UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA In re ) ) ) ) ) ) Debtor(s). ) _____ ______) MONTH ENDING Case No. MONTHLY REPORT OF OPERATIONS (Local Rule No. 2015-1) , 20 Debtor-in-possession hereby submits its Monthly Report on the Accrual Basis of accounting. ACCRUAL BASIS Attached hereto are the following schedules: A. Cash Receipts and Cash Disbursements I. Federal and State Taxes J. Monthly Operating Statement Questionnaire K. Other Appropriate Schedules Balance Sheet Income Statement Schedules of Account Receivable/Post-Petition Debt Note: The Balance Sheet, Income Statement and Schedules I and J MUST be filed. Schedule A MUST be filed. A Statement of Cash Flows may be substituted for Schedule A. Schedule K as appropriate EDC 3-462 (Accrual) (Rev. 9/07) 1 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE A CASH RECEIPTS AND DISBURSEMENTS RECEIPTS Cash Sales $ Rents Collected Accounts Receivable collected Other Receipts (describe): TOTAL RECEIPTS $ DISBURSEMENTS Payments to vendors for merchandise $ Net payroll paid Payroll taxes paid/deposited to tax account: Employee withholdings Employer portion Sales taxes paid/deposited to tax account Other Disbursements (describe): a. b. c. d. f. g. h. I. j. k. Miscellaneous (attach listing) Living allowance or draw 2. TOTAL DISBURSEMENTS $ 3. Receipts OVER or (UNDER) Disbursements$ EDC 3-462 (Rev. 9/07) 2 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE B SUMMARY OF CASH TRANSACTIONS SINCE FILING PETITION 4. Total receipts to date (prior month Schedule B line 4 plus current month Schedule A line 1) $ 5. Total disbursements to date (prior month Schedule B line 5 plus current month Schedule A line 2) 6. Net receipts OVER (UNDER) disbursements $ SCHEDULE C BALANCE IN DEBTOR-IN-POSSESSION ACCOUNT Balance at end of last month $ Net transactions for this month (Line 3 - Schedule A) Balance at end of this month $ SCHEDULE D BALANCE IN TAX ACCOUNT Balance at end of last month $ Add deposits from general account Subtotal Deduct payments to taxing agencies Balance at end of this month $ SCHEDULE E BALANCE IN _______________ ACCOUNT Balance at end of last month $ Add deposits from general account Subtotal Deduct disbursements Balance at end of this month $ EDC 3-462 (Rev. 9/07) 3 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE F POST PETITION DEBTS Balance at end of last month $ Add debts incurred this month Subtotal Deduct payments made this month on this balance Subtotal Adjustments (Explain on separate sheet) Balance at end of this month (Attach listing) $ SCHEDULE G ACCOUNTS RECEIVABLE BALANCE Balance of receivables at end of last month $ Add new receivables for this month Subtotal Deduct accounts collected (from Schedule A) Subtotal Adjustments (Explain on separate sheet) Balance at end of this month $ SCHEDULE H INVENTORY AND COST OF GOODS SOLD Inventory balance at end of last month $ Add merchandise purchases Total inventory available Adjustments (Explain on separate sheet) Less inventory balance at end of month Total cost of goods sold $ EDC 3-462 (Rev. 9/07) 4 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE I FEDERAL AND STATE TAXES 1. Tax balance at end of last month $ PAYROLL TAX LIABILITY THIS MONTH: Period: ( ) Weekly ( ) Biweekly ( ) Semimonthly ( ) Monthly Federal Employer ID # EDD ID # Withholdings: Federal Income Tax $ FICA Withheld State Income Tax State Disability Employer tax liability: FICA Federal unemployment State unemployment 2. Total payroll taxes due SALES AND OTHER TAX LIABILITY THIS MONTH: SBE ID # Sales tax liability Other (excise, city, business, etc.) 3. $ Total sales and other taxes due SUMMARY OF TAX PAYMENTS MADE THIS MONTH: Payee Date Bank acct. # Ck. # $ 4. Total tax payments made 5. Tax balance at end of this month (add lines 1-3 less line 4) $ EDC 3-462 (Rev. 9/07) 5 American LegalNet, Inc. www.FormsWorkflow.com SCHEDULE J MONTHLY OPERATING STATEMENT QUESTIONNAIRE YES 1. Listing of unpaid postpetition debts (include unpaid professional fees & interest owed) 3. Have any payments been made to secured creditors or lessors? (If yes, attach listing of payments made) 4. (a) N/A Copies of checkbooks or receipts and disbursements listing attached: Debtor-in-possession account Tax account Other account 2. NO Have any payments been made to officers, shareholders, insiders, relatives or professionals? (If yes, attach listing of payments made) Were these payments approved by the court? (b) 5. (a) (b) Have any payments been made on prepetition debts? (If yes - attach listing of payments made) Were these payments approved by the court? 6. Do you carry insurance coverage of any kind? (attach copies of declaration pages) NOTE: If you have previously submitted copies of declaration pages & there have been no changes in coverage, initial here: (no copies needed) 7. Have U.S. Trustee quarterly fees been paid (If yes - attach listing of payments made) (If no - attach explanation) DECLARATION OF DEBTOR I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. EXECUTED ON (Date) (Signature) DEBTOR-IN-POSSESSION I have reviewed the Monthly Report of Operations and, after making reasonable inquiry, believe that the information is true and correct. (Signature of Preparer) (Attorney or Accountant) (Date) EDC 3-462 (Rev. 9/07) 6 American LegalNet, Inc. www.FormsWorkflow.com MONTHLY OPERATING REPORT INSTRUCTION SHEET 1. Cover Sheet a. b. 2. Enter the case name, case number, month of report on the appropriate cover sheet (cash basis or accrual basis). Place a check mark in each box for which a schedule is filed. Schedule A a. b. 3. Complete this schedule for all receipts and cash disbursements for the month. If additional lines are needed for listing receipts or disbursements attach additional pages. Schedule B a. b. Total receipts = this line from last month + Schedule A, total receipts. c. 4. This schedule must reflect all receipts and disbursements since filing the petition (cumulative). Total disbursements = this line from last month + Schedule A, total disbursements. Schedule C This schedule must reflect the balance in the debtor-in-possession account (or general account). This balance must equal the balance on Schedule B, Line 6, plus any beginning bank balance at the time the bankruptcy was filed. 5. Schedule D This schedule must reflect the balance in the tax account, if you are required to have one. 6. Schedule E This schedule must reflect the balance in any other account you maintain. The number of cash accounts held should be kept to a minimum, mainly the debtor-in-possession account and tax and/or cash collateral accounts, if required. Any account required by court order should also be included. 7. Schedule F This schedule must reflect all debts incurred and not paid since the date of filing the petition. Do not include any debts owed prior to filing the petition. 8. Schedule I a. This schedule must reflect all transactions occurring for the month for payroll and sales taxes. b. The first section of the form lists amounts owed for both employee payroll tax withholdings and the employer's portion for payroll taxes. EDC 3-462 (Rev. 9/07) 7 American LegalNet, Inc. www.FormsWorkflow.com c. d. The third section of the form lists all payments made during the month for both payroll and sales taxes. e. 9. The second section of the form lists all amounts owed for sales and other business taxes. To compute the tax balance at the end of the month, add the balance from last month (line 1) plus payroll taxes due (line 2) plus sales taxes due (line 3) and subtract all payments made (line 4). Schedule J a. This schedule is a checklist of items that must be included with the basic monthly report of operations. b. Copies of checkbooks (or cash receipts & disbursements listings) must be attached for all bank accounts. All copies attached should be legible. c. A listing of unpaid post petition debts must be attached, if applicable. The listing must be in the following form and the total of the listing must agree with the ending balance for Schedule F. Date Incurred d. Vendor Description Amount If payments have been made to secured creditors or lessors during the month, attach a listing which includes the following information: Payee name/address Payment amount Payment period (weekly, month, annual) Date of last payment e. If post petition payments to secured creditors are in arrears, list the number of payment missed and the total amount in arrears. f. If payments have been made to officers, insiders, shareholders, relatives or professionals during the month, attach a listing which includes the following information: Payee name Date of payment Payment amount Basis of payment (reason) g. If payments have been made on prepetition debts during the month, attach a listing which includes the following information: Payee name Date of payment Payment amount Basis of payment (reason) h. If the U.S. Trustee quarterly fees were paid during the month of this report, include a listing of the date, amount and method of payment. EDC 3-462 (Rev. 9/07) 8 American LegalNet, Inc. www.FormsWorkflow.com