UNITED STATES DEPARTMENT OF JUSTICE OFFICE OF THE UNITED STATES TRUSTEE CENTRAL DISTRICT OF CALIFORNIA In Re: CHAPTER 11 (BUSINESS) Case Number: Operating Report Number: For the Month Ending: Debtor(s). I. CASH RECEIPTS AND DISBURSEMENTS A. (GENERAL ACCOUNT*) 1. TOTAL RECEIPTS PER ALL PRIOR GENERAL ACCOUNT REPORTS 2. LESS: TOTAL DISBURSEMENTS PER ALL PRIOR GENERAL ACCOUNT REPORTS 3. BEGINNING BALANCE: 4. RECEIPTS DURING CURRENT PERIOD: Accounts Receivable - Post-filing Accounts Receivable - Pre-filing General Sales Other (Specifiy) **Other (Specifiy) TOTAL RECEIPTS THIS PERIOD: 5. BALANCE: 6. LESS: TOTAL DISBURSEMENTS DURING CURRENT PERIOD Transfers to Other DIP Accounts (from page 2) Disbursements (from page 2) TOTAL DISBURSEMENTS THIS PERIOD:*** 7. ENDING BALANCE: 8. General Account Number(s): Depository Name & Location: * All receipts must be deposited into the general account. ** Include receipts from the sale of any real or personal property out of the ordinary course of business; attach an exhibit specifying what was sold, to whom, terms, and date of Court Order or Report of Sale. ***This amount should be the same as the total from page 2. Revised October 2004 Page 1 of 16 American LegalNet, Inc. www.USCourtForms.com TOTAL DISBURSEMENTS FROM GENERAL ACCOUNT FOR CURRENT PERIOD Date mm/dd/yyyy Check Number Payee or DIP account *Amount Transfer'd **Amount Disbursed Purpose Amount TOTAL DISBURSEMENTS THIS PERIOD: * Fill in amounts in this column if they are TRANSFERS to another DIP account (e.g. Payroll or Tax); the "amount" column will be filled in for you. ** Fill in amounts in this column if they are DISBURSEMENTS to outside payees; the "amount" column will be filled in for you. Page 2 of 16 American LegalNet, Inc. www.USCourtForms.com GENERAL ACCOUNT BANK RECONCILIATION Bank statement Date: Plus deposits in transit (a): Deposit Date Deposit Amount Balance on Statement: TOTAL DEPOSITS IN TRANSIT Less Outstanding Checks (a): Check Number Check Date Check Amount TOTAL OUTSTANDING CHECKS: Bank statement Adustments: Explanation of Adjustments- ADJUSTED BANK BALANCE: * It is acceptable to replace this form with a similar form ** Please attach a detailed explanation of any bank statement adjustment Page 3 of 16 American LegalNet, Inc. www.USCourtForms.com I. CASH RECEIPTS AND DISBURSEMENTS B. (PAYROLL ACCOUNT) 1. TOTAL RECEIPTS PER ALL PRIOR PAYROLL ACCOUNT REPORTS 2. LESS: TOTAL DISBURSEMENTS PER ALL PRIOR PAYROLL ACCOUNT REPORTS 3. BEGINNING BALANCE: 4. RECEIPTS DURING CURRENT PERIOD: (Transferred from General Account) 5. BALANCE: 6. LESS: TOTAL DISBURSEMENTS DURING CURRENT PERIOD TOTAL DISBURSEMENTS THIS PERIOD:*** 7. ENDING BALANCE: 8. PAYROLL Account Number(s): Depository Name & Location: Page 4 of 16 American LegalNet, Inc. www.USCourtForms.com TOTAL DISBURSEMENTS FROM PAYROLL ACCOUNT FOR CURRENT PERIOD Date Check mm/dd/yyyy Number Payee Purpose Amount TOTAL DISBURSEMENTS THIS PERIOD: Page 5 of 16 American LegalNet, Inc. www.USCourtForms.com PAYROLL ACCOUNT BANK RECONCILIATION Bank statement Date: Plus deposits in transit (a): Deposit Date Deposit Amount Balance on Statement: TOTAL DEPOSITS IN TRANSIT Less Outstanding Checks (a): Check Number Check Date Check Amount TOTAL OUTSTANDING CHECKS: Bank statement Adustments: Explanation of Adjustments- ADJUSTED BANK BALANCE: * It is acceptable to replace this form with a similar form ** Please attach a detailed explanation of any bank statement adjustment Page 6 of 16 American LegalNet, Inc. www.USCourtForms.com I. CASH RECEIPTS AND DISBURSEMENTS C. (TAX ACCOUNT) 1. TOTAL RECEIPTS PER ALL PRIOR TAX ACCOUNT REPORTS 2. LESS: TOTAL DISBURSEMENTS PER ALL PRIOR TAX ACCOUNT REPORTS 3. BEGINNING BALANCE: 4. RECEIPTS DURING CURRENT PERIOD: (Transferred from General Account) 5. BALANCE: 6. LESS: TOTAL DISBURSEMENTS DURING CURRENT PERIOD TOTAL DISBURSEMENTS THIS PERIOD:*** 7. ENDING BALANCE: 8. TAX Account Number(s): Depository Name & Location: Page 7 of 16 American LegalNet, Inc. www.USCourtForms.com TOTAL DISBURSEMENTS FROM TAX ACCOUNT FOR CURRENT PERIOD Date Check mm/dd/yyyy Number Payee Purpose Amount TOTAL DISBURSEMENTS THIS PERIOD: Page 8 of 16 American LegalNet, Inc. www.USCourtForms.com TAX ACCOUNT BANK RECONCILIATION Bank statement Date: Plus deposits in transit (a): Deposit Date Deposit Amount Balance on Statement: TOTAL DEPOSITS IN TRANSIT Less Outstanding Checks (a): Check Number Check Date Check Amount TOTAL OUTSTANDING CHECKS: Bank statement Adustments: Explanation of Adjustments- ADJUSTED BANK BALANCE: * It is acceptable to replace this form with a similar form ** Please attach a detailed explanation of any bank statement adjustment Page 9 of 16 American LegalNet, Inc. www.USCourtForms.com I.D SUMMARY SCHEDULE OF CASH ENDING BALANCES FOR THE PERIOD: (Provide a copy of of montly account statements for each of the below) General Account: Payroll Account: Tax Account: *Other Accounts: *Other Monies: **Petty Cash (from below): TOTAL CASH AVAILABLE: Petty Cash Transactions: Date Purpose Amount TOTAL PETTY CASH TRANSACTIONS: * Specify the Type of holding (e.g. CD, Savings Account, Investment Security), and the depository name, location & account# ** Attach Exhibit Itemizing all petty cash transactions Page 10 of 16 American LegalNet, Inc. www.USCourtForms.com II. STATUS OF PAYMENTS TO SECURED CREDITORS, LESSORS AND OTHER PARTIES TO EXECUTORY CONTRACTS Post-Petition Frequency of Payments payments not made (Mo/Qtr) Amount of Payment (Number) Creditor, Lessor, Etc. Total Due TOTAL DUE: III. TAX LIABILITIES FOR THE REPORTING PERIOD: Gross Sales Subject to Sales Tax: Total Wages Paid: Total Post-Petition Amounts Owing Amount Delinquent Federal Withholding State Withholding FICA- Employer's Share FICA- Employee's Share Federal Unemployment Sales and Use Real Property Other: TOTAL: Page 11 of 16 American LegalNet, Inc. www.USCourtForms.com Date Delinquent Amount Due IV. AGING OF ACCOUNTS PAYABLE AND RECEIVABLE *Accounts Payable Post-Petition 30 days or less 31 - 60 days 61 - 90 days 91 - 120 days Over 120 days TOTAL: V. INSURANCE COVERAGE Amount of Coverage Policy Expiration Date Premium Paid Through (Date) Accounts Receivable Pre-Petition Post-Petition Name of Carrier General Liability Worker's Compensation Casualty Vehicle Others: VI. UNITED STATES TRUSTEE QUARTERLY FEES (TOTAL PAYMENTS) Quarterly Period Ending (Date) Total Disbursements Quarterly Fees Still Owing Quarterly Fees Date Paid Amount Paid * Post-Petition Accounts