1/06 U.S. Department of Justice Office of the United States Trustee ______________________________________________________________________________________________________ INSTRUCTIONS FOR PREPARATION OF DEBTOR'S CHAPTER 11 MONTHLY OPERATING REPORT INDIVIDUAL AND INDIVIDUAL WITH A SOLE-PROPRIETORSHIP Debtors-in-Possession and Trustees must file with the Bankruptcy Court, and serve on the United States Trustee, financial reports reflecting the activities of debtor(s) each month. While Local Rules or practice may vary regarding the filing of monthly operating reports, to the extent permissible, the required reports with attachments should be filed with the Bankruptcy Court and a complete copy of the report and all attachments, whether or not included with the report filed with the Bankruptcy Court, must be provided to the United States Trustee. These reports are to be submitted by the 20th of the month following the reporting period. Individual debtors who are not either a) operating a business or b) managing rental property are only required to complete: (1) Summary of Cash Receipts and Cash Disbursements; (2) Schedule of Household Cash Receipts and Cash Disbursements; (3) Questionnaire/Insurance - Attachment 1; (4) Bank Account Reconciliation - Attachment 2; and (5) Cash Disbursements DetailAttachment 3A. Individual debtors operating a business, including the management of rental property, as a sole-proprietor must complete,: (1) Summary of Cash Receipts and Cash Disbursements; (2) Schedule of Household Cash Receipts and Cash Disbursements; (3) Schedule of Business Cash Receipts and Cash Disbursements; (4) Questionnaire /Insurance-Attachment 1; (5) Bank Account Reconciliation-Attachment 2; (6) Cash Disbursements Detail-Attachments 3A, 3B, and 3C; (6) Account Receivable/Tax Information - Attachment 4; and (7) Account/Note Payable Information - Attachment 5. The following additional comments are provided to assist in the preparation of the forms provided by the United States Trustee. CASH AT BEGINNING OF PERIOD. For your first report this will be the amount of cash-on-hand and cash in all bank < accounts at the time of filing (Listed on Schedule B). For subsequent reports, this should be the cash balance from the prior month's report. < SUMMARY OF CASH RECEIPTS AND CASH DISBURSEMENTS. The amounts recorded on this Summary are obtained from the Schedule of Household Cash Receipts and Cash Disbursement Monthly Operating Report and Schedule of Business Cash Receipts and Cash Disbursement Monthly Operating Report. The Total Disbursements recorded on the Summary of Cash Receipts and Cash Disbursements is used to determine the quarterly fees due the United States Trustee. reported should be taken directly from the debtor's books and records, not from the bank statement. For your first report the beginning cash balance will be cash on hand at the time of filing (Listed on Schedule B). For subsequent reports, the beginning cash balance should be the ending cash balance from the prior month. The beginning cash for the Cumulative Total should always be the actual beginning cash from the first Monthly Operating Report. The schedules are self-explanatory and the debtor will categorize all receipts and disbursements for the month. The debtor will also provide a separate schedule of all "Other" receipts and disbursements. American LegalNet, Inc. www.USCourtForms.com < ATTACHMENT 1 - QUESTIONNAIRE/INSURANCE INFORMATION. You must submit this information each month even if there have been no changes from the prior periods. If a new insurance policy is issued, coverage is changed, limits are changed, or if there is any other change in insurance coverage, a copy of the new certificate of insurance reflecting such changes must be attached. ATTACHMENT 2 - BANK ACCOUNT RECONCILIATION. You must include each bank account, including savings < accounts and negotiable instruments (e.g. certificates of deposit, money market accounts, stocks or bonds). < ATTACHMENT 3 - CHECK DISBURSEMENT DETAILS. A separate attachment must be utilized for each account. Itemize all checks written or wire transfers on each accounts. Debtors using computerized systems may submit computer-generated registers. The check disbursement details must account for ALL checks in sequential order, including those that have been voided. Additionally, the total amount recorded on the check disbursements detail must agree with the amounts recorded on either the Household or Business Schedule of Receipts and Disbursements. Note: All disbursements must be made by pre-numbered check. Counter checks are prohibited. Cash disbursements by the business are prohibited. Requests to use, create or maintain petty cash accounts must be submitted to the United States Trustee in writing. Cash disbursements by the individuals must be kept to a minimum and the debtor must maintain supportive documentation (i.e., receipts) for such disbursements over $100.00. < ATTACHMENT 4 - ACCOUNTS RECEIVABLE and POST-PETITION TAX INFORMATION. Debtors must show all accounts receivable requested on the attachment. Adjustments and writeoffs of any account receivable must be fully explained. Debtor must note all payroll tax deposits made during the period and attach copies of the payroll tax receipts. < ATTACHMENT 5- ACCOUNTS PAYABLE and SECURED CREDITOR PAYMENT TAX INFORMATION. Debtors must show all outstanding bills or invoices that have been received, but not paid. < The debtor must submit all attachments of the monthly operating report. Any attachments not applicable must be so noted on the attachment. The required reports with attachments should be stapled together and filed with the cover sheet listing the name, address and telephone number of debtor and debtor's attorney. conversion of your case to a Chapter 7. If you have any questions regarding these reports which your attorney cannot answer, your attorney should contact the attorney or bankruptcy analyst in the United States Trustee's office who is assigned to your case. American LegalNet, Inc. www.USCourtForms.com UNITED STATES BANKRUPTCY COURT ________________ DISTRICT OF _____________ __________________ DIVISION IN RE: } } } } } } DEBTOR. CASE NUMBER: JUDGE CHAPTER 11 DEBTOR'S MONTHLY OPERATING REPORT (INDIVIDUAL) FOR THE PERIOD TO FROM Comes now the above-named debtor and files its Monthly Operating Report in accordance with the Guidelines established by the United States Trustee and FRBP 2015. Dated: Attorney for Debtor Debtor's Address and Phone Number: Attorney's Address and Phone Number: ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ Bar No. ____________________ Tel. ________________________ Tel. ________________________ Note: The original Monthly Operating Report is to be filed with the court and a copy simultaneously provided to the United States Trustee. Monthly Operating Reports must be filed by the 20th day of the following month. For assistance in preparing the Monthly Operating Report, refer to the followng resources: 1) 2) 3) Instructions for Preparation Debtor's Chapter 11 Monthly Operating Report Initial Filing Requirements Frequently Asked Questions (FAQs) American LegalNet, Inc. www.USCourtForms.com American LegalNet, Inc. www.USCourtForms.com SUMMARY OF CASH RECEIPTS AND CASH DISBURSEMENTS Case Name: Case Number: Note: The information requested below is a summary of the information reported the various Schedules and Attachments contained within this repo . Month Cumulative Total CASH- Beginning of Month (Household) CASH- Beginning of Month (Business) Total Household Receipts Total Business Receipts Total Receipts Total Household Disbursements Total Business Disbursements Total Disbursements NET CASH FLOW (Total Receipts minus Total Disbursements) CASH- End of Month (Individual) CASH- End of Month (Business) CALCULATION OF DISBURSEMENTS FOR UNITED STATES TRUSTEE QUARTERLY FEES TOTAL DISBURSEMENTS (From Above) Less: Any Amounts Transferred or Paid from the Business Account to the Household Account (i.e., Salary Paid to Debtor or Owner's Draw) DISBURSEMENTS FOR U.S. TRUSTEE FEE CALCULATION I declare under penalty of perjury that this statement and the accompanying documents and reports are true and correct to the best of my knowledge and belief This ___________ day of _________________________ 20_____. _____________________________________ Debtor's Signature Monthly Operating Report - Indivdual American LegalNet, Inc. www.USCourtForms.com SCHEDULE OF HOUSEHOLD CASH RECEIPTS AND CASH DISBURSEMENTS Month Cumulative Total CASH - Beginning of Month CASH RECEIPTS Salary or Cash from Business Wages from Other Sources (attach list to this report) Interest or Dividend Income Alimony or Child Support Social Security/Pension/Retirement Sale of Household Assets (attach list to this report) Loans/Borrowing from Outside Sources (attach list to this report) Other (specify) (attach list to this report) TOTAL RECEIPTS CASH DISBURSEMENTS Alimony or Child Support Payments Charitable Contributions Gifts Household Expenses/Food/Clothing Household Repairs & Maintenance Insurance IRA Contribution Lease/Rent Payments Medical/Dental Payments Mortgage Payment(s) Other Secured Payments Taxes - Personal Property Taxes - Real Estate Taxes Other (attach schedule) Travel & Entertainment Tuition/Education Utilities (Electric, Gas, Water, Cable, Sanitation) Vehicle Expenses Vehicle Secured Payment(s) U. S. Trustee Quarterly Fees Professional Fees (Legal, Accounting) Other (attach schedule) Total Household Disbursements CASH - End of Month (Must equal reconciled bank statementAttachment No. 2) Monthly Operating Report - Individual American LegalNet, Inc. www.USCourtForms.com SCHEDULE OF BUSINESS CASH RECEIPTS AND CASH DISBURSEMENTS Month Cumulative Total CASH - Beginning of Month BUSINESS CASH RECEIPTS Cash Sales Account Receivable Collection Loans/Borrowing from Outside Sources (attach list to this report) Rental Income Sale of Business Assets (attach list to this report) Other (specify) (attach list to this report) Total Business Receipts BUSINESS CASH DISBURSEMENTS Net Payroll (Excluding Self) Salary Paid to Debtor or Owner's Draw (e.g., transfer to Household Account) Taxes - Payroll Taxes - Sales Taxes Other (attach schedule) Contract Labor (Subcontractors) Inventory Purchases Secured/Lease Payments (Business) Utilities (Business) Insurance Vehicle Expenses Travel & Entertainment Repairs and Maintenance Supplies Charitable Contributions/Gifts Purchase of Fixed Assets Advertising Bank Charges Other (attach schedule) Total Business Disbursements CASH - End of Month (Must equal reconciled bank statement Attachment No. 2) Monthly Operating Report - Individual American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVDUAL ATTACHMENT NO. 1 QUESTIONNAIRE YES* 1. 4. 5. Have any post-petition loans been received by the debtor from any party? 6. Are any post-petition payroll taxes past due? 7. Are any post-petition state or federal income taxes past due? 8. Are any post-petition state or local sales taxes past due? 9. Are any post-petition real estate taxes past due? 10. Are any amounts owed to post-petition creditors/vendors delinquent? 11. NO Have any assets been sold or transferred outside the normal course of business during this reporting period? Have any funds been disbursed from any account other than a debtor in possession account? Are any post-petition receivables (accounts, notes, or loans) due from any relatives, insiders, or related party? Have any payments been made on pre-petition liabilities this reporting period? Are any wage payments past due? 2. 3. *If the answer to any of the above questions is "YES," provide a detailed explanation of each item on a separate sheet. INSURANCE INFORMATION YES 1. 2. NO* Are real and personal property, vehicle/auto, general liability, fire, theft, worker's compensation, and other necessary insurance coverages in effect? Are all premium payments current? *If the answer to any of the above questions is "NO," provide a detailed explanation of each item on a separate sheet. CONFIRMATION OF INSURANCE TYPE of POLICY and CARRIER Period of Coverage Payment Amount and Frequency Delinquency Amount ____ Check here if United States Trustee has been listed a a Certificate Holder on all policies of insurance. DESCRIBE PERTINENT DEVELOPMENTS, EVENTS, AND MATTERS DURING THIS REPORTING PERIOD: Estimated Date of Filing the Plan of Reorganization and Disclosure Statement: ____________________ American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ATTACHMENT NO. 2 BANK ACCOUNT RECONCILIATIONS Bank Account Information Account #1 Account #2 Account #3 Account #4 Name of Bank: Account Number: Purpose of Account (Business/Personal) Type of Account (e.g. checking) 1. Balance per Bank Statement 2. ADD: Deposits not credited (attach list to this report) 3. SUBTRACT: Outstanding Checks (attach list) 4. Other Reconciling Items (attach list to this report) 5. Month End Balance (Must Agree with Books) TOTAL OF ALL ACCOUNTS $ Note: Attach a copy of the bank statement and bank reconciliation for each account. Investment Account Information Bank / Account Name / Number Date of Purchase Type of Instrument Purchase Price Current Value Note: Attach a copy of each investment account statement. American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ATTACHMENT NO. 3A CASH DISBURSEMENTS DETAILS - HOUSEHOLD Name of Bank Account Number Purpose of Account (Personal) Type of Account (e.g., Checking) Check Number Date of Check Payee Purpose or Description Amount TOTAL $ If any checks written this period have not been delivered to the payee, provide details, including the payee, amount, explanation for holding check and anticipated delivery date of check. American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ATTACHMENT NO. 3B CASH DISBURSEMENTS DETAILS - BUSINESS Name of Bank Account Number Purpose of Account (Business) Type of Account (e.g., Checking) Check Number Date of Check OPERATING Payee Purpose or Description Amount TOTAL If any checks written this period have not been delivered to the payee, provide details, including the payee, amount, explanation for holding check and anticipated delivery date of check. American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ATTACHMENT NO. 3C CASH DISBURSEMENTS DETAILS - BUSINESS Name of Bank Account Number Purpose of Account (Business) Type of Account (e.g., Checking) Check Number Date of Check Payee Purpose or Description Amount TOTAL $ If any checks written this period have not been delivered to the payee, provide details, including the payee, amount, explanation for holding check and anticipated delivery date of check. American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ACCOUNTS RECEIVABLE RECONCILIATION (Pre- & Post- Petition) ATTACHMENT NO. 4 Scheduled Amount Current Month Scheduled Amount Current Month Accounts Receivable Beginning Balance Plus: Billings During the Month Less: Collections During the Month Adjustments or WriteOffs* Accounts Receivable Ending Balance** ACCOUNTS RECEIVABLE AGING (Pre- & Post- Petition) 0 - 30 Days 31 - 60 Days 61 - 90 Days Over 90 Days Total Accounts Receivable** * Attach explanation of any adjustment or writeoff. ** The "current month" of these two lines must equal. POST-PETITION TAXES Beginning Tax Liability* Amount Withheld & or Accrued Federal Taxes Withholding** FICA - Employee FICA - Employer Unemployment Income Other (Attach List) Total Federal Taxes State & Local Taxes Withholding Sales Unemployment Real Property Personal Property Other (Attach List) Total State & Local Taxes Total Post-Petition Taxes * The beginning tax liability should represent the liability from the prior month, or if this is the first report, the amount should be zero ** Attach copies of IRS Form 6123 or your FTD coupon and payment receipt to verify payment or deposit American LegalNet, Inc. www.USCourtForms.com MONTHLY OPERATING REPORT INDIVIDUAL ATTACHMENT NO. 5 ACCOUNTS PAYABLE RECONCILIATION (Post-Petition Only) Month Month Month Accounts Payable Beginning Balance* Plus: New Indebtedness During the Month Less: Amount Paid on Acct. Payables in Month Adjustments or WriteOffs** Accounts Payable Ending Balance * The beginning A/P liability should represent the liability from the prior month, or if this is the first report, the amount should be zero **Attach explanation for any adjustment or write-off. ACCOUNTS PAYABLE LISTING [List all bills or invoices incurred since the filing of the petition (Post-Petition Only) and have NOT been paid]*** Vendor & Description of Bill/Invoice Date Incurred Days Outstanding Amount *** List any additional payables on a separate sheet and attach to this schedule. POST-PETITION STATUS OF SECURED NOTES, LEASES, AND ADEQUATE PROTECTION PAYMENTS Scheduled Total Past Due Monthly Payment From Prior Amount Paid Total Unpaid Due Month(s) During Month Postpetition Name of Secured Creditor / Lessor Total Number of Payments Past Due American LegalNet, Inc. www.USCourtForms.com