Form 5500-C/R
Department of the Treasury
Internal Revenue Service
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Department of Labor
Pension and Welfare Benefits
Administration
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Pension Benefit Guaranty Corporation
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RETURN/REPORT OF EMPLOYEE BENEFIT PLAN
(WITH FEWER THAN 100 PARTICIPANTS)
THIS FORM IS REQUIRED TO BE FILED UNDER SECTIONS 104 AND 4065 OF THE EMPLOYEE
RETIREMENT INCOME SECURITY ACT OF 1974 AND SECTIONS 6039D, 6047(e),
6057(b), AND 6058(a) OF THE INTERNAL REVENUE CODE.
> See separate instructions
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OMB Nos. 1210-0016
1210-0089
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1995
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THIS FORM IS OPEN TO PUBLIC INSPECTION.
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FOR THE CALENDAR PLAN YEAR 1995 OR FISCAL PLAN YEAR BEGINNING MARCH 1, 1995,
AND ENDING FEBRUARY 29, 1996.
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FOR IRS USE ONLY
EP-ID
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If A(1) through A(4), B, C, and/or D do not apply to this year's return/report,
leave the boxes unmarked.
YOU MUST CHECK EITHER BOX A(5) OR A(6), WHICHEVER IS APPLICABLE. SEE INSTRUCTIONS.
A This return/report is:
(1) / / this first return/report filed for the plan;
(2) / / an amended return/report;
(3) / / the final return/report filed for the plan; or
(4) / / a short plan year return/report (less than 12 months).
(5) FORM 5500-C FILER CHECK HERE.............................. / /
(Complete only pages 1 and 3 through 6)
(Code section 6039D filers see instructions on page 5.)
(6) FORM 5500-R FILER CHECK HERE.............................. /X/
(Complete only pages 1 and 2. Detach pages 3 through 6
before filing.) If you checked box (1) or (3), you must
file a Form 5500-C. (See page 6 of the instructions.)
IF ANY INFORMATION ON A PREPRINTED PAGE 1 IS INCORRECT, CORRECT IT. IF ANY INFORMATION
IS MISSING, ADD IT. PLEASE USE RED INK WHEN MAKING THESE CHANGES AND INCLUDE THE
PREPRINTED PAGE 1 WITH YOUR COMPLETED RETURN/REPORT.
B Check here if any information reported in 1a, 2a, 2b, or 5a changed since the last
return/report for this plan..................................................... > / /
C If your plan year changed since the last return/report, check here.............. > / /
D If you filed for an extension of time to file this return/report, check here and
attach a copy of the approved extension......................................... > / /
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1a Name and address of plan sponsor (employer, if for a single-employer plan)
(Address should include room or suite no.)
ROCKY MOUNTAIN CHOCOLATE FACTORY, INC.
000 XXXXXX XXXXX
XXXXXXX, XX 00000
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1b Employer identification number (EIN)
84 0910696
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1c Sponsor's telephone number
(000) 000-0000
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1d Business code (see instructions, page 19)
2060
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1e CUSIP issuer number
N/A
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2a Name and address of plan administrator (if same as plan sponsor, enter "Same")
SAME
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2b Administrator's EIN
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2c Administrator's telephone number
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3 If you are filing this page without the preprinted historical plan information and the name,
address, and EIN of the plan sponsor or plan administrator has changed since the last return/
report filed for this plan, enter the information from the last return/report on lines 3a and/
or 3b and complete line 3c.
a Sponsor___________________________ EIN_________________ Plan number________________________
b Administrator_____________________________________ EIN______________________________________
c If the 3a indicates a change in the sponsor's name, address, and EIN, is this a change in
sponsorship only? (See line 3c on page 9 of the instructions for the definition of
sponsorship.) enter "Yes" or "No." >
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4 ENTITY CODE. (If not shown, enter applicable code from page 9 of the instructions.) > A
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5a Name of plan > ROCKY MOUNTAIN CHOCOLATE
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FACTORY, INC. 401(K) PLAN
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5b Effective date of plan (mo., day, yr.)
June 1, 1994
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5c Three-digit plan number > 0 0 1
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ALL FILERS MUST COMPLETE 6a THROUGH 6d, AS APPLICABLE.
6a / / Welfare benefit plan 6b /X/ Pension benefit plan
(If the correct codes are not preprinted below, enter the applicable
codes from page 9 of the instructions in the boxes.)
2
--|--|--|--|--|--|--|--
6c Pension plan features. (If the correct codes are not preprinted below, enter the
applicable pension plan feature codes from page 9 of the instructions in the boxes.)
C G
--|--|--|--|--|--|--|--
6d / / Fringe benefit plan. Attach Schedule F (Form 5500). See instructions.
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CAUTION: A PENALTY FOR THE LATE OR INCOMPLETE FILING OF THIS RETURN/REPORT WILL BE ASSESSED
UNLESS REASONABLE CAUSE IS ESTABLISHED.
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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 for employer/plan sponsor ________________________________
Date > ___________________________
Signature of plan administrator > _______________________________________ Date > __________________
Type or print name or individual signing for plan administrator
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FOR PAPERWORK REDUCTION ACT NOTICE, SEE PAGE 1 OF THE INSTRUCTIONS. FORM 5500-C/R(1995)
Page 2
FORM 5500-C/R(1995) FORM 5500-R FILERS, COMPLETE PAGES 1 AND 2 ONLY. FORM 5500-C
FILERS, COMPLETE PAGE 1, SKIP PAGE 2, AND COMPLETE PAGES 3 THROUGH 6.
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6 e Check investment arrangement(s): (1)/ /Master trust (2)/ /Common/Collective trust (3)/X/Pooled separate account. YES NO
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7 a Total participants: (1)At the beginning of plan year > 74 (2)At the end of plan year > 85
-------- ---------
b Enter number of participants with account balances at the end of the plan year (defined benefits plans do not
complete this item) > 64
--------
c (1) Were any participants in the pension benefit plan separated from service with a deferred vested benefit for
which a Schedule SSA (Form 5500) is required to be attached? (See instructions.) ........................... 7c(1) X
(2) If "Yes," enter the number of separated participants required to be reported >
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8 a Was this plan terminated during this plan year or any prior plan year? If "Yes," enter the year >_____________ 8a X
b Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought
under the control of PBGC? 8b X
c If line 8a is "Yes" and the plan is covered by PBGC, is the plan continuing to file PBGC Form 1 and pay premiums
until the end of the plan year in which assets are distributed or brought under control of PBGC? .............. 8c
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9 Is this a plan established or maintained pursuant to one or more collective bargaining agreements? ............ 9 X
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10 If any benefits are provided by an insurance company, insurance service, or similar organization, enter the
number of Schedules A (Form 5500), Insurance Information, that are attached. If none, enter -0-. > 1
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11 a (1) Were any plan amendments adopted during this plan year? ................................................... 11a(1) X
(2) Enter the date the most recent amendment was adopted > Month 05 Day 27 Year 94
---- ---- ----
b If line 11A is "Yes," did any amendment result in a retroactive reduction of accrued benefits for any
participant? .................................................................................................. 11b
c If line 11A is "Yes," did any amendment change the information contained in the latest summary plan description
of summary description of modifications available at the time of the amendment? ............................... 11d
d If line 11C is "Yes," has a summary plan description or summary description of modifications that reflects the
plan amendments referred to on line 11c been both furnished to participants and filed with the Department
Labor? ........................................................................................................ 11d
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12 a If this a pension benefit plan subject to the minimum funding standards, has the plan experienced a funding
deficiency for this plan year? (See instructions) ............................................................. 12a X
b If line 12a is "Yes," have you filed Form 5530 to pay excise tax? ............................................. 12b
c Is the plan administrator making an election under section 412(c)(8) for an amendment after the end of the
plan year? (See instructions) ................................................................................. 12c X
d If a change in the actuarial funding method was made for the plan year pursuant to a Revenue Procedure providing
automatic approval for the change, indicate whether the plan sponsor/administrator agrees to the change ....... 12d
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13 a Total plan assets as of the beginning 85,877 and end 198,682 of the plan year
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b Total liabilities as of the beginning 0 and end 0 of the plan year
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c Net assets as of the beginning > 85,877 and end > 198,682 of the plan year
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14 For this plan year, enter: a Plan income 115,644 d Plan contributions 136,990
----------- -----------
b Expenses 2,839 e Total benefits paid 2,839
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c Net income (loss)(subtract 14B from 14A) 112,805
---------
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15 You may NOT use N/A in response to line 15a through 15o. If you check "Yes," you must enter YES NO AMOUNT
a dollar amount in the amount column. DURING THIS PLAN YEAR: -----------------------------
a Was this plan covered by a fidelity bond? .................................................... 15a X 50,000
b If line 15a is "Yes," enter the name of the surety company > HARTFORD FIRE INSURANCE CO.
-------------------------------
c Was there any loss to the plan, whether or not reimbursed, caused by fraud or dishonesty? ..... 15c X
d Was there any sale, exchange, or lease or any property between the plan and the employer, any
fiduciary, any of the five most highly paid employees of the employer, any owner of a 10% or
more interest in the employer, or relatives of any such persons? .............................. 15d X
e Was there any loan or extension of credit by the plan to the employer, any fiduciary, any of the
five most highly paid employees of the employer, any owner of a 10% interest in the employer, or
relatives of any such persons? ................................................................ 15e X
f Did the plan acquire or hold any employer security or employer real property ? ................ 15f X
g Has the plan granted an extension on any delinquent loan owed to the plan? .................... 15g X
h Were any participant contributions transmitted to the plan more than 31 days after receipt or
withholding by the employer? .................................................................. 15h X
i Were there any loans by the plan or fixed income obligations due to the plan classified as
uncollectible or in default as of the close of the plan year? ................................. 15i X
j Has any plan fiduciary had a financial interest in excess of 10% in any party providing services
to the plan or received anything of value from any such party? ................................ 15j X
k Did the plan at any time hold 20% or more of its assets in any single security, debt, mortgage,
parcel of real estate, or partnership/joint venture interests? ................................ 15k X
l Did the plan at any time engage in any transaction or series of related transactions involving
20% or more of the current value of plan assets? .............................................. 15l X
m Were there any noncash contributions made to the plan the value of which was set without an
appraisal by an independent third party? ...................................................... 15m X
n Were there any purchases of nonpublicly traded securities by the plan the value of which was set
without an appraisal by an independent third party? ........................................... 15n X
o Has the plan reduced or failed to provide any benefit when due under the plan because of
insufficient assets? .......................................................................... 15o X
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16 a Is the plan covered under the Pension Benefit Guaranty Corporation termination insurance
program? / / Yes / X / No / /Not determined
b If line 16a is "Yes" or "Not determined," enter the employer identification number and the plan number used to identify it.
Employer identification number > Plan number >
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12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
MONEY MARKET
BALANCE SHEET
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ASSETS LIABILITIES & SURPLUS
Bonds $1,049,466,343 Unallocated Reserves $1,110,373,410
Bank Deposits 3,493,793 Remitted & Items Not Allocated 4,087,491
Receivable From Principal Mutual Payable for Investments Purchased 70,818
Insurance Co. General Account 61,571,583 -------------
-------------
Total Liabilities 1,114,531,719
Surplus 0
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Total Assets $1,114,531,719 Total Liabilities and Surplus $1,114,531,719
------------- -------------
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SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 399,224,591 Benefit Payments $ 158,978,225
Interest Income 61,383,226 Funds Withdrawn 146,374,011
------------- Investment Management, Mortality,
and Administration Charges 7,320,325
Investment Expenses 810,550
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Total Disbursements 313,483,111
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Total Receipts $ 460,607,817 Increase in Reserves $ 147,124,706
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Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
GOVERNMENT SECURITIES
BALANCE SHEET
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ASSETS LIABILITIES & SURPLUS
Bonds $ 136,866,836 Unallocated Reserves $ 143,085,744
Bank Deposits 6,737 Remitted & Items Not Allocated 58,170
Adjustment to Investements Payable For Investments Purchased 2,903,559
to Reflect Market Value 4,592,398
Investment Income Due & Accrued 755,293 Total Liabilities 146,047,473
Receivable From Principal Mutual
Insurance Co. General Account 5,775,123 Surplus 1,948,914
------------- -------------
Total Assets $ 147,996,387 Total Liabilities & Surplus $ 147,996,387
------------- -------------
------------- -------------
SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 73,674,020 Funds Withdrawn $ 5,423,770
Gross Investment Income: Benefit Payments 5,298,288
Interest Income 7,621,159 Investment Management, Mortality,
Change In: and Administration Charges 697,661
Investment Income Investment Expenses 84,047
-------------
Earned But Not Collected 317,718
Accrued Interest Receivable (217,840) 7,721,037 Total Disbursements 11,503,766
Change in Net Unrealized ----------- -------------
Appreciation/Depreciation of Increase in Reserves 79,071,274
Investments 10,213,195 Contributed Surplus 1,275,080
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Realized Capital Gain 241,868
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Total Receipts $ 91,850,120 $ 80,346,354
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Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
BOND EMPHASIS BALANCED
BALANCE SHEET
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ASSETS LIABILITIES & SURPLUS
Investment in Principal Mutual Life Unalloacated Reserves $ 150,787,602
-------------
Insurance Company Separate Account:
Bond and Mortgage $ 48,920,839 Total Liabilities 150,787,602
Government Securities 32,627,377
U.S. Stock 21,942,876 Surplus 0
International Stock 13,366,603 -------------
Real Estate 13,388,518
Remitted and Items Not Allocated 6,350,446
Adjustment to Investments
to Reflect Market Value 14,190,943
-------------
Total Assets $ 150,787,602 Total Liabilities & Surplus $ 150,787,602
------------- -------------
------------- -------------
SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 78,719,366 Funds Withdrawn $ 9,166,543
Change in Net Unrealized Benefit Payments 5,833,804
Appreciation/Depreciation of Investment Management, Mortality,
Investments 14,190,943 and Administration Charges 167,929
Realized Capital Gain 3,558,199 -------------
-------------
Total Disbursements 15,168,276
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Total Receipts $ 96,468,508 Increase in Reserves $ 81,300,232
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-------------
Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
STOCK EMPHASIS BALANCED
BALANCE SHEET
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ASSETS LIABILITIES & SURPLUS
Investment in Principal Mutual Life Unallocated Reserves $ 263,653,707
--------------
Insurance Company Separate Account:
Bond and Mortgage $ 40,361,702 Total Liabilities 263,653,707
Government Securities 23,798,228
U.S. Stock 91,886,631 Surplus 0
International Stock 33,763,390 --------------
Real Estate 34,955,565
Remitted and Items Not Allocated 9,412,784
Adjustments to Investments
to Reflect Market Value 29,475,407
---------------
Total Assets $ 263,653,707 Total Liabilities & Surplus $ 263,653,707
--------------- --------------
--------------- --------------
SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 127,412,781 Funds Withdrawn $ 12,952,269
Change in Net Unrealized Benefit Payments 9,497,359
Appreciation/Depreciation of Investment Management, Mortality,
Investments 29,475,407 and Administration Charges 307,297
Realized Capital Gain 7,191,852 ------------
------------ Total Disbursements 22,756,925
------------
Total Receipts $ 164,080,040 Increase in Reserves $141,323,115
------------
------------
Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
STOCK INDEX
BALANCE SHEET
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ASSETS LIABILITIES
Bonds 7,746,138 Unallocated Reserves $837,519,806
Preferred Stock 1,188 Remitted & Items Not Allocated 257,194
Common Stock 615,962,903 Payable for Investments Purchased 7,873,924
Bank Deposits 264,289 ------------
Adjustment to Investments Total Liabilities 845,650,924
to Reflect Market Value 199,214,385
Investment Income Due & Accrued 1,370,369 Surplus* 3,113,525
Receivable From Principal Mutual ------------
Insurance Co. General Account 24,205,177
------------
Total Assets $ 848,764,449 Total Liabilities & Surplus $848,764,449
------------ ------------
------------ ------------
SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 282,900,273 Benefit Payments $ 34,952,467
Gross Investment Income: Funds Withdrawn 25,669,290
Dividend Income 15,134,950 Investment Management, Mortality,
Interest Income 186,677 and Administration Charges 3,126,642
Change in Investment Income Investment Expenses 483,690
Earned But Not Collected 206,130 15,527,757 -------------
Change in Net Unrealized ---------- Total Disbursements 64,232,089
Appreciation/Depreciation of
Investments 172,036,424 Increase in Reserves 405,459,988
Realized Capital Gain 1,519,348 Contributed Surplus 2,291,725
----------- -------------
407,751,713
-------------
-------------
Total Receipts $ 471,983,802
*This is Principal Mutual Life Insurance Company Surplus Funds used as seed
money to the account; it is net of deposits + (-) income and disbursements.
Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
12/31/95 FUND STATEMENT
[LOGO OF PRINCIPAL FINANCIAL GROUP] POOLED SEPARATE ACCOUNT-
SMALL COMPANY STOCK
BALANCE SHEET
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ASSETS LIABILITIES & SURPLUS
Bonds $ 14,235,146 Unallocated Reserves $ 523,098,931
Common Stock 425,605,158 Remitted & Items Not Allocated 220,980
Bank Deposits 71,941 -------------
Adjustment to Investments Total Liabilities 523,319,911
to Reflect Market Value 56,626,014
Investment Income Due & Accrued 280,789 Surplus 0
-------------
Receivable for Investments Sold 1,703,264
Receivable From Principal Mutual
Insurance Co. General Account 24,797,599
-------------
Total Assets $ 523,319,911 Total Liabilities & Surplus $ 523,319,911
------------- -------------
------------- -------------
SUMMARY OF OPERATIONS
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RECEIPTS DISBURSEMENTS
Deposits and Net Transfers $ 270,001,365 Benefit Payments $ 15,512,462
Gross Investment Income: Funds Withdrawn 9,591,102
Dividend Income 3,326,381 Investment Management, Mortality,
Interest Income 851,955 and Administration Charges 2,367,445
Change in Investment Income Investment Expenses 278,650
-------------
Earned But Not Collected 47,666 4,226,002
Change in Net Unrealized ---------- Total Disbursements 27,749,659
-------------
Appreciation/Depreciation of
Investments 52,184,154 Increase in Reserves 327,657,799
Realized Capital Gain 30,998,445 Contributed Surplus 2,002,508
----------- -------------
Total Receipts $ 357,409,966 $ 329,660,307
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Principal Mutual Life Insurance Company, Des Moines, Iowa 50392-0001
SCHEDULE A INSURANCE INFORMATION OMB No. 1210-0016
(FORM 5500) -------------------
1995
Department of the Treasury This schedule is required to be filed under section 104 of the
Internal Revenue Service Employee Retirement Income Security Act of 1974. -------------------
-----------
Department of Labor > FILE AS AN ATTACHMENT TO FORM 5500 OR 5500-C/R. THIS FORM IS
Pension and Welfare Benefits > Insurance companies are required to provide this information OPEN TO PUBLIC
Administration as per ERISA section 103(a)(2). INSPECTION
-----------
Pension Benefit Guaranty Corporation
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For calendar year 1995 or fiscal plan year beginning March 1, 1995, and ending February 29, 1996.
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> PART I MUST BE COMPLETED FOR ALL PLANS REQUIRED TO FILE THIS SCHEDULE. > ENTER MASTER TRUST OR 103-12 IE NAME IN PLACE
> PART II MUST BE COMPLETED FOR ALL INSURED PENSION PLANS. OF "SPONSOR" AND SPECIFY INVESTMENT ACCOUNT OR
> PART III MUST BE COMPLETED FOR ALL INSURED WELFARE PLANS. 103-12 IE IN PLACE OF "PLAN" IF FILING WITH DOL FOR A
MASTER TRUST OR 103-12 IE.
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Name 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
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Name of plan ROCKY MOUNTAIN CHOCOLATE Three-digit
FACTORY, INC. 401(K) PLAN plan number > 0 0 1
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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.
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1 Check appropriate box: a / / Welfare plan b /x/ Pension plan c / / Combination pension and welfare plan
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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
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PRINCIPAL MUTUAL LIFE INSURANCE CO 4-12731 85 03/01/95 02/29/96
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3 Insurance fees and commissions paid to agents and brokers: (c) AMOUNT OF (d) FEES PAID
(a) CONTRACT OR (b) NAME AND ADDRESS OF THE AGENTS OR BROKERS TO COMMISSIONS PAID --------------------------------
IDENTIFICATION NUMBER WHOM COMMISSIONS OR FEES WERE PAID AMOUNT PURPOSE
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4-12731 XXXXXXX & XXXXXXX OF COLORA 1,891
000 00XX XX XXX 0000 0 - XXXXXXXX XXXXXXXXX
XXXXXX XX 00000-2818 AMOUNT NOT CHARGED
TO YOUR PLAN
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TOTAL 1,891 6
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4 Premiums due and unpaid at end of the plan year > $ : Contract or identification number > 4-12731
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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.
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> Contract or identification number > 4-12731
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5 Contracts with allocated funds, (for example, individual policies or group deferred annuity contracts):
a State the basis of premium rates >
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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 >
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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 .......................................................... 9,606
-----------
b Additions: (i) Contributions deposited during year ................................. 14,694
------------
(ii) Dividends and credits ........................................................ 0
------------
(iii) Interest credited during the year ............................................ 1,145
------------
(iv) Transferred from separate account ............................................ 0
------------
(v) Other (specify) > ROLLOVER 850
-------------------------------------------------------------- ------------
(vi) Total additions .................................................................................... 16,689
-----------
c Total of balance and additions (add a and b(vi)) ........................................................ 26,295
-----------
d Deductions:
(i) Disbursed from fund to pay benefits or purchase annuities during year ........ 516
------------
(ii) Administration charge made by carrier ........................................ 0
------------
(iii) Transferred to separate account .............................................. 820
------------
(iv) Other (specify) > MKT VALUE CHANGE 3
------------------------------------------------------------- ------------
(v) Total Deductions ................................................................................... 1,339
-----------
e Balance at end of current policy year (subtract d(v) from c) ........................................... 24,956
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7 Separate accounts: Current value of plan's interest in separate accounts at year end ....................... 97,800
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FOR PAPERWORK REDUCTION ACT NOTICE, SEE PAGE 1 OF THE INSTRUCTIONS FOR FORM 5500 OR 5500-C/R. SCHEDULE A (FORM 5500) 1995
D132
GROUP CONTRACT 4-12731 SCHEDULE A (FORM 5500) SUPPLEMENT
PLAN NAME
ROCKY MOUNTAIN CHOCOLATE PLAN SPONSOR
FACTORY, INC. 401(K) PLAN EIN 84 0910696 PLAN NO. 001
CERTIFICATION
The Schedule(s) A and supplement(s) provided by The Principal Mutual Life
Insurance Company, are certified to be complete and accurate according to the
best of our knowledge.
8-6-96 /s/ XXXXX X. XXXXXX
----------------- ------------------------------
DATE SIGNATURE
SCHEDULE P ANNUAL RETURN OF FIDUCIARY OMB No. 1210-0016
(FORM 5500) OF EMPLOYEE BENEFIT TRUST 1995
DEPARTMENT OF THE TREASURY FILE AS AN ATTACHMENT TO FORM 5500, 5500-C/R, OR 5500-EZ This Form is Open
INTERNAL REVENUE SERVICE FOR THE PAPERWORK REDUCTION NOTICE, SEE PAGE 1 OF THE FORM 5500 INSTRUCTIONS to Public Inspection
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For trust calendar year 1995 or fiscal year beginning March 1, 1995, and ending February 29, 1996
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PLEASE TYPE OR PRINT
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1a Name of trustee or custodian
TRUSTEE OF ROCKY MOUNTAIN CHOCOLATE
FACTORY, INC. 401 (K) PLAN
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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 XXXXXX DRIVE
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c City or town, state and ZIP code
DURANGO, CO 81301
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2a Name of trust b Trust's employer identification number
TRUST FOR ROCKY MOUNTAIN CHOCOLATE
FACTORY, INC. 401 (K) PLAN 42 0127290
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3 Name of plan if different from name of trust
ROCKY MOUNTAIN CHOCOLATE
FACTORY, INC. 401 (K) PLAN
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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
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5 Enter the plan sponsor's employer identification number as shown on Form 5500,
5500-C/R, or 5500-EZ .................................................................... 84 0910696
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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
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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.
NOTES: 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.)
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SCHEDULE P (FORM 5500) 1995
