Official Form 426 Periodic Report About Controlled Non-, and Profitability page 1 Official Form 426 Periodic Report Regarding Value, Operations, and Profitability of Entities in Which the Estate Holds a Substantial or Controlling Interest 12/17 This is the Periodic Report as of on the value, operations , and profitability of those entities in which a - Debto r Debtor. [ Name of Debtor ] holds a substantial or controlling interest in the following entities: Name of Controlled Non - Debtor En tity Interest of the Debtor Tab # This Periodic Report contains separate reports ( Entity Reports ) on the value, operations, and profitability of each Controlled Non - Debtor Entity. Each Entity Report consists of five exhibits. Exhibit A contains the most recently available: balance sheet, statement of income ( loss ), statement of cash flows, deficit ) for the period covered by the Entity Report , along with summarized footnote s. Exhibit B describes the Controlled Non - Exhibit C describes claims between the Controlled Non - Debtor Entity and any other Controlled Non - Debtor Entity. Exhibit D describes how federal, state or local taxes, and any t ax attributes, refunds, or other benefits, have been allocated between or among the Controlled Non - Debtor Entity and any Debtor or any other Controlled Non - Debtor Entity and includes a copy of each tax sharing or tax allocation agreement to which the Contr olled Non - Debtor Entity is a party with any other Controlled Non - Debtor Entity. Exhibit E describes any payment, by the Controlled Non - Debtor Entity, of any claims, administrative expenses or professional fees that have been or could be asserted against an y Debtor, or the incurrence of any obligation to make respect thereto. This Periodic Report must be signed by a re presentative of the trustee or d ebtor in possession. D ebtor Name United States Bankruptcy Court for the: District of ( State ) Case number: Fill in this information to identify the case: American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 2 The undersigned, having reviewed the Entity Reports for each Controlled Non - financial affairs, verifies under the penalty of perjury that to the be st of his or her knowledge, ( i) this Periodic Report and the attached Entity Reports are complete, accurate , and truthful to the best of his or her knowledge, and (ii) the Debtor did not cause the creation of any entity with actual deliberate intent to evade the requirements of Bankru ptcy Rule 2015.3 For non - individual Debtors: Signature of Authorized Individual Printed name of Authorized Individual Date MM / DD / YYYY For individual Debtors: Signature of Debtor 1 Printed name of Debtor 1 Date MM / DD / YYYY Signature of Debtor 2 Printed name of Debtor 2 Date MM / DD / YYYY American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 3 Exhibit A: Financial Statements for [ Name of Controlled Non - Debtor Entity ] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 4 Exhibit A - 1: Balance Sheet for [ Name of Controlled Non - Debtor Entity ] as of [ date ] [Provide a balance sheet dated as of the end of the most recent 3 - month period of the current fiscal year and as of the end of the preceding fiscal year. Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 5 Exhibit A - 2 : Statement of Income ( Loss ) for [ Name of Controlled Non - Debtor Entity ] for period ending [ date ] [Provide a statement of income ( loss ) for the following periods: (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent 3 - month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequent reports, since the closing date of the last report. Describe the sourc e of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 6 Exhibit A - 3: Statement of Cash Flows f or [ Name of Controlled Non - Debtor Entity ] for period ending [ date ] [Provide a statement of changes in cash position for the following periods: (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent 3 - month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequent reports, since the closing date of the last report. Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 7 Exhibit A - 4 : Deficit ) for [ Name of Controlled Non - Debtor Entity ] for period ending [ date ] deficit ) for the following periods: (i) For the initial report: a. the period between the end of the preceding fiscal year and the end of the most recent 3 - month period of the current fiscal year; and b. the prior fiscal year. (ii) For subsequ ent reports, since the closing date of the last report. Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 8 Exhibit B : Description of Operations for [ Name of Controlled Non - Debtor Entity ] - Debtor Entity. Describe the business conducted and intended to be conducted by the Controlled Non - Debtor Entity, focusing on the Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 9 Exhibit C : Description of Intercompany Claims [List and describe the Controlled Non - - Debtor Entity, together with the basis for such claims and whether each claim is contingent, unliquidated or disputed . Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 10 Exhibit D : Allocation of Tax Liabilities and Assets [Describe how income, losses, tax payments, tax refunds , or other tax attributes relating to federal, state , or local taxes have been allocated between or among the Controlled Non - Debtor Entity and one or more other Controlled Non - Debtor Entities. Include a copy of each tax sharing or tax allocation agreement to which the entity is a party with any other Controlled Non - Debtor Entity. Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com Debtor Name Case number Official Form 426 Periodic Report About Controlled Non-, and Profitability page 11 Exhibit E : Description of Controlled Non - , or Professional Fees otherwise payable by a Debtor [Describe any payment made, or obligations incurred (or claims purchased), by the Controlled Non - Debtor Entity in connection with any claims, administrative expe nses , or professional fees that have been or could be asserted against any Debtor . Describe the source of this information.] American LegalNet, Inc. www.FormsWorkFlow.com