R.I. Local Form 3020-1.3 Rev. 12/1/09 UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF RHODE ISLAND - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -* In re: : : Debtor(s) : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -* CHAPTER 11 CONFIRMATION WORKSHEET AND CERTIFICATION I. GENERAL PLAN INFORMATION BK No. Chapter Date of Bankruptcy Filing: ____________________________ Date of Hearing on Confirmation: _______________________ Effective Date of Plan: ________________________________ Method/Type of Plan Funding: ____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Projections attached for life of plan (if appropriate): Summary of cash flow statements for the life of the Ch. 11 plan (included): Amount required to Fund Plan: ______________________ Total initial Deposit required at Confirm: ______________ Number of Creditor Classes: ________________________ Classes that are impaired under the Plan: _______________ Indicate whether the Debtor intends to see cramdown of the Plan: Indicate whether any equity shareholders will be retaining any Interest under the Plan: Liquidation analysis included: YES _____ NO _____ YES _____ NO _____ YES _____ NO _____ YES _____ NO _____ YES _____ NO _____ American LegalNet, Inc. www.FormsWorkFlow.com II. 1. FILING OF REQUIRED DOCUMENTS PROOF OF DEPOSIT is attached to worksheet: YES _____ NO _____ If NO, the required Proof of Deposit MUST be filed at least 7 days prior to the hearing on confirmation or such hearing will be automatically vacated. See, R.I. LBR 3020-1(b). Do not issue a check to the Court. A copy of the bank statement showing the amount on deposit in accordance with Fed. R. Bankr. P. 3020(a) will suffice. The amount of the deposit must be equal to the initial distribution for all classes on the effective date of the plan. 2. CLAIMS REGISTER is attached to worksheet: YES _____ NO _____ 3. PROPOSED ORDER OF DISTRIBUTION (R.I. Local Form 3020-1.1) is attached to worksheet and has been mailed to all creditors, or the NOTICE OF FILING OF PROPOSED ORDER OF DISTRIBUTION (R.I. Local Form 3020-1.2) in accordance with R.I. LBR 30201(a)(2) at least fourteen (14) days before the hearing on confirmation: YES _____ NO _____ WRITTEN SUMMARY OF BALLOTS (R.I. Local Form 3018-1.1) in accordance with 4. YES _____ NO _____ R.I. LBRs 3018-1 and 3020-1 is attached to worksheet: 5. AFFIDAVIT RELATING TO REQUIREMENTS UNDER 11 U.S.C. §1129 is attached to worksheet. See R.I. LBR 3020-1(a)(6): YES _____ NO _____ CERTIFICATE OF SERVICE has been filed or is attached to worksheet certifying that the 6. approved Disclosure Statement, latest Amended Plan, the Order approving the Disclosure Statement, and the Ballots for Acceptances or Rejections were mailed to all creditors at least twenty-eight (28) days before the hearing on confirmation, or the date set by the Court: YES _____ NO _____ A. Administrative Expenses/Applications for Compensation: TOTAL OF ADMININSTRATIVE EXPENSES: ______________* Payment for administrative claims will be ________ percent (%). Payment for administrative claims will be made on ____________________________________ ______________________________________________________________________________ Amount of deposit for administrative claims on effective date: ___________________________ *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. B. CLASS I TOTAL OF CLASS I CLAIMS: ________________________________________* 2 American LegalNet, Inc. www.FormsWorkFlow.com Payment for Class I will be ______________________________ percent (%). Payment for Class I will be made on ________________________________________________ ______________________________________________________________________________ Amount of deposit for Class I claims on effective date: ____________________ *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. C. CLASS II TOTAL OF CLASS II CLAIMS: ________________________________________* Payment for Class II will be ______________________________ percent (%). Payment for Class II will be made on _______________________________________________ ______________________________________________________________________________ Amount of deposit for Class II claims on effective date: ____________________ *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. D. CLASS III TOTAL OF CLASS III CLAIMS: ________________________________________* Payment for Class III will be ______________________________ percent (%). Payment for Class III will be made on _______________________________________________ ______________________________________________________________________________ Amount of deposit for Class III claims on effective date: ____________________ *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. E. CLASS IV TOTAL OF CLASS IV CLAIMS: ________________________________________* Payment for Class IV will be ______________________________ percent (%). Payment for Class IV will be made on ______________________________________________ ______________________________________________________________________________ Amount of deposit for Class IV claims on effective date: ____________________ 3 American LegalNet, Inc. www.FormsWorkFlow.com *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. F. CLASS V TOTAL OF CLASS V CLAIMS: ________________________________________* Payment for Class V will be ______________________________ percent (%). Payment for Class V will be made on _______________________________________________ ______________________________________________________________________________ Amount of deposit for Class V claims on effective date: ____________________ *NOTE: See breakdown of claimants as set forth in the debtor's proposed order of distribution. G. CLASS VI TOTAL OF CLASS VI CLAIMS: ________________________________________* Payment for Class VI will be ______________________________ percent (%). Payment for Class VI will be made on ______________________________________________ ______________________________________________________________________________ Amount of deposit for Class VI claims on effective date: _________________