Periodic Report Regarding Value, Operations and Profitability of Entities in Which the Estate Holds a Substantial or Controlling Interest

The Arizona Bankruptcy Chapter 11 Requirements form is provided by the court for the general public to know the requirements of the State of Arizona for seeking a Chapter 11 bankruptcy.

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B26 (Official Form 26) (12/08) 
 
   United States Bankruptcy Court 
                                       District of Arizona	
 
 
 
In re ______   ,	
      Case  No. ____________________ 
  Debtor                            Chapter 11 
 
       
PERIODIC REPORT REGARDING VALUE, OPERATIONS AND PROFITABILITY OF 
ENTITIES IN WHICH THE ESTATE  
HOLDS A SUBSTANTIAL OR CONTROLLING INTEREST	
 
 
This is the report as of ___________________on the value, operations and profitability of 
those entities in which the estate holds a substantial or controlling interest, as required by 
Bankruptcy Rule 2015.3.  The estate holds a substantial or controlling interest in the following 
entities:   
 
 
Name of Entity  
Interest of the Estate Tab # 	
 
   
  
 
  
  
 
  
  
 
This periodic report (the “Periodic Report”) contains separate reports (“Entity Reports”) on the 
value, operations, and profitability of each entity listed above.   
 
Each Entity Report shall consist of three exhibits.  Exhibit A contains a valuation estimate 
for the entity as of a date not more than two years prior to the date of this report.  It also contains 
a description of the valuation method used.  Exhibit B contains a balance sheet, a statement of 
income (loss), a statement of cash flows, and a statement of changes in shareholders’ or partners’ 
equity (deficit) for the period covered by the Entity Report, along with summarized footnotes.  
Exhibit C contains a description of the entity’s business operations.  
 
 
THIS REPORT MUST BE SIGNED BY A REPRESENTATIVE OF THE TRUSTEE OR DEBTOR IN 
POSSESSION. 
  
The undersigned, having reviewed the above listing of entities in which the estate holds a 
substantial or controlling interest, and being familiar with the Debtor’s financial affairs, verifies 
under the penalty of perjury that the listing is complete, accurate and truthful to the best of his/her 
knowledge.

B26 (Official Form 26) (12/08) – Cont. 
 	
2
 
Date: ___________                                   
      _____________________________________ 
      Signature of Authorized Individual 
 
      _____________________________________ 
      Name of Authorized Individual 
 
      _____________________________________ 
      Title of Authorized Individual 
 
 
[If the Debtor is an individual or in a joint case] 
 
      Signature(s) of Debtor(s) (Individual/Joint) 
   
      _____________________________________ 
      Signature of Debtor 
  
      _____________________________________ 
      Signature of Joint Debtor

B26 (Official Form 26) (12/08) – Cont. 
 
    3
 Exhibit A 
 Valuation Estimate	
 
 
 
[Provide a statement of the entity’s value and the value of the estate’s interest in the entity, 
including a description of the basis for the valuation, the date of the valuation and the valuation 
method used.  This valuation must be no more than two years old.  Indicate the source of this 
information.]

B26 (Official Form 26) (12/08) – Cont. 
 
    4
 Exhibit B 
 Financial Statements

B26 (Official Form 26) (12/08) – Cont. 
 
    5
 Exhibit B-1 
 Balance Sheet 
  
 
[Provide a balance sheet dated as of the end of the most recent six-month period of the current 
fiscal year and as of the end of the preceding fiscal year. Indicate the source of this information.]

B26 (Official Form 26) (12/08) – Cont. 
 
    6
 Exhibit B-2 
  Statement of Income (Loss)	
 
  
 
[Provide a statement of income (loss) for the following periods:  
 
  (i) For the initial report: 
    a. the period between the end of the preceding fiscal year and the end of the 
most recent six-month period of the current fiscal year; and 
    b. the prior fiscal year.   
  (ii) For subsequent reports, since the closing date of the last report. 
 
Indicate the source of this information.]

B26 (Official Form 26) (12/08) – Cont. 
 
    7
 Exhibit B-3 
 Statement of Cash Flows	
   
 
 
[Provide a statement of changes in cash flows for the following periods:  
 
  (i) For the initial report: 
    a. the period between the end of the preceding fiscal year and the end of the 
most recent six-month period of the current fiscal year; and 
    b. the prior fiscal year.   
  (ii) For subsequent reports, since the closing date of the last report. 
 
Indicate the source of this information.]

B26 (Official Form 26) (12/08) – Cont. 
 
    8
 Exhibit B-4 
 Statement of Changes in Shareholders’/Partners’ Equity (Deficit) 
 
 
[Provide a statement of changes in shareholders’/partners equity (deficit) for the following 
periods:  
 
  (i) For the initial report: 
    a. the period between the end of the preceding fiscal year and the end of the 
most recent six-month period of the current fiscal year; and 
    b. the prior fiscal year.   
  (ii) For subsequent reports, since the closing date of the last report. 
 
Indicate the source of this information.]

B26 (Official Form 26) (12/08) – Cont. 
 
    9
Exhibit C 
  Description of Operations	
 
 
[Describe the nature and extent of the estate’s interest in the entity. 
 
Describe the business conducted and intended to be conducted by the entity, focusing on the 
entity’s dominant business segment(s).  Indicate the source of this information.]