UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI ____________DIVISION In re DEBTOR NAME, ) ) Case No.___-________-___ ) Chapter ___ Debtor(s). ) ) REPOR T OF MEDIATOR The undersigned court-appointed mediator, reports to the Court as follows: ____ A. A mediation conference was conducted on ____ B. The conference resulted in the following: __________ Agreement signed (total resolution). The parties reached an impasse. The parties settled the following issues: (a) (b) (c) ____ C. The conference was continued and an additional mediation conference has be scheduled on: __________________________________________ ____ D. The matter was settled prior to mediation conference. Attendance: Parties and Counsel present: Parties and Counsel not present: Dated: Signature of Mediator Print Name Address City, State, Zip Code Telephone (L.F. 24 Rev. 05/03)