B 25C (Official Form 25C) (12/08) UNITED STATES BANKRUPTCY COURT __________ District of __________ In re , Case No. Debtor Small Business Case under Chapter 11 SMALL BUSINESS MONTHLY OPERATING REPORT Month: Date filed: Line of Business: NAISC Code: IN ACCORDANCE WITH TITLE 28, SECTION 1746, OF THE UNITED STATES CODE, I DECLARE UNDER PENALTY OF PERJURY THAT I HAVE EXAMINED THE FOLLOWING SMALL BUSINESS MONTHLY OPERATING REPORT AND THE ACCOMPANYING ATTACHMENTS AND, TO THE BEST OF MY KNOWLEDGE, THESE DOCUMENTS ARE TRUE, CORRECT AND COMPLETE. RESPONSIBLE PARTY: Original Signature of Responsible Party Printed Name of Responsible Party Questionnaire: (All questions to be answered on behalf of the debtor.) Yes No 1. IS THE BUSINESS STILL OPERATING? ’ ’ 2. HAVE YOU PAID ALL YOUR BILLS ON TIME THIS MONTH? ’ ’ 3. DID YOU PAY YOUR EMPLOYEES ON TIME? ’ ’ 4. HAVE YOU DEPOSITED ALL THE RECEIPTS FOR YOUR BUSINESS INTO THE DIP ACCOUNT THIS MONTH? ’ ’ 5. HAVE YOU FILED ALL OF YOUR TAX RETURNS AND PAID ALL OF YOUR TAXES THIS MONTH ’ ’ 6. HAVE YOU TIMELY FILED ALL OTHER REQUIRED GOVERNMENT FILINGS? ’ ’ 7. HAVE YOU PAID ALL OF YOUR INSURANCE PREMIUMS THIS MONTH? ’ ’ 8. DO YOU PLAN TO CONTINUE TO OPERATE THE BUSINESS NEXT MONTH? ’ ’ 9. ARE YOU CURRENT ON YOUR QUARTERLY FEE PAYMENT TO THE U.S. TRUSTEE? ’ ’ 10. HAVE YOU PAID ANYTHING TO YOUR ATTORNEY OR OTHER PROFESSIONALS THIS MONTH? ’ ’ 11. DID YOU HAVE ANY UNUSUAL OR SIGNIFICANT UNANTICIPATED EXPENSES THIS MONTH? ’ ’ 12. HAS THE BUSINESS SOLD ANY GOODS OR PROVIDED SERVICES OR TRANSFERRED ANY ASSETS TO ANY BUSINESS RELATED TO THE DIP IN ANY WAY? ’ ’ 13. DO YOU HAVE ANY BANK ACCOUNTS OPEN OTHER THAN THE DIP ACCOUNT? ’ ’ American LegalNet, Inc. www.FormsWorkflow.com Page 2 B 25C (Official Form 25C) (12/08) 14. HAVE YOU SOLD ANY ASSETS OTHER THAN INVENTORY THIS MONTH? ’ ’ 15. DID ANY INSURANCE COMPANY CANCEL YOUR POLICY THIS MONTH? ’ ’ 16. HAVE YOU BORROWED MONEY FROM ANYONE THIS MONTH? ’ ’ 17. HAS ANYONE MADE AN INVESTMENT IN YOUR BUSINESS THIS MONTH? ’ ’ 18. HAVE YOU PAID ANY BILLS YOU OWED BEFORE YOU FILED BANKRUPTCY? ’ ’ ’ ’ TAXES DO YOU HAVE ANY PAST DUE TAX RETURNS OR PAST DUE POST-PETITION TAX OBLIGATIONS? IF YES, PLEASE PROVIDE A WRITTEN EXPLANATION INCLUDING WHEN SUCH RETURNS WILL BE FILED, OR WHEN SUCH PAYMENTS WILL BE MADE AND THE SOURCE OF THE FUNDS FOR THE PAYMENT. (Exhibit A) INCOME PLEASE SEPARATELY LIST ALL OF THE INCOME YOU RECEIVED FOR THE MONTH. THE LIST SHOULD INCLUDE ALL INCOME FROM CASH AND CREDIT TRANSACTIONS. (THE U.S. TRUSTEE MAY WAIVE THIS REQUIREMENT.) TOTAL INCOME $ SUMMARY OF CASH ON HAND Cash on Hand at Start of Month $ Cash on Hand at End of Month $ PLEASE PROVIDE THE TOTAL AMOUNT OF CASH CURRENTLY AVAILABLE TO YOU TOTAL $ (Exhibit B) EXPENSES PLEASE SEPARATELY LIST ALL EXPENSES PAID BY CASH OR BY CHECK FROM YOUR BANK ACCOUNTS THIS MONTH. INCLUDE THE DATE PAID, WHO WAS PAID THE MONEY, THE PURPOSE AND THE AMOUNT. (THE U.S. TRUSTEE MAY WAIVE THIS REQUIREMENT.) TOTAL EXPENSES $ (Exhibit C) CASH PROFIT INCOME FOR THE MONTH (TOTAL FROM EXHIBIT B) $ EXPENSES FOR THE MONTH (TOTAL FROM EXHIBIT C) $ (Subtract Line C from Line B) CASH PROFIT FOR THE MONTH $ American LegalNet, Inc. www.FormsWorkflow.com Page 3 B 25C (Official Form 25C) (12/08) UNPAID BILLS PLEASE ATTACH A LIST OF ALL DEBTS (INCLUDING TAXES) WHICH YOU HAVE INCURRED SINCE THE DATE YOU FILED BANKRUPTCY BUT HAVE NOT PAID. THE LIST MUST INCLUDE THE DATE THE DEBT WAS INCURRED, WHO IS OWED THE MONEY, THE PURPOSE OF THE DEBT AND WHEN THE DEBT IS DUE. (THE U.S. TRUSTEE MAY WAIVE THIS REQUIREMENT.) TOTAL PAYABLES $ (Exhibit D) MONEY OWED TO YOU PLEASE ATTACH A LIST OF ALL AMOUNTS OWED TO YOU BY YOUR CUSTOMERS FOR WORK YOU HAVE DONE OR THE MERCHANDISE YOU HAVE SOLD. YOU SHOULD INCLUDE WHO OWES YOU MONEY, HOW MUCH IS OWED AND WHEN IS PAYMENT DUE. (THE U.S. TRUSTEE MAY WAIVE THIS REQUIREMENT.) TOTAL RECEIVABLES $ (Exhibit E) BANKING INFORMATION PLEASE ATTACH A COPY OF YOUR LATEST BANK STATEMENT FOR EVERY ACCOUNT YOU HAVE AS OF THE DATE OF THIS FINANCIAL REPORT OR HAD DURING THE PERIOD COVERED BY THIS REPORT. (Exhibit F) EMPLOYEES NUMBER OF EMPLOYEES WHEN THE CASE WAS FILED? NUMBER OF EMPLOYEES AS OF THE DATE OF THIS MONTHLY REPORT? PROFESSIONAL FEES BANKRUPTCY RELATED: PROFESSIONAL FEES RELATING TO THE BANKRUPTCY CASE PAID DURING THIS REPORTING PERIOD? $ TOTAL PROFESSIONAL FEES RELATING TO THE BANKRUPTCY CASE PAID SINCE THE FILING OF THE CASE? $ NON-BANKRUPTCY RELATED: PROFESSIONAL FEES NOT RELATING TO THE BANKRUPTCY CASE PAID DURING THIS REPORTING PERIOD? $ TOTAL PROFESSIONAL FEES NOT RELATING TO THE BANKRUPTCY CASE PAID SINCE THE FILING OF THE CASE? $ American LegalNet, Inc. www.FormsWorkflow.com Page 4 B 25C (Official Form 25C) (12/08) PROJECTIONS COMPARE YOUR ACTUAL INCOME AND EXPENSES TO THE PROJECTIONS FOR THE FIRST 180 DAYS OF YOUR CASE PROVIDED AT THE INITIAL DEBTOR INTERVIEW. Projected Actual Difference INCOME $ $ $ EXPENSES $ $ $ CASH PROFIT $ $ $ TOTAL PROJECTED INCOME FOR THE NEXT MONTH: $ TOTAL PROJECTED EXPENSES FOR THE NEXT MONTH: $ TOTAL PROJECTED CASH PROFIT FOR THE NEXT MONTH: $ ADDITIONAL INFORMATION PLEASE ATTACH ALL FINANCIAL REPORTS INCLUDING AN INCOME STATEMENT AND BALANCE SHEET WHICH YOU PREPARE INTERNALLY. American LegalNet, Inc. www.FormsWorkflow.com Reset Save As... Print