CHICAGO RIVET & MACHINE CO
8-K/A, 1997-02-14
METALWORKG MACHINERY & EQUIPMENT
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<PAGE>   1
                       SECURITIES AND EXCHANGE COMMISSION
                             WASHINGTON, DC  20549

                                 -------------


                                    FORM 8-K
                                 CURRENT REPORT
                               (AMENDMENT NO. 1)

                     PURSUANT TO SECTION 13 OR 15(d) OF THE
                        SECURITIES EXCHANGE ACT OF 1934




                               December 3, 1996
                       ---------------------------------
                       (Date of earliest event reported)


                          CHICAGO RIVET & MACHINE CO.            
             ------------------------------------------------------

             (Exact Name of Registrant as Specified in its Charter)


      Illinois                         0-1227                        36-0904920 
- --------------------------------------------------------------------------------
      (State or Other              (Commission File                (IRS Employer
      Jurisdiction of                File Number)                 Identification
      Incorporation)                                                  Number)


                901 Frontenac Road, Naperville, IL 60566-7061
     ------------------------------------------------------------------
             (Address of Principal Offices, including zip code)


                               (630) 357-8500
         ----------------------------------------------------------
            (Registrant's telephone number, including area code)

                                      
                                     N/A
        -------------------------------------------------------------
        (Former name or former address, if changed since last report)





 
<PAGE>   2
<TABLE>
<CAPTION>

                                                                                                        Page No.
<S>                                                                                                    <C>      
Item 7.  FINANCIAL STATEMENTS AND EXHIBITS


    (a)  FINANCIAL STATEMENTS OF ACQUIRED COMPANY
  
         Report of Independent Certified Public Accountants                                                3

         Balance Sheets at September 30, 1996 and October 31, 1995                                       4-5

         Statements of Income and Retained Earnings for the eleven months ended
         September 30, 1996 and the year ended October 31, 1995                                            6

         Statements of Cash Flows for the eleven months ended September 30, 1996
         and the year ended October 31, 1995                                                               7    

         Summary of Accounting Policies                                                                  8-9

         Notes to Financial Statements                                                                 10-11    

    (b)  PRO FORMA FINANCIAL INFORMATION

         Pro Forma Condensed Consolidated Financial Statements (unaudited)                                12

         Pro Forma Condensed Consolidated Balance Sheet at September 30, 1996
         (unaudited)                                                                                      13 

         Notes to Pro Forma Condensed Consolidated Balance Sheet at September 30, 1996
         (unaudited)                                                                                      14

         Pro Forma Condensed Consolidated Statement of Income for the nine
         months ended September 30, 1996 (unaudited)                                                      15

         Notes to Pro Forma Condensed Consolidated Statement of Income for the nine
         months ended September 30, 1996 (unaudited)                                                      16

         Pro Forma Condensed Consolidated Statement of Income for the year
         ended December 31, 1995 (unaudited)                                                              17

         Notes to Pro Forma Condensed Consolidated Statement of Income for the year
         ended December 31, 1995 (unaudited)                                                           18-19    

</TABLE>

<PAGE>   3
REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS




H & L Tool Company, Inc.
Madison Heights, Michigan

We have audited the accompanying balance sheets of H & L Tool Company, Inc. as
of September 30, 1996 and October 31, 1995, and the related statements of
income and retained earnings, and cash flows for the eleven months ended
September 30, 1996 and the year ended October 31, 1995.  These financial
statements are the responsibility of the Company's management.  Our
responsibility is to express an opinion on these financial statements based on
our audits.

We conducted our audits in accordance with generally accepted auditing
standards.  Those standards require that we plan and perform the audit to
obtain reasonable assurance about whether the financial statements are free of
material misstatement.  An audit includes examining, on a test basis, evidence
supporting the amounts and disclosures in the financial statements.  An audit
also includes assessing the accounting principles used and significant
estimates made by management, as well as evaluating the overall financial
statement presentation.  We believe that our audits provide a reasonable basis
for our opinion.

In our opinion, the financial statements referred to above present fairly, in
all material respects, the financial position of H & L Tool Company, Inc. at
September 30, 1996 and October 31, 1995, and the results of its operations and
its cash flows for the eleven months ended September 30, 1996 and the year
ended October 31, 1995 in conformity with generally accepted accounting
principles.





                                             /s/ BDO SEIDMAN, LLP

Troy, Michigan
November 18, 1996


<PAGE>   4

                           H & L TOOL COMPANY, INC.
                                 BALANCE SHEETS



<TABLE>
<CAPTION>
                                                                  September 30,  October 31,
                                                                           1996         1995
<S>                                                              <C>             <C>
           ASSETS                                                                           
                                                                                 
           CURRENT ASSETS                                                                   
             Cash and equivalents                                  $  4,894,334  $ 2,181,284
             Marketable securities                                    1,942,556    1,702,654
             Accounts receivable, less allowance for                             
              possible losses of $21,000 (Note 1)                     3,179,957    3,086,456
             Inventories (Notes 1 and 2)                              1,179,537    1,525,046
             Prepaid expenses and other current assets (Note 1)         383,192      158,804
                                                                   ------------  -----------
                                                                                 
           TOTAL CURRENT ASSETS                                      11,579,576    8,654,244
                                                                   ------------  -----------
                                                                                 
           PROPERTY AND EQUIPMENT (Note 1)                                       
             Land                                                       175,500      175,500
             Building and improvements                                2,008,046    2,008,046
             Machinery and equipment                                 14,487,284   14,487,284
             Motor equipment                                            161,077      211,278
             Furniture and equipment                                    422,747      410,443
                                                                   ------------  -----------
                                                                                 
                                                                     17,254,654   17,292,551
             Less accumulated depreciation                           15,237,960   14,661,863
                                                                   ------------  -----------
                                                                                 
           NET PROPERTY AND EQUIPMENT                                 2,016,694    2,630,688
                                                                   ------------  -----------
                                                                                 
           OTHER                                                                 
             Cash surrender value of life insurance, net                         
              of policy loans of $80,000                                285,759      264,364
             Miscellaneous                                              226,334      229,795
                                                                   ------------  -----------
           TOTAL OTHER ASSETS                                           512,093      494,159
                                                                   ------------  -----------
           TOTAL ASSETS                                            $ 14,108,363  $11,779,091
                                                                   ============  ===========
</TABLE>



           SEE ACCOMPANYING SUMMARY OF ACCOUNTING POLICIES AND NOTES TO
           FINANCIAL STATEMENTS.        

<PAGE>   5

                           H & L TOOL COMPANY, INC.
                                BALANCE SHEETS



<TABLE>
<CAPTION>
                                                                  September 30,     October 31,
                                                                           1996            1995
          <S>                                                     <C>             <C>       
          LIABILITIES AND STOCKHOLDERS' EQUITY                                     
                                                                                   
          CURRENT LIABILITIES                                                      
           Accounts payable                                         $   684,451     $   627,513
           Accruals                                                               
             Compensation and witholdings (Note 7)                    2,404,316         506,254
             Profit-sharing (Note 4)                                    200,000         200,000
             Taxes, other than income                                    98,028          73,100
             Other                                                       28,570           7,629
           Current maturities of long-term debt (Note 3)                   --           166,668
                                                                    -----------     -----------
                                                                                  
          TOTAL CURRENT LIABILITIES                                   3,415,365       1,581,164
                                                                                  
          LONG-TERM DEBT, less current maturities (Note 3)               --             152,775
                                                                    -----------     -----------
                                                                                  
          TOTAL LIABILITIES                                           3,415,365       1,733,939
                                                                    -----------     -----------
                                                                                  
          COMMITMENTS (Note 5)                                                    
                                                                                  
          STOCKHOLDERS' EQUITY                                                    
           Common stock - $1 par value, 50,000 shares authorized,                 
             30,000 issued and outstanding                               30,000          30,000
           Additional paid-in capital                                    35,000          35,000
           Retained earnings                                         10,627,998       9,980,152
                                                                    -----------     -----------
                                                                                  
          TOTAL STOCKHOLDERS' EQUITY                                 10,692,998      10,045,152
                                                                    -----------     -----------
                                                                                  
          TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY                $14,108,363     $11,779,091
                                                                    ===========     ===========
</TABLE>

         SEE ACCOMPANYING SUMMARY OF ACCOUNTING POLICIES AND NOTES TO
                             FINANCIAL STATEMENTS.






<PAGE>   6
                           H & L TOOL COMPANY, INC.
                   STATEMENTS OF INCOME AND RETAINED EARNINGS


<TABLE>
<CAPTION>
                                                  Eleven months   Year Ended
                                            ended September 30,  October 31,
                                                           1996         1995

   <S>                                             <C>           <C>
   NET SALES (Note 6)                               $19,661,602  $22,285,744

   COST OF SALES                                     14,801,048   16,298,541
                                                    -----------  -----------

   GROSS PROFIT                                       4,860,554    5,987,203

   SELLING AND ADMINISTRATIVE EXPENSES                4,515,892    4,232,330
                                                    -----------  -----------

   OPERATING INCOME                                     344,662    1,754,873
                                                    -----------  -----------

   OTHER INCOME (EXPENSE)
    Interest income                                     283,089      228,369
    Gain on sale of equipment                            20,984       21,615
    Interest expense                                     (8,331)     (39,431)
    Miscellaneous                                         7,442         (255)
                                                    -----------  -----------

   TOTAL                                                303,184      210,298
                                                    -----------  -----------

   NET INCOME (Note 7)                                  647,846    1,965,171

   RETAINED EARNINGS, at beginning of year            9,980,152    8,314,981

   DIVIDENDS PAID                                            --     (300,000)
                                                    -----------  -----------

   RETAINED EARNINGS, at end of year                $10,627,998   $9,980,152
                                                    ===========   ==========
</TABLE>

         SEE ACCOMPANYING SUMMARY OF ACCOUNTING POLICIES AND NOTES TO
                             FINANCIAL STATEMENTS.










<PAGE>   7




                            H & L TOOL COMPANY, INC.
                            STATEMENTS OF CASH FLOWS

<TABLE>
<CAPTION>                                                 
                                                                   Eleven months   Year Ended
                                                             ended September 30,  October 31,
                                                                            1996         1995
                                                          
<S>                                                                  <C>           <C>
CASH FLOWS FROM OPERATING ACTIVITIES                      
 Net income                                                             $647,846   $1,965,171
 Adjustments to reconcile net income to net               
  cash provided by operating activities                   
    Depreciation                                                         703,302      787,767
    Gain on sale of equipment                                            (20,984)     (21,615)
 Changes in non-investing and non-financing               
  assets and liabilities                                  
    Increase in accounts receivable                                      (93,501)     (39,890)
    Decrease (increase) in inventories                                   345,509      (10,599)
    Increase in prepaid expenses and other current assets               (224,388)     (64,746)
    Increase (decrease) in accounts payable                               56,938     (580,519)
    Increase (decrease) in accrued expenses                            1,943,931     (152,533)
                                                                      ----------   ----------
                                                          
NET CASH PROVIDED BY OPERATING ACTIVITIES                              3,358,653    1,883,036
                                                                      ----------   ----------
                                                          
CASH FLOWS FROM INVESTING ACTIVITIES                      
 Proceeds from sale of marketable securities                           2,000,000    2,500,000
 Purchase of marketable securities                                    (2,239,902)  (3,228,449)
 Proceeds from sale of equipment                                          23,000       30,174
 Purchase of property and equipment                                      (87,863)  (1,238,387)
 Increase in cash surrender value of life insurance                      (21,395)     (22,383)
                                                                      ----------  -----------
                                                          
NET CASH USED IN INVESTING ACTIVITIES                                   (326,160)  (1,959,045)
                                                                      ----------  -----------
                                                          
CASH FLOWS FROM FINANCING ACTIVITIES                      
 Repayment of debt                                                      (319,443)    (166,668)
 Dividends paid                                                           ---        (300,000)
                                                                      ----------  -----------
                                                          
NET CASH USED IN FINANCING ACTIVITIES                                   (319,443)    (466,668)
                                                                      ----------  -----------
NET INCREASE (DECREASE) IN CASH AND EQUIVALENTS                        2,713,050     (542,677)
CASH AND EQUIVALENTS, beginning of year                                2,181,284    2,723,961
                                                                      ----------  -----------
CASH AND EQUIVALENTS, end of year                                     $4,894,334   $2,181,284
                                                                      ==========   ==========
</TABLE>

         SEE ACCOMPANYING SUMMARY OF ACCOUNTING POLICIES AND NOTES TO
                             FINANCIAL STATEMENTS.





<PAGE>   8



                            H & L TOOL COMPANY, INC.
                         SUMMARY OF ACCOUNTING POLICIES



NATURE OF           H & L Tool Company, Inc. (the Company) manufactures screw
OPERATIONS          machine and coldheader parts for the automotive industry.

USE OF ESTIMATES    In preparing financial statements in conformity with
                    generally accepted accounting principles, management is
                    required to make estimates and assumptions that affect (1)
                    the reported amounts of assets and liabilities and the
                    disclosure of contingent assets and liabilities as of the
                    date of the financial statements, and (2) revenues and
                    expenses during the reporting period.  Actual results could
                    differ from these estimates.

CONCENTRATIONS OF   Financial instruments which potentially subject the Company
CREDIT RISK         to concentrations of credit risk consist principally of
                    cash, cash equivalents and accounts receivable.  At times,
                    such cash and equivalents in banks are in excess of the
                    respective financial institution's FDIC insurance limit.
                    With respect to accounts receivable, the Company attempts
                    to minimize credit risk by monitoring customers' credit
                    exposure on a continuing basis.  The Company establishes an
                    allowance for possible losses on accounts receivable based
                    upon factors surrounding the credit risk of specific
                    customers, historical trends and other information.  Also
                    see Note 6.

FAIR VALUE OF       The carrying amounts of cash and equivalents, accounts
FINANCIAL           receivable, accounts payable and accrued expenses
INSTRUMENTS         approximate fair value because of the short maturity of
                    these items.

CASH EQUIVALENTS    Cash equivalents consist of certificates of deposit with
                    original maturities of three months or less.

MARKETABLE          Marketable securities, consisting of U.S. treasury bills,
SECURITIES          are classified as "available-for-sale" and therefore are
                    stated at market value (which equals cost) in accordance
                    with Statement of Financial Accounting Standards (SFAS) No.
                    115 "Accounting for Certain Investments in Debt and Equity
                    Securities." Marketable securities all mature within one
                    year of the respective balance sheet dates.

INVENTORIES         Inventories are valued at the lower-of-cost or market.  Cost
                    is determined by the dollar value last-in, first-out (LIFO)
                    method.


<PAGE>   9




                            H & L TOOL COMPANY, INC.
                         SUMMARY OF ACCOUNTING POLICIES




PROPERTY,            Property and equipment are stated at cost. 
EQUIPMENT AND        Depreciation is computed over the estimated useful
DEPRECIATION         lives of the assets ranging from 3 to 30 years using
                     both straight-line and  accelerated methods.
        
REVENUE RECOGNITION  The Company recognizes product sales at the time of 
                     shipment.

RECENT ACCOUNTING    The Financial Accounting Standards Board has issued
PRONOUNCEMENTS       SFAS No. 121, "Accounting for the Impairment of
                     Long-Lived Assets and Long-Lived Assets Being Disposed
                     Of," which provides guidance on how and when impairment
                     losses are recognized on long-lived assets.  This
                     statement will be adopted November 1, 1996 and
                     will not have a material impact on the Company.
                     


<PAGE>   10




                            H & L TOOL COMPANY, INC.
                         NOTES TO FINANCIAL STATEMENTS


1. SALE OF ASSETS   The Company has entered into a purchase and sale
                    agreement to sell substantially all of its operating
                    assets for approximately $19,000,000 in cash and the 
                    assumption of certain liabilities. The purchase price is
                    subject to a credit of $4,800,000 in consideration of cash
                    and equivalents which are being retained by H & L Tool
                    Company, Inc. The sale is expected to be finalized in
                    December 1996.

2. INVENTORIES      Inventories consisted of the following:


<TABLE>
<CAPTION>


                                                           September 30,  October 31,
                                                                    1996         1995
                                            
                      <S>                                  <C>            <C>
                                            
                      Raw material                          $1,053,777   $1,342,954
                      Work-in-process                          757,261      900,476
                      Finished goods                           368,750      385,918
                      LIFO reserve                          (1,000,251)  (1,104,302)
                                                           -----------  -----------
                                                           $ 1,179,537  $ 1,525,046
                                                           ===========  =========== 
                                            
</TABLE>

                    If the first-in, first-out method of inventory  valuation
                    had been used by the Company, inventories would have been
                    approximately $1,000,000 and $1,104,000 higher than
                    reported at September 30, 1996 and October 31, 1995,
                    respectively.

                    During the eleven months ended September 30, 1996 and the
                    year ended October 31, 1995, inventory quantities were
                    reduced.  This resulted in liquidations of LIFO inventory
                    carried at costs lower than replacement value.  The effect
                    of this reduction was to increase net income by 
                    approximately $151,000 in 1996 and $51,000 in 1995.

3. LONG-TERM DEBT   Long-term debt at October 31, 1995, consisted of a note
                    payable to a bank, payable monthly in installments of 
                    $13,889, plus interest at 8.5% per annum.  This note was
                    collateralized by specific equipment.  The Company repaid
                    this obligation during the eleven months ended 
                    September 30, 1996.






<PAGE>   11




                           H & L TOOL COMPANY, INC.
                         NOTES TO FINANCIAL STATEMENTS


4. EMPLOYEE         The Company has a profit-sharing plan for the benefit of 
   BENEFIT PLANS    all eligible employees. The Company's contribution to the
                    plan, as determined by its board of directors, is
                    discretionary but may not exceed 15% of the annual aggregate
                    compensation, as defined, paid to all participating
                    employees. Provision for profit-sharing expense for the
                    eleven months ended September 30, 1996 and fiscal year ended
                    October 31, 1995 was $407,241 and $476,399, respectively.

5. OPERATING LEASE  The Company leases a warehouse facility from its
                    stockholders. The lease, which will be terminated when the
                    sale of assets is finalized (Note 1), requires monthly
                    rental payments of $8,400. The lease also requires that the
                    Company be responsible for insurance, property taxes, and
                    repairs and maintenance on the warehouse. Rent expense
                    amounted to $92,400 for the eleven months ended September
                    30, 1996 and $100,800 for the fiscal year ended October 31,
                    1995.

6. MAJOR            Sales to three major customers amounted to approximately 
   CUSTOMERS        75% of total sales for the eleven months ended 
                    September 30, 1996 and fiscal year ended October 31, 1995.

7. ABSENCE OF A     The absence of a provision for taxes on income is due to
   PROVISION FOR    an election made by the Company, with consent of its
   TAXES ON         stockholders, to include the stockholders' respective shares
   INCOME           of the Company's taxable income in their individual
                    tax returns. As a result, no federal tax is imposed on
                    the Company. The Company pays bonuses in October to its
                    affected stockholders to cover their estimated tax
                    liabilities on their respective shares of
                    taxable income. Bonus expense was $1,805,000 and $1,441,000
                    for the eleven months ended September 30, 1996 and year
                    ended October 31, 1995, respectively. 

8. SUPPLEMENTAL     Cash paid for interest for the eleven months ended
   CASH FLOW        September 30, 1996 and fiscal year ended October 31, 1995
   INFORMATION      was $10,790 and $45,638, respectively.
                    









<PAGE>   12


                        PRO FORMA CONDENSED CONSOLIDATED
                        FINANCIAL STATEMENTS (UNAUDITED)


The following unaudited pro forma financial statements give effect to the
acquisition of certain assets and liabilities of H & L Tool Company, Inc.
(H & L) by Chicago Rivet & Machine Co. (the Company) in a transaction
accounted for as a purchase.  The pro forma financial data are based upon the
historical financial statements of H & L  and the Company and the assumptions
and adjustments described in the notes to the financial data.  The pro forma
financial data reflect the preliminary allocation of purchase price.  The final
allocation of purchase price and the resulting depreciation expense will differ
from the preliminary allocation since it will reflect the actual closing date
asset and liability amounts, as well as any other purchase price adjustments
pursuant to the asset purchase agreement.
        
The following unaudited pro forma balance sheet as of September 30, 1996 was
prepared as if the acquisition had occurred on that date.  The unaudited pro
forma statements of income were prepared as if the acquisition had occurred at
the beginning of the Company's year ended December 31, 1995, using fiscal year
ended October 31, 1995 data for H & L and as if the acquisition had occurred at
the beginning of the Company's nine month period ended September 30, 1996,
using H & L data for the nine month period ended July 31, 1996.

These unaudited pro forma financial statements should be read in conjunction
with the  historical financial statements and notes thereto of Chicago Rivet &
Machine Co. filed with the Company's Form 10-Q for the quarter ended September
30, 1996 and with the Company's Annual Report on From 10-K for the year ended
December 31, 1995, as well as with the audited historical financial statements
and notes thereto of H & L Tool Company, Inc. appearing elsewhere in this
Form 8-K.

The unaudited pro forma financial statements do not necessarily reflect the
operations of Chicago Rivet & Machine Co. and H & L Tool Company, Inc. as they
would have been had the two entities existed as one for the periods shown and
the operating results should not be deemed to be indicative of the future
operations of the combined entity.  The pro forma adjustments are based upon
available information and certain assumptions that management believes are
reasonable.








<PAGE>   13




                          CHICAGO RIVET & MACHINE CO.
                PRO FORMA CONDENSED CONSOLIDATED BALANCE SHEET
                        SEPTEMBER 30, 1996 (UNAUDITED)

<TABLE>
<CAPTION>
                                                               Historical
                                        ----------------------------------------                            Company
                                        Chicago Rivet  H & L Tool     Combined     Adjustments             Pro Forma
                                        -------------  ----------    -----------   ------------           -----------
<S>                                      <C>          <C>           <C>            <C>                   <C>
Current Assets:
      Cash                               $ 6,950,761   $ 4,894,334   $11,845,095   $(10,150,084) (1)      $ 1,695,011
      Marketable securities                1,662,319     1,942,556     3,604,875     (1,942,556) (1)        1,662,319
      Accounts receivable (net of
       allowances)                         2,681,328     3,179,957     5,861,285           ---              5,861,285              
      Inventories                          3,497,701     1,179,537     4,677,238      1,240,038  (2)        5,917,276
      Prepaid expenses and other assets      605,413       383,192       988,605       (297,684) (3)          690,921
                                         -----------   -----------   -----------   ------------           -----------
      Total Current Assets                15,397,522    11,579,576    26,977,098    (11,150,286)           15,826,812
                                         -----------   -----------   -----------   ------------           -----------

Property, plant and equipment, net         4,971,807     2,016,694     6,988,501      7,423,967  (4)       14,412,468
Goodwill, net of amortization                 14,597         ---          14,597          ---                  14,597
Other assets                                 722,951       512,093     1,235,044       (512,093) (5)          722,951
                                         -----------   -----------   -----------   ------------           -----------
Total assets                             $21,106,877   $14,108,363   $35,215,240   $ (4,238,412)          $30,976,828
                                         ===========   ===========   ===========   ============           ===========
Current Liabilities:
      Accounts payable                   $   792,170   $   684,451   $ 1,476,621   $      ---             $ 1,476,621
      Accrued expense                      2,113,401     2,730,914     4,844,315     (2,545,414) (6)        2,298,901
                                         -----------   -----------   -----------   ------------           -----------
      Total Current Liabilities            2,905,571     3,415,365     6,320,936     (2,545,414)            3,775,522
                                         -----------   -----------   -----------   ------------           -----------

Deferred Income Taxes                      1,031,190         ---       1,031,190         --                 1,031,190

Note Payable                                  ---            ---           ---        9,000,000  (7)        9,000,000

Shareholders' Equity
     Common stock                          1,171,496        30,000     1,201,496        (30,000) (8)        1,171,496
     Additional paid-in-capital              460,252        35,000       495,252        (35,000) (8)          460,252
     Retained earnings                    15,538,368    10,627,998    26,166,366    (10,627,998)           15,538,368
                                         -----------   -----------   -----------   ------------           -----------
     Total Shareholders' Equity           17,170,116    10,692,998    27,863,114    (10,692,998)           17,170,116
                                         -----------   -----------   -----------   ------------           -----------

     Total Liabilities and       
      Shareholders' Equity               $21,106,877   $14,108,363   $35,215,240   $ (4,238,412)          $30,976,828
                                         ===========   ===========   ===========   ============           ===========

</TABLE>




                            See accompanying notes

<PAGE>   14


                          CHICAGO RIVET & MACHINE CO.
           NOTES TO PRO FORMA CONDENSED CONSOLIDATED BALANCE SHEET
                        SEPTEMBER 30, 1996 (UNAUDITED)


The  unaudited Pro Forma Balance Sheet gives effect to the following pro forma
adjustments:

    (1)  Represents the estimated drawdown of cash required as a source
         of funds to finance a portion of the acquisition ($5,255,750) and an
         adjustment for H & L cash retained by seller ($4,894,334) and an
         adjustment for marketable securities retained by seller ($1,942,556).

    (2)  Represents the estimated write up to fair market value of
         acquired inventories due to the reversal of H & L's LIFO reserve
         ($1,000,251) less an adjustment for obsolescence reserve ($140,000)
         and an additional write up arising from the application of APB
         Statement No. 16, which management expects will be realized prior
         to the end of the first quarter of 1997 ($379,787).

    (3)  Reflects an adjustment for assets not acquired.

    (4)  Reflects the estimated adjustment to record the acquired
         property, plant and equipment at its fair  value in accordance with
         APB No. 16.

    (5)  Represents an adjustment for assets not acquired.

    (6)  Represents an adjustment for liabilities not assumed.

    (7)  Represents the incremental borrowings necessary as a source of
         funds to finance a portion of the acquisition. The borrowings are
         pursuant to an unsecured  term loan with principal and interest to be
         paid quarterly over five years at a variable rate of interest that is
         adjusted subject to changes in the reference rate specified in the
         loan agreement.  The current interest rate associated with this
         borrowing is 6.30%.

    (8)  Represents the elimination of the historical equity and net
         assets of H & L in connection with purchase accounting.


<PAGE>   15


                         CHICAGO RIVET & MACHINE CO.
            PRO FORMA CONDENSED CONSOLIDATED STATEMENT OF INCOME
           FOR THE NINE MONTHS ENDED SEPTEMBER 30, 1996 (UNAUDITED)



<TABLE>
<CAPTION>
                                             Historical         Adjustments       Company
                                      ------------------------  ------------     Pro Forma
                                        Chicago       H & L                      ---------
                                         Rivet        Tool
                                      ---------       ----
<S>                                <C>             <C>           <C>          <C>
Net sales and lease revenue           $16,293,372  $15,826,245     $  ---      $32,119,617
Cost of goods sold                     11,071,626   12,002,384     48,536 (1)   23,122,546 
                                      -----------  -----------   --------      -----------
Gross profit                            5,221,746    3,823,861    (48,536)       8,997,071

Shipping, selling and administrative    3,673,185    3,400,443   (901,503)(2)    6,172,125
                                      -----------  -----------   --------      -----------

Income from operations                  1,548,561      423,418    852,967        2,824,946
                                      -----------  -----------   --------      -----------

Other income                              337,068      161,416   (407,214)(3)       91,270
Interest expense                            ----        (6,531)  (425,250)(4)     (431,781)
                                      -----------  -----------   --------      -----------

Total other income and expense            337,068      154,885   (832,464)        (340,511)
                                      -----------  -----------   --------      -----------

Income before income taxes              1,885,629      578,303     20,503        2,484,435

Provision for income taxes                720,000          ---    234,000          954,000
                                      -----------  -----------   --------      -----------

Net income                             $1,165,629     $578,303  $(213,497)     $ 1,530,435
                                      ===========  ===========  =========      ===========
Average shares outstanding                585,748                                  585,748
                                      ===========                              ===========

Net income per share                  $      1.99                              $      2.61
                                      ===========                              ===========
</TABLE>

                            See accompanying notes
                                       

<PAGE>   16



                          CHICAGO RIVET & MACHINE CO.
        NOTES TO PRO FORMA CONDENSED CONSOLIDATED STATEMENT OF INCOME
           FOR THE NINE MONTHS ENDED SEPTEMBER 30, 1996 (UNAUDITED)


The unaudited Pro Forma Consolidated Statement of Income gives effect to the
following unaudited pro forma adjustments:

    (1)  Includes an adjustment of $123,545 to cost of sales to reflect
         the removal of  H & L's favorable LIFO impact since the Company
         records inventory on a FIFO basis; elimination of $92,400 in rental
         expense associated with warehouse facilities that were rented by H &
         L Tool, but have been purchased by Chicago Rivet; additional
         depreciation expense of $17,391,  assumed to be allocated entirely to
         cost of sales, resulting from write-up of property, plant and
         equipment to fair value in accordance with APB No. 16.

    (2)  H & L Tool, with the consent of its stockholders, made an election to
         include the stockholders' respective shares of H & L's taxable income
         in their individual tax returns.  Accordingly, no federal tax is
         recorded on the books of H & L.  However, H & L paid bonuses to its
         affected stockholders to cover the estimated tax liabilities on 
         their respective shares of taxable income.  In addition, the
         stockholders who were also employees of H & L were paid additional
         amounts for services rendered in connection with general management,
         sales development and sales management.  This adjustment gives effect
         to the estimated saving from the elimination of all amounts previously
         paid to the stockholders ($2,067,200), the additional expenses
         associated with the addition of staff to perform certain services
         previously rendered by the former stockholders and estimated
         incremental sales and marketing expenses ($1,241,700) and a reduction
         in expenses associated with assets not purchased by Chicago Rivet
         ($76,003).

    (3)  Reflects the elimination of interest income of $213,277
         reported by H & L on investments in marketable securities and an
         estimated reduction of $193,937 in interest income earned by Chicago
         Rivet, due to the use of cash to finance the acquisition.  The
         reduction in interest income assumes that the Company would have
         earned approximately 4.9%, (which was the average rate of return
         earned by the Company on investments in marketable securities during
         1996) on $5,255,750 of cash that was used as a portion of the funding
         for the acquisition.

    (4)  Reflects additional interest expense pursuant to a term loan
         agreement between the Company and Bank of America, NA.  The agreement
         provides for 20 quarterly payments of principal plus interest at a
         variable rate equal to a reference rate plus 80 basis points. The
         adjustment of $425,250 is based upon the current rate of 6.30% on the
         full amount of borrowing.


    (5)  Reflects tax provision, for H & L's pro forma income, before tax,
         at a rate of 39%, which is approximately equal to the combined
         statutory federal rate plus an estimate of state income taxes net of
         federal benefit.


<PAGE>   17




                          CHICAGO RIVET & MACHINE CO.
             PRO FORMA CONDENSED CONSOLIDATED STATEMENT OF INCOME
               FOR THE YEAR ENDED DECEMBER 31, 1995 (UNAUDITED)


<TABLE>
<CAPTION>
                                                 Historical                   Adjustments         
                                            ------------------------          -----------         Company
                                            Chicago            H & L                             Pro Forma
                                             Rivet              Tool                             ---------
                                             -----              ----
<S>                                <C>                  <C>               <C>             <C>
Net sales and lease revenue             $23,717,410          $22,285,744      $    ---        $ 46,003,154
Cost of goods sold                       15,036,303           16,298,541        (44,575)(1)     31,290,269 
                                        -----------          -----------      ---------       ------------
Gross profit                              8,681,107            5,987,203         44,575         14,712,885

Shipping, selling and administrative      5,347,049            4,232,330       (784,900)(2)      8,794,479
                                        -----------          -----------      ---------       ------------

Income from operations                    3,334,058            1,754,873        829,475          5,918,406

Other income                                311,157              249,729       (475,915)(3)        84,971
Interest expense                             ----                (39,431)      (567,000)(4)       (606,431)
                                        -----------          -----------      ---------       ------------
Total other income and expense              311,157              210,298     (1,042,915)          (521,460)
                                        -----------          -----------      ---------       ------------

Income before income taxes                3,645,215            1,965,171       (213,440)         5,396,946
Provision for income taxes                1,410,000                 ---         683,000 (5)      2,093,000
                                        -----------          -----------     ----------       ------------

Net income                              $ 2,235,215          $ 1,965,171     $ (896,440)      $ 3,303,946
                                        ===========          ===========     ==========       ===========

Average shares outstanding                  585,748                                                585,748 
                                            =======                                                =======

Net income per share                    $      3.81                                            $      5.64 
                                        ===========                                            ===========
</TABLE>

                            See accompanying notes



<PAGE>   18




                          CHICAGO RIVET & MACHINE CO.
        NOTES TO PRO FORMA CONDENSED CONSOLIDATED STATEMENT OF INCOME
               FOR THE YEAR ENDED DECEMBER 31, 1995 (UNAUDITED)


The unaudited Pro Forma Consolidated Statement of Income gives effect to the
following unaudited pro forma adjustments:

     (1)  Includes elimination of $100,800 in rental expense associated with
          warehouse facilities that were rented by H & L Tool, but have been
          purchased by Chicago Rivet; a $51,000 adjustment to cost of sales to
          reflect the removal of H & L's favorable LIFO impact, since the
          Company records inventory on a FIFO basis; additional depreciation
          expense of $5,225, assumed to be allocated entirely to cost of sales,
          resulting from the write-up of property, plant and equipment to fair 
          value in accordance with APB No. 16.
        

     (2)  H & L Tool, with the consent of its stockholders, made an election to
          include the stockholders' respective shares of H & L's taxable income
          in their individual tax returns.  Accordingly, no federal tax is
          recorded on the books of H & L.  However, H & L paid bonuses to its
          affected stockholders to cover the estimated tax liabilities on their
          respective shares of taxable income.  In addition, the stockholders
          who were also employees of H & L were paid additional amounts for
          services rendered in connection with general management, sales
          development and sales management.  This adjustment gives effect to the
          estimated saving from the elimination of all amounts previously paid
          to the stockholders ($2,354,900), the additional expenses associated
          with the addition of staff to perform certain services previously
          rendered by the former stockholders and estimated incremental sales
          and marketing expenses ($1,669,000) and a reduction in expenses
          associated with assets not purchased by Chicago Rivet ($99,000).
        
     (3)  Reflects the elimination of interest income of $228,369 reported
          by H & L on investments in marketable securities and an estimated
          reduction of $247,546 in interest income earned by Chicago Rivet, due
          to the use of cash to finance the acquisition.  The reduction in
          interest income assumes that the Company would have earned
          approximately 4.7%, (which was the average rate of return earned by
          the Company on investments in marketable securities during 1995) on
          $5,255,750 of cash that was used as a portion of the funding for the
          acquisition.

     (4)  Reflects additional interest expense pursuant to a term loan
          agreement between the Company and Bank of America, NA.  The agreement
          provides for 20 quarterly payments of principal plus interest at a
          variable rate equal to a reference rate plus 80 basis points. The
          adjustment of $567,000 is based upon the current rate of 6.30% on the
          full amount of borrowing.





<PAGE>   19



     (5)  Reflects tax provision, for H & L's pro forma income, before tax,
          at a rate of 39%, which is approximately equal to the combined
          statutory federal rate plus an estimate of state income taxes net of
          federal benefit.






<PAGE>   20

                                   SIGNATURE


   Pursuant to the requirements of the Securities Exchange Act of 1934, the
registrant has duly caused this report to be signed on its behalf by the
undersigned hereunto duly authorized.


                                         CHICAGO RIVET & MACHINE CO.


                                         By: /s/ John C. Osterman
                                            ---------------------------- 
                                            Name:John C. Osterman
                                            Title: President, Chief
                                                   Operating Officer and
                                                   Treasurer


Dated:   February 14, 1997







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