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8-K
COSI INC filed this Form 8-K on 01/20/2017
Entire Document
 

Exhibit 99.4
 
UNITED STATES BANKRUPTCY COURT
DISTRICT OF MASSACHUSETTS
 
In re
Hearthstone Associates, LLC.
Case No.
16-13707-MSH
   
Reporting Period
11/29/16-01/02/17
 
MONTHLY OPERATING REPORT
Complete and submit to the United States Trustee within 15 days after end of month
 
Submit copy of report to any official committee appointed in the case
REQUIRED DOCUMENTS
Form No.
Document
Attached
Explanation
Attached
Monthly Reporting Questionnaire
MOR-1
YES
 
Schedule of Cash Receipts and Disbursements
MOR-2
YES
 
Copies of Debtor's Bank Reconciliations
 
YES
 
Copies of Debtor's Bank Statements
 
YES
 
Copies of Cash Disbursements Journals
 
N/A
 
Statement of Operations
MOR-3
N/A
 
Balance Sheet
MOR-4
N/A
 
Schedule of Post-Petition Liabilities
MOR-5
N/A
 
Copies of IRS Form 6123 or payment receipt
 
N/A
 
Copies of tax returns filed during reporting period
 
N/A
 
Detailed listing of aged accounts payables
 
N/A
 
Accounts Receivable Reconciliation and Aging
MOR-6
N/A
 

I declare under penalty of perjury (28 U.S.C. Section 1746) that this report and all attachments are true and correct to the best of my knowledge and belief.
 
   
Signature of Debtor
 
Date
 
 
   
Signature of Joint Debtor
 
Date
 
       
/s/ Edward P. Schatz
  1/16/2017  
Signature of Authorized Individual*
 
Date
 
       
Edward P. Schatz
  Acting Interim CFO  
Printed Name of Authorized Individual
 
Title of Authorized Individual

*Authorized individual must be an officer, director or shareholder if the debtor is a corporation; a partner if debtor is a partnership; a manager or member if debtor is a limited liability company.
 
COVER PAGE
9/04
 

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