) DETAILED DESCRIPTION OF LOAN INCLUDING AMOUNT OVERDUE (a) IDENTITY AND ORIGINAL --------------------- UNPAID DATES OF MAKING AND MATURITY, INTEREST ------------------- ADDRESS OF OBLIGOR AMOUNT OF BALANCE AT RATE, THE TYPE AND VALUE OF COLLATERAL, LOAN (d) (e) END OF YEAR ANY RENEGOTIATION OF THE LOAN AND THE (h) (i) PRINCIPAL INTEREST TERMS OF THE RENEGOTIATION AND OTHER PRINCIPAL INTEREST MATERIAL ITEMS - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - 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Schedule G (Form 5500) 1997 Page 3 - ------------------------------------------------------------------------------------------------------------------------------------ PART IV SCHEDULE OF LEASES IN DEFAULT OR CLASSIFIED AS UNCOLLECTIBLE--SEE FORM 5500, 27c - ------------------------------------------------------------------------------------------------------------------------------------ (d) TERMS AND DESCRIPTION (TYPE OF (c) PROPERTY, LOCATION (f) (g) (h) (b) RELATIONSHIP TO PLAN, AND DATE IT WAS (e) CURRENT GROSS RENTAL EXPENSES (i) (j) (a) IDENTITY OF EMPLOYER, EMPLOYEE, PURCHASED, TERMS ORIGINAL VALUE AT RECEIPTS PAID DURING NET AMOUNT IN LESSOR/LESSEE ORGANIZATION, OR REGARDING RENT, COST TIME OF DURING THE THE PLAN RECEIPTS ARREARS OTHER TAXES, INSURANCE, LEASE PLAN YEAR YEAR PARTY-IN-INTEREST REPAIRS, EXPENSES, RENEWAL OPTIONS, DATE PROPERTY WAS LEASED) - ------------------------------------------------------------------------------------------------------------------------------------ - 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------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ PART V SCHEDULE OF REPORTABLE TRANSACTIONS--SEE FORM 5500, LINE 27d. - ------------------------------------------------------------------------------------------------------------------------------------ (b) (f) (h) (a) DESCRIPTION OF ASSET (c) (d) (e) EXPENSE (g) CURRENT VALUE (i) IDENTITY OF (INCLUDE INTEREST RATE AND PURCHASE SELLING LEASE INCURRED COST OF OF ASSET ON NET GAIN PARTY INVOLVED MATURITY IN CASE OF A LOAN) PRICE PRICE RENTAL WITH ASSET TRANSACTION OR (LOSS) TRANSACTION DATE - 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Schedule G (Form 5500) 1997 Page 4 - ----------------------------------------------------------------------------------------------------------------------------------- PART VI SCHEDULE OF NONEXEMPT TRANSACTIONS--SEE FORM 5500, ITEM 27e If a nonexempt prohibited transaction occurred with respect to a disqualified person, file Form 5330 with the IRS to pay the excise tax on the transaction. - ----------------------------------------------------------------------------------------------------------------------------------- (g) (b) (c) EXPENSES (a) RELATIONSHIP TO DESCRIPTION OF INCURRED IN (i) (j) IDENTITY OF PLAN, EMPLOYER TRANSACTIONS (d) (e) (f) CONNECTION (h) CURRENT NET GAIN OR PARTY OR OTHER INCLUDING MATURITY PURCHASE SELLING LEASE WITH COST OF VALUE OF (LOSS) ON INVOLVED PARTY-IN-INTEREST DATE, RATE OF PRICE PRICE RENTAL TRANSACTION ASSET ASSET EACH INTEREST, COLLATERAL, TRANSACTION PAR OR MATURITY VALUE - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- PART VII SCHEDULE OF NONEXEMPT TRANSACTIONS--SEE FORM 5500, ITEM 27f. If a nonexempt prohibited transaction occurred with respect to a disqualified person, file Form 5330 with the IRS to pay the excise tax on the transaction. - ----------------------------------------------------------------------------------------------------------------------------------- (g) (b) (c) EXPENSES (a) RELATIONSHIP TO DESCRIPTION OF INCURRED IN (i) (j) IDENTITY OF PLAN, EMPLOYER TRANSACTIONS (d) (e) (f) CONNECTION (h) CURRENT NET GAIN OR PARTY OR OTHER INCLUDING MATURITY PURCHASE SELLING LEASE WITH COST OF VALUE OF (LOSS) ON INVOLVED PARTY-IN-INTEREST DATE, RATE OF PRICE PRICE RENTAL TRANSACTION ASSET ASSET EACH INTEREST, COLLATERAL TRANSACTION PAR OR MATURITY VALUE - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES--SEE FORM 5500 ITEM 27a ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN EIN 84 0910696 PLAN NUMBER 001 PLAN YEAR 03/01/1997 TO 02/28/1998 - ----------------------------------------------------------------------------------------------------------------------------------- (A) (B) (C) (D) (E) IDENTITY OF ISSUER, DESCRIPTION OF INVESTMENT INCLUDING COST CURRENT VALUE BORROWER, LESSOR OR MATURITY DATE, RATE OF INTEREST, COLLATERAL, SIMILAR PARTY. PAR OR MATURITY DATE. - ----------------------------------------------------------------------------------------------------------------------------------- * Principal Life Insurance Company Guarantee Interest $ 54,707.12 $ 54,707.12 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Money Market $ 19,565.05 $ 21,325.66 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Government Securities $ 11,937.44 $ 13,460.60 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Bond and Mortgage $ 362.02 $ 375.81 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Bond Emphasis Balance $ 19,603.78 $ 24,732.49 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Stock Emphasis Balanced $ 33,177.88 $ 45,677.02 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Stock Index 500 $ 49,101.01 $ 71,043.17 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company U.S. Stock $ 23,648.03 $ 26,940.50 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Medium Company Value $ 5,038.13 $ 6,011.14 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Medium Company Blend $ 13,364.11 $ 15,266.98 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Small Company Blend $ 60,673.05 $ 84,721.75 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company International Stock $ 6,112.12 $ 6,686.30 - ----------------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account * Principal Life Insurance Company Real Estate $ 2,290.89 $ 2,414.11 - ----------------------------------------------------------------------------------------------------------------------------------- RMCF STOCK * ROCKY MOUNTAIN CHOCOLATE FACTORY Employer Securities, Common $ 206,592.19 $ 118,302.23 - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
SCHEDULE OF REPORTABLE TRANSACTIONS--SEE FORM 5500 LINE 27d* ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN EIN 84 0910696 PLAN NUMBER 001 PLAN YEAR 03/01/1997 TO 02/28/1998 - ---------------------------------------------------------------------------------------------------------------------------- DESCRIPTION OF ASSET (A) (B) (C) (D) (E) TOTAL NUMBER TOTAL NUMBER TOTAL VALUE OF PURCHASES TOTAL VALUE OF SALES NET GAIN/(LOSS) OF PURCHASES OF SALES - ---------------------------------------------------------------------------------------------------------------------------- Guaranteed Interest 26 $19,435.19 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Guaranteed Interest 10 $ 5,521.59 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Stock Emphasis Balanced 27 $11,109.58 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Stock Emphasis Balanced 10 $10,144.81 $ 2,359.44 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Stock Index 500 30 $27,668.59 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Stock Index 500 7 $ 3,582.80 $ 1,097.73 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account U.S. Stock 27 $20,607.83 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account U.S. Stock 2 $ 18.00 $ 1.32 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Small Company Blend 28 $23,846.24 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- Pooled Separate Account Small Company Blend 9 $ 5,690.43 $ 1,413.95 - ---------------------------------------------------------------------------------------------------------------------------- RMCF STOCK Employer Securities, Common 25 $52,435.85 $ 0.00 - ---------------------------------------------------------------------------------------------------------------------------- RMCF STOCK Employer Securities, Common 11 $ 2,136.99 $2,397.43- - ----------------------------------------------------------------------------------------------------------------------------
* Schedule is prepared using the alternative way of reporting (iii) series transactions under DOL Regulation 2520.103-6(d)(2). SCHEDULE P ANNUAL RETURN OF FIDUCIARY OMB No. 1210-0016 (FORM 5500) OF EMPLOYEE BENEFIT TRUST -------------------- Department of the Treasury FILE AS AN ATTACHMENT TO FORM 5500, 5500-C/R, OR 5500-EZ. 1997 Internal Revenue Service FOR THE PAPERWORK REDUCTION NOTICE, SEE THE FORM 5500 INSTRUCTIONS. -------------------- This Form is Open to Public Inspection - ----------------------------------------------------------------------------------------------------------------------------------- For trust calendar year 1997 or fiscal year beginning March 1, 1997, and ending February 28, 1998. - ----------------------------------------------------------------------------------------------------------------------------------- PLEASE TYPE OR PRINT - ----------------------------------------------------------------------------------------------------------------------------------- 1a Name of trustee or custodian TRUSTEE OF ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN - ----------------------------------------------------------------------------------------------------------------------------------- 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.) 265 TURNER DRIVE - ----------------------------------------------------------------------------------------------------------------------------------- c City or town, state, and ZIP code DURANGO, CO 81301-7941 - ----------------------------------------------------------------------------------------------------------------------------------- 2a Name of trust b Trust's employer identification number TRUST FOR ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN 42 0127290 - ----------------------------------------------------------------------------------------------------------------------------------- 3 Name of plan if different from name of trust ROCKY MOUNTAIN CHOCOLATE FACTORY, INC. 401(K) PLAN - ----------------------------------------------------------------------------------------------------------------------------------- 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.) - ------------------------------------------------------------------------------- SCHEDULE P (FORM 5500) 1997 -----END PRIVACY-ENHANCED MESSAGE-----