Chapter 13 Business Case Questionnaire {5}

LOCAL BANKRUPTCY FORM NO. 13 IN THE UNITED STATES DISTRICT COURT FOR THE UNITED STATES VIRGIN ISLANDS, BANKRUPTCY DIVISION In Re: Debtor(s) BANKRUPTCY NO. CHAPTER NO.11 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 American LegalNet, Inc. www.FormsWorkflow.com 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). American LegalNet, Inc. www.FormsWorkflow.com 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) Unliquidate d (U) Will Liens Be Retained Under the Plan? (Y) or (N) TOTAL $ $ American LegalNet, Inc. www.FormsWorkflow.com B. Priority Claims PRIORITY CLAIMS Creditor Total Amount Owed Type of Collateral (D) (L) (U) * TOTAL $ * Disputed (D), Liquidated (L), or Unliquidated (U) American LegalNet, Inc. www.FormsWorkflow.com 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 American LegalNet, Inc. www.FormsWorkflow.com 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. $ TOTAL Are any assets listed above claimed as exempt? If so attach a copy of Schedule C and any amendments. American LegalNet, Inc. www.FormsWorkflow.com 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 $ American LegalNet, Inc. www.FormsWorkflow.com 5. Treatment of Administrative Non-Tax Claims2 ADMINISTRATIVE NON-TAX CLAIMS Name of Creditor* Amount Type of Summary of Proposed Treatment and Date of First 6. Treatment of Administrative Tax Claims ADMINISTRATIVE TAX CLAIMS Name of Creditor* Amount Type of Summary of Proposed Treatment and Date of First * 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. American LegalNet, Inc. www.FormsWorkflow.com 7. Treatment of Priority Non-Tax PRIORITY NON-TAX CLAIMS Name of Creditor Class Amount Owed Date of Summary of Proposed Treatment American LegalNet, Inc. www.FormsWorkflow.com 8. Treatment of Priority Tax Claims3 PRIORITY TAX CLAIMS Name of Creditor Class Amount Owed Date of Summary of Proposed Treatment 3 Include dates when any §507(a)(7) taxes were assessed. American LegalNet, Inc. www.FormsWorkflow.com 9. Treatment of General Unsecured Non-Tax Claims GENERAL UNSECURED NON-TAX CLAIMS Creditor Class Total Amount Owed Percent of Dividend TOTAL $ American LegalNet, Inc. www.FormsWorkflow.com 10. Treatment of General Unsecured Tax Claims GENERAL UNSECURED TAX CLAIMS Total Amount Owed Percent of Dividend Creditor Class TOTAL $ American LegalNet, Inc. www.FormsWorkflow.com 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