Free Local Form #13 revised 2-28-06 - Pennsylvania

LOCAL BANKRUPTCY FORM NO. 13 IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF PENNSYLVANIA In Re: Bankruptcy No.

DISCLOSURE STATEMENT TO ACCOMPANY PLAN DATED _____________ Chapter 11 Small Business (Check box only if debtor has elected to be considered a small business under 11 U.S.C. §1121(e)) Debtor furnishes this disclosure statement to creditors in the above-captioned matter pursuant to Bankruptcy Code §1125 to assist them in evaluating debtor's proposed Chapter 11 plan, a copy of which is attached hereto. Creditors may vote for or against the plan of reorganization. Creditors who wish to vote must complete their ballots and return them to the following address before the deadline noted in the order approving the disclosure statement and fixing time. The Court will schedule a hearing on the plan pursuant to 11 U.S.C. §1129.) Address for return of ballots:

I.

Background 1. Name of Debtor

2.

Type of Debtor (individual, partnership, corporation)

3.

Debtor's Business or Employment

4.

Date of Chapter 11 Petition

5.

Events that Caused the Filing:

6.

Anticipated Future of the Company & Source of this Information and Opinion

7.

Summarize all Significant Features of the Plan Including When and How Each Class of Creditor Will Be Paid and What, If Any, Liens Will Be Retained By Secured Creditors or Granted to Any Creditor Under the Plan

8.

Are All Monthly Operating Statements Current and on File With The Clerk of Court? Yes _______ No _______ If Not, Explain:

9.

Does the plan provided for releases of nondebtor parties? Specify which parties and terms of release.

10.

Identify all executory contracts that are to be assumed or assumed and assigned.

11.

Has a bar date been set? Yes _______ No _______ (If not, a motion to set the bar date has been filed simultaneously with the filing of this disclosure statement.)

12.

Has an election under 11 U.S.C. §1121(e) has been filed with the Court to be treated as a small business? Yes _______ No _______

13.

Specify property that will be transferred subject to 11 U.S.C. §1146(c).

II.

Creditors A. Secured Claims SECURED CLAIMS

Creditor

Total Amount Owed

Arrearages

Type of Collateral Priority of Lien (1, 2, 3)

Disputed (D) Liquidated (L) Unliquidated (U)

Will Liens Be Retained Under the Plan? (Y) or (N)

TOTAL

$

$

B.

Priority Claims

PRIORITY CLAIMS

Creditor

Total Amount Owed

Type of Collateral

(D) (L) (U) *

TOTAL

$

* Disputed (D), Liquidated (L), or Unliquidated (U)

C.

Unsecured Claims 1. 2. 3. 4. 5. Amount Debtor Scheduled (Disputed and Undisputed) Amount of Unscheduled Unsecured Claims1 Total Claims Scheduled or Filed Amount Debtor Disputes Estimated Allowable Unsecured Claims $ $ $ $ $

D.

Other Classes of Creditors 1. 2. 3. 4. 5. Amount Debtor Scheduled (Disputed and Undisputed) Amount of Unscheduled Claims1 Total Claims Scheduled or Filed Amount Debtor Disputes Estimated Allowable Claims $ $ $ $ $

E.

Other Classes of Interest Holders 1. 2. 3. 4. 5. Amount Debtor Scheduled (Disputed and Undisputed) Amount of Unscheduled Claims1 Total Claims Scheduled or Filed Amount Debtor Disputes Estimated Allowable Claims $ $ $ $ $

Includes (a.) unsecured claims filed by unscheduled creditors; (b.) that portion of any unsecured claim filed by a scheduled creditor that exceeds the amount debtor scheduled; and (c.) any unsecured portion of any secured debt not previously scheduled.

1

III.

Assets ASSETS

Assets

Value

Basis for Value Priority of Lien

Name of Lien Holder (if any) (Fair Market Value/ Book Value)

Amount of Debtor's Equity (Value Minus Liens)

$ TOTAL 1. Are any assets which appear on Schedule A or B of the bankruptcy petition not listed above? If so, identify asset and explain why asset is not in estate: 2. Are any assets listed above claimed as exempt? If so attach a copy of Schedule C and any amendments.

$ TOTAL

IV.

SUMMARY OF PLAN 1. 2. 3. Effective Date of Plan: Will cramdown be sought? If Yes, state bar date: Yes No

Treatment of Secured Non-Tax Claims SECURED NON-TAX CLAIMS

Name of Creditor

Class

Amount Owed

Summary of Proposed Treatment

TOTAL 4.

$ Treatment of Secured Tax Claims SECURED TAX CLAIMS

Name of Creditor

Class

Amount Owed

Summary of Proposed Treatment

TOTAL

$

5.

Treatment of Administrative Non-Tax Claims2 ADMINISTRATIVE NON-TAX CLAIMS

Name of Creditor*

Amount Owed

Type of Debt**

Summary of Proposed Treatment and Date of First Payment

6.

Treatment of Administrative Tax Claims ADMINISTRATIVE TAX CLAIMS

Name of Creditor*

Amount Owed

Type of Debt**

Summary of Proposed Treatment and Date of First Payment

* Identify and Use Separate Line for Each Professional and Estimated Amount of Payment ** Type of Debt (P=Professional, TD=Trade, TX=Taxes)
2

Include all §503(b) administrative claims.

7.

Treatment of Priority Non-Tax PRIORITY NON-TAX CLAIMS

Name of Creditor

Class

Amount Owed

Date of Assessment

Summary of Proposed Treatment

8.

Treatment of Priority Tax Claims3 PRIORITY TAX CLAIMS

Name of Creditor

Class

Amount Owed

Date of Assessment

Summary of Proposed Treatment

3

Include dates when any §507(a)(7) taxes were assessed.

9.

Treatment of General Unsecured Non-Tax Claims GENERAL UNSECURED NON-TAX CLAIMS

Creditor

Class

Total Amount Owed

Percent of Dividend

TOTAL

$

10.

Treatment of General Unsecured Tax Claims GENERAL UNSECURED TAX CLAIMS

Creditor

Class

Total Amount Owed

Percent of Dividend

TOTAL

$

11.

Will periodic payments be made to unsecured creditors? Yes _______ If so: Amount of each payment (aggregate to all unsecured claimants) Estimated date of first payment: Time period between payments: Estimated date of last payment: Contingencies, if any: State source of funds for planned payments, including funds necessary for capital replacement, repairs, or improvements: No ________ First payment to begin __________________

Other significant features of the plan:

Include any other information necessary to explain this plan:

V.

Comparison of Plan with Chapter 7 Liquidation If debtor's proposed plan is not confirmed, the potential alternatives would include proposal of a different plan, dismissal of the case or conversion of the case to Chapter 7. If this case is converted to Chapter 7, a trustee will be appointed to liquidate the debtor's non-exempt assets. In this event, all secured claims and priority claims, including all expenses of administration, must be paid in full before any distribution is made to unsecured claimants. Total value of Chapter 7 estate (See Section III) 1. Less secured claims (See Section IV-2) 2. Less administrative expenses (See Section IV-3 and include approximate Chapter 7 expenses) 3. Less other priority claims (See Section IV-4) Total Amount Available for Distribution to Unsecured Creditors Divided by total allowable unsecured claims of (See Section II C) Percentage of Dividend to Unsecured Creditors: $ $ $ $ $

Will the creditors fare better under the plan than they would in a Chapter 7 liquidation? Yes _______ Explain: No ________

VI.

Feasibility A. B. C. Attach Income Statement for Prior 12 Months. Attach Cash Flow Statement for Prior 12 Months. Attach Cash Flow Projections for Next 12 Months.

Estimated amount to be paid on effective date of plan, including administrative expenses. $ Show how this amount was calculated. $ $ $ $ $ Administrative Class Taxes Unsecured Creditors UST Fees TOTAL

What assumptions are made to justify the increase in cash available for the funding of the plan?

Will funds be available in the full amount for administrative expenses on the effective date of the plan? From what source? If not available, why not and when will payments be made?

Cash on hand $ Cash on hand $

(Current). Attach current bank statement. (Estimated amount available on date of confirmation)

If this amount is less than the amount necessary at confirmation, how will debtor make up the shortfall?

VII.

Management Salaries MANAGEMENT SALARIES Position/Name of Person Holding Position Proposed Salary (Post-Confirmation)

Salary at Time of Filing

VIII.

Identify the Effect on Plan Payments and Specify Each of the Following: 1. What, if any, litigation is pending?

2.

What, if any, litigation is proposed or contemplated?

IX.

Additional Information and Comments

IX.

Certification The undersigned hereby certifies that the information herein is true and correct to the best of my knowledge and belief formed after reasonable inquiry. If Debtor is a corporation, attach a copy of corporate resolution authorizing the filing of this Disclosure Statement and Plan. If Debtor is a general partnership, attach a copy of the consent agreement of all general partners to the filing of the bankruptcy.

_____________________________________ Signature of Debtor or Authorized Representative _____________________________________ Signature of Debtor or Authorized Representative _____________________________________ Debtor's Counsel

____________________ Date ____________________ Date ____________________ Date

OPTIONAL TABLE 6. Treatment of Other Claims N/A OTHER CLASSES OF CREDITORS

Creditor

Class

Total Amount Owed

Percent of Dividend

A.

Will periodic payments be made? Yes ____ If so: No _____ $_____________ _____________ _____________ _____________

Amount of each payment (aggregate to all claimants) Estimated date of first payment Time period between payments Estimated date of last payment Contingencies, if any:

OPTIONAL TABLE 7. Treatment of Interest Holders (Other Than Equity Holders) OTHER CLASSES OF INTEREST HOLDERS Creditor Class Total Amount Owed Percent of Dividend

8.

Treatment of Equity Holders (Specify how the market test of Bank of America National Trust and Savings Association v. 203 North LaSalle Street Partnership, 526 U.S. 434, 110 S.Ct. 1411 (1999), is met) EQUITY HOLDERS Creditor Class Total Amount Owed Percent of Dividend

A.

Will periodic payments be made? Yes ____ No _____ If so: Amount of each payment (aggregate to all claimants) Estimated date of first payment Time period between payments Estimated date of last payment Contingencies, if any:

$_____________ _____________ _____________ _____________

1994 HISTORIC SUMMARY
POST PETITION PERIODS
1. TOTAL CASH FLOW FROM OPERATIONS: 2. LESS TOTAL DISBURSEMENTS EXCLUDING PAYMENTS TO CREDITORS IN A PLAN:
MONTH ONE MONTH TWO MONTH THREE MONTH FOUR MONTH FIVE MONTH SIX MONTH SEVEN MONTH EIGHT MONTH NINE MONTH TEN MONTH ELEVEN MONTH TWELVE

$10,000

$12,000

$14,000

$9,000

$15,000

$18,000

$14,000

$22,000

$35,000

$30,000

$38,000

$36,000

$10,000

$14,000

$12,000

$10,000

$12,000

$15,000

$12,500

$16,000

$30,000

$23,000

$30,000

$30,000

3. TOTAL NET CASH FLOW:

0

(2,000)

2,000

(1,000)

3,000

3,000

1,500

6,000

5,000

7,000

8,000

6,000

DEFINITIONS TOTAL CASH FLOW FROM OPERATIONS: TOTAL DISBURSEMENTS EXCLUDING PAYMENTS TO CREDITORS IN A PLAN: THE TOTAL AMOUNT OF FUNDS COLLECTED IN A SPECIFIC PERIOD FROM CASH SALES, COLLECTION OF ACCOUNTS RECEIVABLE, AND OTHER INCOME, EXCLUDING LOANS PROCEEDS, CASH CONTRIBUTIONS FROM INSIDERS, AND SALES TAXES COLLECTED. THE TOTAL DISBURSEMENTS IN A SPECIFIC PERIOD FOR PRODUCTION COSTS, GENERAL AND ADMINISTRATIVE COSTS, EXCLUDING PAYMENTS TO CREDITORS TO BE PAID UNDER THE TERMS OF

1994 PROJECTED SUMMARY
POST PETITION PERIODS
4. TOTAL PROJECTED CASH FLOW FROM OPERATIONS: 5. LESS TOTAL PROJECTED DISBURSEMENTS EXCLUDING PMTS TO CREDITORS IN A PLAN:
MONTH ONE MONTH TWO MONTH THREE MONTH FOUR MONTH FIVE MONTH SIX MONTH SEVEN MONTH EIGHT MONTH NINE MONTH TEN MONTH ELEVEN MONTH TWELVE

$38,000

$40,000

$41,000

$43,000

$45,000

$45,000

$46,000

$47,000

$48,000

$48,000

$48,000

$50,000

$30,000

$32,000

$32,000

$32,000

$33,000

$33,000

$35,000

$35,000

$38,000

$38,000

$38,000

$39,000

6. ANTICIPATED CASH FLOW AVAILABLE FOR PLAN:

8,000

8,000

9,000

11,000

12,000

12,000

11,000

12,000

10,000

10,000

10,000

11,000

DEFINITIONS TOTAL PROJECTED CASH FLOW FROM OPERATIONS: TOTAL DISBURSEMENTS EXCLUDING PAYMENTS TO CREDITORS IN A PLAN: TOTAL AMOUNT OF PROJECTED FUNDS COLLECTED IN A SPECIFIC PERIOD FROM CASH SALES, COLLECTION OF ACCOUNTS RECEIVABLE, AND OTHER INCOME, EXCLUDING LOANS PROCEEDS, CASH CONTRIBUTIONS FROM INSIDERS, AND SALES TAXES COLLECTED. TOTAL PROJECTED DISBURSEMENTS IN A SPECIFIC PERIOD FOR PRODUCTION COSTS, GENERAL AND ADMINISTRATIVE COSTS, EXCLUDING PAYMENTS TO CREDITORS TO BE PAID UNDER THE TERMS OF THE PROPOSED PLAN.

1994 PLAN FEASIBILITY
POST PETITION PERIODS
ANTICIPATED RECEIPTS AVAILABLE FOR PLAN (SEE LINE 6, ABOVE): LESS PROPOSED PLAN PAYMENTS (SEE SECTION IV): OVERAGE/(SHORTAGE)OF CASH FLOW AVAILABLE TO FUND PLAN:
MONTH ONE MONTH TWO MONTH THREE MONTH FOUR MONTH FIVE MONTH SIX MONTH SEVEN MONTH EIGHT MONTH NINE MONTH TEN MONTH ELEVEN MONTH TWELVE

$8,000

$8,000

$9,000

$11,000

$12,000

$12,000

$11,000

$12,000

$10,000

$10,000

$10,000

$11,000

$5,000 3,000

$5,000 3,000

$5,000 4,000

$ 5,000 6,000

$ 5,000 7,000

$ 5,000 7,000

$ 5,500 5,500

$ 5,000 7,000

$ 5,000 5,000

$ 5,000 5,000

$ 5,000 5,000

$ 5,000 6,000