Free Financial Report for Chapter 11 (monthly) - Utah

DEBTOR: ______________________________

INITIAL FINANCIAL REPORT CHAPTER 11 COVERSHEET __________
Date of Report

CASE NO: ____________________ ______________________________________________________________________
THIS REPORT IS DUE 20 DAYS AFTER THE PETITION FILING DATE Mark One Box For Each Required Document Debtor must attach each of the following documents or a satisfactory explanation for failure to attach a document. File original with the Clerk of Court. Transmit a duplicate to the U.S. Trustee.

______________________________________________________________________ REQUIRED DOCUMENTS Document Previously Explanation
Attached [ ] [ [ ] ] Submitted [ ] [ [ ] ] Attached [ ] [ [ ] ] 1. Latest Fiscal Year Financial Statements or Tax Returns. 2. Balance Sheet as of Month End Immediately Preceding Filing or Appropriate Tax Return. 3. Profit and Loss Statement For Month immediately Preceding Filing or Appropriate Tax Return. 4. Proof of Insurance Coverage [ [ [ [ [ [ ] ] ] ] ] ] [ [ [ [ [ [ ] ] ] ] ] ] [ [ [ [ [ [ ] ] ] ] ] ] A. B. C. D. E. General Liability Coverage Property (Fire, Theft, etc.) Insurance Workers' Compensation Insurance Vehicle Insurance Other:______________________________

5. Projected Revenue, Expenses, and Cash Flow for First 120 Days (or longer) of Post Petition Operations 6. Name and Address of Financial Institution, Account Number and Sample Voided Check For Each Debtor in Possession Bank Account

[ [ [

] ] ]

[ [ [

] ] ]

[ [ [

] ] ]

A. General Account B. Payroll Account C. Tax Account

______________________________________________________________________
I declare under penalty of perjury that the following Initial Financial Report, and any attachments thereto, is true and correct to the best of my knowledge and belief.

Executed on: _______________________

Debtor(s): By Position:

________________________________ ________________________________ ________________________________

Form 1
Revised 10/96

DEBTOR: ____________________________

MONTHLY FINANCIAL REPORT CHAPTER 11

CASE NO: ____________________ For Period ____________ to ____________, ________

COVER SHEET Accounting Method Used: [ ] Accrual Basis [ ] Cash Basis ______________________________________________________________________
THIS REPORT IS DUE 15 DAYS AFTER THE END OF THE MONTH Mark One Box For Each Required Document Debtor must attach each of the following reports/documents unless the U.S. Trustee has waived the requirement in writing. File the original with the Clerk of Court. Transmit a duplicate, with original signature, to the U.S. Trustee.

______________________________________________________________________ REQUIRED REPORTS/DOCUMENTS Report/Document Previously
Attached [ [ [ [ [ [ [ ] ] ] ] ] ] ] Waived [ [ [ [ [ [ [ ] ] ] ] ] ] ] Cash Receipts & Disbursements Statement (Form 2-B) Balance Sheet (Form 2-C) Profit and Loss Statement (Form 2-D) Supporting Schedules (Form 2-E) Quarterly Fee Summary (Form 2-F) Narrative (Form 2-G) Bank Statement(s) for Debtor in Possession Account(s)

______________________________________________________________________
I declare under penalty of perjury that the following Monthly Financial Report, and any attachments thereto, is true and correct to the best of my knowledge and belief.

Executed on: _______________________

Debtor(s): By Position:

________________________________ ________________________________ ________________________________

DEBTOR: _______________________________

CASE NO: ______________

Form 2-B Page 1 of 2
Revised 10/96

CASH RECEIPTS AND DISBURSEMENTS STATEMENT For Period __________ to ____________,______

CASH RECONCILIATION 1. Beginning Cash Balance (Ending Cash Balance from last month's report) 2. Cash Receipts (from Cash Receipts Journal on next page) $ ___________

$ ___________

3. Cash Disbursements (from Cash Disbursements Journal on next page) (___________) 4. Net Cash Flow (line 2 minus line 3) 5. Ending Cash Balance (to Form 2-C) ___________ $ ___________

CASH SUMMARY - ENDING BALANCE Amount Petty Cash Regular Checking Tax Account Other Checking Accounts Interest-Bearing Deposits Short-Term Investments TOTAL (must agree with line 5 above) $ ___________ ___________ ___________ ___________ ___________ ___________ Financial Institution _________________________ _________________________ _________________________ _________________________ _________________________ _________________________

$ 0

Form 2-B Page 1 of 2
Revised 10/96

CASH RECEIPTS AND DISBURSEMENTS STATEMENT For Period ____________ to ____________,______

CASH RECEIPTS JOURNAL (attach additional sheets as necessary) Date Description (Source) Amount

Total Cash Receipts (to line 2 of Cash Reconciliation,

$

CASH DISBURSEMENTS JOURNAL (attach additional sheets as necessary) Date Check Nos. Payee Description (Purpose) Amount

Total Cash Disbursements (from line 3 of Cash Reconciliation)

$

DEBTOR: _______________________________

CASE NO: ______________

Form 2-C
Revised 10/96

BALANCE SHEET - As of _________________, _______ ASSETS
Current Assets: Cash (from Form 2-B, line 5) Accounts Receivable (from Form 2-E) Receivable from Officers, Employees, Affiliates Inventory Other Current Assets: __________ __________ Total Current Assets Fixed Assets: Land Building Equipment, Furniture and Fixtures Total Fixed Assets Less: Accumulated Depreciation Net Fixed Assets ___________ Other Long Term Assets: __________ __________ TOTAL ASSETS $ ___________ ___________ ___________ ___________ ___________ ___________ $ ___________ ___________ ___________ ___________ (___________) ___________ ___________ ___________

LIABILITIES
Post Petition Liabilities: Accounts Payable (from Form 2-E) Notes Payable Rents and Leases Payable Taxes Payable (from Form 2-E) Accrued Interest Other: _______________ _______________ Total Post Petition Liabilities Pre-Petition Liabilities: Priority Claims Secured Debt Unsecured Dept Total Pre-Petition Liabilities TOTAL LIABILITIES ___________ ___________ ___________ ___________ ___________ ___________ ___________ $ __________ ___________ ___________ ___________ ___________ $___________

OWNERS' EQUITY
Capital Stock or Owners' Investment Paid-In Capital Retained Earnings: Pre Petition Post Petition TOTAL OWNERS' EQUITY TOTAL LIABILITIES AND OWNERS' EQUITY $ ___________ ___________ ___________ ___________ $ __________ $ __

DEBTOR: _______________________________

CASE NO: ______________

Form 2-D
Revised 10/96

PROFIT AND LOSS STATEMENT For Period __________ to __________, _______

Gross Operating Revenue Less: Discounts, Returns and Allowances Net Operating Revenue Cost of Goods Sold Gross Profit Operating Expenses: Salaries and Wages Rents and Leases Payroll Taxes Other (list): _______________ _______________ Total Operating Expenses Operating Income (Loss) Legal and Professional Fees Depreciation, Depletion and Amortization Interest Expense Net Operating Income (Loss) Non-Operating Income and Expenses Other Non-Operating (Expenses) Gains (Losses) on Sale of Assets Interest Income Other Non-Operating Income Net Non-Operating Income or (Expenses) Net Income (Loss) Before Income Taxes Federal and State Income Tax Expense (Benefit) NET INCOME (LOSS)

$

____________ (____________) $ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ $ ____

Form 2-D
Revised 10/96

DEBTOR: ________________________________

CASE NO: _____________

SUPPORTING SCHEDULES For Period __________ to __________, ______ POST-PETITION TAXES PAYABLE SCHEDULE
Beginning Balance Income Tax Withheld: Federal State FICA Tax Withheld Employer's FICA Tax Unemployment Tax: Federal State Sales, Use & Excise Taxes Property Taxes Accrued Income Tax: Federal State Other: Additions Payments / Deposits Date Paid Check No. Ending Balance

$ ________ ________ ________ ________

________ ________ ________ ________

________ ________ ________ ________

______ ______ ______ ______

________ ________ ________ ________

_________ _________ _________ _________

________ ________ ________ ________ ________

________ ________ ________ ________ ________

________ ________ ________ ________ ________

______ ______ ______ ______ ______

________ ________ ________ ________ ________

_________ _________ _________ _________ _________

________ ________ ________

________ ________ ________

________ ________ ________

______ ______ ______

________ ________ ________

_________ _________ _________

TOTALS (Post Petition) (Ending Balance to Form 2-C) $ ________

________

________

______

________

_________

INSURANCE SCHEDULE
Carrier / Agent Workers' Compensation General Liability Property (Fire, Theft) Vehicle Other (list): ________________ ________________ ________________ ________________ ________________ Amount of Coverage $ __________ __________ __________ __________ __________ Policy Expiration Date _____/____/____ _____/____/____ _____/____/____ _____/____/____ _____/____/____ Premium Paid Through Date _____/____/____ _____/____/____ _____/____/____ _____/____/____ _____/____/____

SUPPORTING SCHEDULES For Period __________ to __________, _____

Form 2-E Page 1 of 2
Revised 10/96

ACCOUNTS RECEIVABLE AND POST-PETITION PAYABLE AGING Accounts Receivable
$ ____________ ____________ ____________ ____________ ____________ ____________ ____________ $ ____________ (____________) $ ____________

Due
Under 30 days 30 to 60 days 61 to 90 days 91 to 120 days Over 120 days Total Post Petition Pre Petition Amounts Total Accounts Receivable Less: Bad Debt Reserve Net Accounts Receivable (to Form 2-C) Total Post Petition Accounts Payable (to Form 2-C)

Post Petition Accounts Payable
$ ____________________ ____________________ ____________________ ____________________ ____________________ XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXX $ ____________________

SCHEDULE OF PAYMENTS TO ATTORNEYS AND OTHER PROFESSIONALS Amount Paid
Debtor's Counsel $ Counsel for Unsecured Creditors' Committee Trustee's Counsel Accountant Other: _____________ __________ __________ __________ __________ __________

Date of Court Approval
_________________ _________________ _________________ _________________ _________________

Estimated Balance Due*
$ _______________ _______________ _______________ _______________ _______________

*Balance due to include fees and expenses incurred but not yet paid.

SCHEDULE OF PAYMENTS AND TRANSFERS TO PRINCIPALS / EXECUTIVES**
Payee Name _______________________ _______________________ _______________________ Position ________________________ ________________________ ________________________ Nature of Payment __________________ __________________ __________________ Amount ____________ ____________ ____________

**List payments and transfers of any kind and in any form made to or for the benefit of any proprietor, owner, partner, shareholder, officer or director.

Form 2-E Page 1 of 2
Revised 10/96

DEBTOR: ________________________________

CASE NO: ______________

QUARTERLY FEE SUMMARY(1) Month Ended __________________________, ______ Payment Date
January February March TOTAL 1st Quarter April May June TOTAL 2nd Quarter July August September TOTAL 3rd Quarter October November December TOTAL 4th Quarter

Cash Disbursements(2)
_________________ _________________ _________________ $ _________________ _________________ _________________ _________________ $ _________________ _________________ _________________ _________________ $ _________________ _________________ _________________ _________________ $ _________________

Quarterly Fee Due

Check No.

Date

____________

___________

_________

____________

___________

_________

____________

___________

_________

____________

___________

_________

___________________________________________________________________________ (1) This Summary is to reflect the current calendar year's information cumulative to the end of the reporting period.

(2)

Should agree with line 3, FORM 2-B, Disbursements are net of transfers to other debtor in possession bank accounts.

Form 2-F Page 1 of 2
Revised 10/96

CHAPTER 11 QUARTERLY FEES

FEE SCHEDULE TOTAL QUARTERLY DISBURSEMENTS QUARTERLY FEE

-0- to $ 14,999.00 $ 250.00 15,000.00 to $ 74,999.00 500.00 75,000.00 to 149,999.00 750.00 150,000.00 to 224,999.00 1,250.00 225,000.00 to 299,999.00 1,500.00 300,000.00 to 999,999.00 3,750.00 1,000,000.00 to 1,999,999.00 5,000.00 2,000,000.00 to 2,999,999.00 7,500.00 3,000,000.00 to 4,999,999.00 8,000.00 5,000,000.00 or more 10,000.00 ___________________________________________________________________ __ $

Failure to pay the quarterly fee is cause for conversion or dismissal of the Chapter 11 case [11 USC §1112(b)(10)]. Checks are to be made payable to The United States Trustee and mailed to the address set forth below. Fees are not to be mailed or delivered to the local Office of the United States Trustee. If any check is returned "unpaid" for any reason, all subsequent payments must be made by way of cashier's check, certified check, or money order. To ensure proper credit, it is imperative that the debtor in possession and Chapter 11 Trustee write the case number on each check and remit the payment with the coupon provided with the quarterly billing. A separate check and coupon is required for each quarterly payment even if more than one quarterly fee is paid at the same time.

Send all payments to:

UNITED STATES TRUSTEE PAYMENT CENTER P.O. Box 198246 Atlanta, GA 30384

Form 2-F Page 1 of 2
Revised 10/96

DEBTOR: ________________________________

CASE NO:______________

NARRATIVE For Period __________ to __________, ______
Please provide a brief description of the significant business and legal actions taken by the debtor, its creditors or the court during the reporting period.

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ________________________________ ___________________________________________________________________ __ Form 2-G
Revised 10/96

Form 2-G
Revised 10/96