REVISED 12/15 UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA In re: Case No. Chapter 7 case, converted from chapter 11 Debtor(s). FINAL REPORT OF DEBTOR AS DEBTOR IN POSSESSION UPON CONVERSION OF CHAPTER 11 CASE TO CHAPTER 7 CASE PURSUANT TO BANKRUPTCY RULE 1019(5) AND LOCAL RULE 1019-1(a)(2) NOTE: The Final Report must be filed with the Clerk of Bankruptcy Court through the Court's Electronic Case Filing (ECF) system within 14 days of receipt of this form. Prepare and attach separate exhibits where necessary. I. (a) CASH Total cash receipts received during chapter 11 case (include cash on hand when the petition was filed): $ Total cash disbursements during chapter 11 case: Cash balance on hand at date of conversion: $ $ (b) (c) (d) (e) Is the cash balance on hand stated above subject to security interest? If so, state the name and address of the secured creditor and the amount unpaid on the security agreement as of the date of conversion: Amount unpaid Name and address of secured creditor Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com II. (a) (b) (c) ACCOUNTS RECEIVABLE Total amount due the debtor from other entities on date the case was converted to a chapter 7 case: $ Is the account receivable balance stated above subject to a security interest? If so, state the name and address of the secured creditor and the amount unpaid on the date of conversion on the security agreement: Name & address of secured creditor Amount paid (d) Itemize below all accounts receivable due the debtor from other entities on the date the case was converted to a chapter 7 case: Kind of obligation Date of obligation Amount due debtor Name & address if account obligor III. (a) (b) ACCOUNTS PAYABLE Total unpaid debts incurred during chapter 11 case. $ Itemize below all unpaid debts incurred during the chapter 11 case, including unsecured debts, secured debts, taxes, wages, administrative expenses, etc., but not including any pre-petition debts: Kind of debt Date incurred Amount unpaid Name & address of unpaid entities Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com IV. MATRIX Pursuant to Local Rule 1019-1(a)(2) prepare and file with this report an appropriate matrix for mailing purposes containing the names and addresses of all unpaid entities listed above in Section III(b). V. ORIGINAL CHAPTER 11 ASSETS Itemize below the assets of the debtor other than cash or accounts receivable on the date the petition was filed that were disposed of during the chapter 11 case or that were retained but had a reduced or increased value on the date of conversion to a chapter 7 case: Description of property Value scheduled in schedules A, B, C or A/B, C If disposed of, explain disposition If retained, value on date of conversion VI. NEW CHAPTER 11 ASSETS Itemize below the assets of the debtor other than cash or accounts receivable that were acquired by the debtor during the chapter 11 case and that were disposed of during the chapter 11 case or that were retained as assets on the date of conversion to a chapter 7 case: Description of property Price paid for property If disposed of, explain disposition If retained, value on date of conversion Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VII. (a) EXECUTORY CONTRACTS AND UNEXPIRED LEASES Rejected List below the unexpired leases and other executory contracts that were rejected during the chapter 11 case, including the name and address of every other party to each contract, the obligations of each party under the contract and the description and value of property covered by the contract: (b) New, assumed, or not rejected List below the unexpired leases and other executory contracts that were assumed or not rejected and the new executory contracts including leases that were entered into during the chapter 11 case, including the name and address of every other party to each contract, the obligations of each party under the contract and the description and value of property covered by the contract: The final report above, consisting of [insert number of pages] pages and [insert number of exhibits] exhibits, has been prepared for or by the undersigned, who declares under penalty of perjury that the statements contained therein are true and correct to the best of my knowledge, information and belief. Executed on: Signed: Name: [type name] The [insert role] of or for the debtor Name of Debtor: NOTE: File matrix of unpaid entities with this report. See section IV above. Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com