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8-K
COSI INC filed this Form 8-K on 12/20/2016
Entire Document
 

Exhibit 99.4
 
UNITED STATES BANKRUPTCY COURT
DISTRICT OF MASSACHUSETTS

In re
Hearthstone Associates, LLC.
Case No.
16-13707-MSH
   
Reporting Period
10/25/16-11/28/16
 
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
 
12/15/2016  
Signature of Authorized Individual*
 
Date
 
       
Edward P. Schatz
 
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
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting
Period
10/25/16-11/28/16
 
MONTHLY REPORTING QUESTIONNAIRE
 
Must be completed each month
 
Yes
No
N/A
1. Have any assets been sold or transferred outside the normal course of business this reporting period? If yes, provide an explanation below.
   
X
 
2. Have any funds been disbursed from any account other than a debtor-in-possession account this reporting period? If yes, provide an explanation below.
   
X
 
3. Have any payments been made on pre-petition debt, other than payments in the normal course to secured creditors or lessors? If yes, attach listing including date of payment, amount of payment, and name of payee. - See Note 1. below.
     
X
4. Have any payments been made to professionals? If yes, attach listing including date of payment, amount of payment, and name of payee.
     
X
5. If the answer to question 3 and/or 4 is yes, were all such payments approved by the Court?
       
6. Have any payments been made to officers, insiders, shareholders, or relatives? If yes, attach listing including date of payment, amount and reason for payment, and name of payee.
     
X
7. Have all postpetition tax returns been timely filed? If no, provide an explanation below.
     
X
8. Is the estate current on the payment of post-petition taxes?
     
X
9. Is the estate insured for the replacement cost of assets and for general liability? If no, provide an explanation below.
     
X
10. Is workers' compensation insurance in effect?
     
X
11. Have all current insurance payments been made? Attach copies of all new and renewed insurance policies.
     
X
12. Are a plan and disclosure statement on file?
   
X
 
13. Was there any post-petition borrowing during this reporting period?
     
X
 
 
 
 
 
 
 
 
MOR-1
9/04
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

SCHEDULE OF CASH RECEIPTS AND DISBURSEMENTS

Amounts reported should be per the debtor's books, not the bank statement.  The beginning cash should be the ending cash from the prior month or, if this is the first report, the amount should be the balance on the date the petition was filed.  Attach copies of the bank statements and the cash disbursements journal.  The total disbursements listed in the disbursements journal must equal the total disbursements reported on this page.  A bank reconciliation must be attached for each account.
 
 
BANK ACCOUNTS
 
Operational
Payroll
Tax
Other
Total
CASH BEGINNING OF MONTH
-
-
-
6,148
6,148
           
RECEIPTS
         
CASH SALES
-
-
-
-
-
ACCOUNTS RECEIVABLE
-
-
-
5,019
5,019
LOANS AND ADVANCES
-
-
-
-
-
SALE OF ASSETS
-
-
-
-
-
OTHER (ATTACH LIST)
-
-
-
-
-
TRANSFERS (FROM DIP ACCTS)
-
-
-
-
-
           
TOTAL RECEIPTS
-
-
-
5,019
5,019
           
DISBURSEMENTS
         
NET PAYROLL
-
-
-
-
-
PAYROLL TAXES
-
-
-
-
-
SALES, USE & OTHER TAXES
-
-
-
-
-
INVENTORY PURCHASES
-
-
-
-
-
SECURED/RENTAL/LEASES
-
-
-
-
-
INSURANCE
-
-
-
-
-
ADMINISTRATIVE
-
-
-
-
-
SELLING
-
-
-
-
-
OTHER (ATTACH LIST)
-
-
-
51
51
______________________________
         
OWNER DRAW *
-
-
-
-
-
TRANSFERS (TO DIP ACCTS)
-
-
-
-
-
______________________________
         
PROFESSIONAL FEES
-
-
-
-
-
U.S. TRUSTEE QUARTERLY FEES
-
-
-
-
-
COURT COSTS
-
-
-
-
-
TOTAL DISBURSEMENTS
-
-
-
51
51
           
NET CASH FLOW
         
(RECEIPTS LESS DISBURSEMENTS)
-
-
-
4,968
4,968
CASH - END OF MONTH
-
-
-
11,115
11,115
*COMPENSATION TO SOLE PROPRIETORS FOR SERVICES RENDERED TO BANKRUPTCY ESTATE
 
THE FOLLOWING SECTION MUST BE COMPLETED
DISBURSEMENTS FOR CALCULATING U.S. TRUSTEE QUARTERLY FEES:
 
TOTAL DISBURSEMENTS
                           51
LESS: TRANSFERS TO DEBTOR IN POSSESSION ACCOUNTS
                             -
PLUS: ESTATE DISBURSEMENTS MADE BY OUTSIDE SOURCES (i.e. from escrow accounts)
0
TOTAL DISBURSEMENTS FOR CALCULATING U.S. TRUSTEE QUARTERLY FEES
                           51
 
MOR-2
9/04
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

STATEMENT OF OPERATIONS - See Note Below
(Income Statement)
The Statement of Operations is to be prepared on an accrual basis.  The accrual basis of accounting recognizes revenue when it is realized and expenses when they are incurred, regardless of when cash is actually received or paid.
REVENUES
Month
Cumulative
Filing to Date
Gross Revenues
   
Less: Returns and Allowances
   
Net Revenue
   
COST OF GOODS SOLD
   
Beginning Inventory
   
Add: Purchases
   
Add: Cost of Labor
   
Add: Other Costs (attach schedule)
   
Less: Ending Inventory
   
Cost of Goods Sold
   
Gross Profit
   
OPERATING EXPENSES
   
Advertising
   
Auto and Truck Expense
   
Bad Debts
   
Contributions
   
Employee Benefits Programs
   
Insider Compensation*
   
Insurance
   
Management Fees/Bonuses
   
Office Expense
   
Pension & Profit-Sharing Plans
   
Repairs and Maintenance
   
Rent and Lease Expense
   
Salaries/Commissions/Fees
   
Supplies
   
Taxes - Payroll
   
Taxes - Real Estate
   
Taxes - Other
   
Travel and Entertainment
   
Utilities
   
Other (attach schedule)
   
Total Operating Expenses Before Depreciation
   
Depreciation/Depletion/Amortization
   
Net Profit(Loss) Before Other Income & Expenses
   
OTHER INCOME AND EXPENSES
   
Other Income (attach schedule)
   
Interest Expense
   
Other Expense (attach schedule)
   
Net Profit (Loss) Before Reorganization Items
   
REORGANIZATION ITEMS
   
Professional Fees
   
U.S. Trustee Quarterly Fees
   
Interest Earned on Accumulated Cash from Chapter 11 (see continuation sheet)
   
Gain(Loss) from Sale of Equipment
   
Other Reorganization Expenses (attach schedule)
   
Total Reorganization Expenses
   
Income Taxes
   
Net Profit(Loss)
   
* "Insider" is defined in 11 U.S.C. Section 101(31).
MOR-3
 
9/04
 
Note - Regarding the MOR-3, the Debtor’s Statement of Operations (Income Statement) is reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-3 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

STATEMENT OF OPERATIONS - continuation sheet - See Note Below
BREAKDOWN OF "OTHER" CATEGORY
Month
Cumulative
Filing to Date
     
Other Costs
   
 
   
 
   
Other Operational Expenses
   
 
   
 
   
Other Income
   
 
   
 
   
Other Expenses
   
 
   
 
   
Other Reorganization Expenses
   
 
   
 
   
 
   
 
Reorganization Items - Interest Earned on Accumulated Cash from Chapter 11:
Interest earned on cash accumulated during the chapter 11 case, which would not have been earned but for the bankruptcy proceeding, should be reported as a reorganization item.

MOR-3
9/04

Note - Regarding the MOR-3, the Debtor’s Statement of Operations (Income Statement) is reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-3 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

BALANCE SHEET - See Note Below
The Balance Sheet is to be completed on an accrual basis only.  Pre-petition liabilities must be classified separately from postpetition obligations.
ASSETS
BOOK VALUE AT END OF
CURRENT REPORTING MONTH
BOOK VALUE ON
PETITION DATE
CURRENT ASSETS
   
Unrestricted Cash and Equivalents
   
Restricted Cash and Cash Equivalents
   
Accounts Receivable (Net)
   
Notes Receivable
   
Inventories
   
Prepaid Expenses
   
Professional Retainers
   
Other Current Assets (attach schedule)
   
TOTAL CURRENT ASSETS
   
PROPERTY AND EQUIPMENT
   
Real Property and Improvements
   
Machinery and Equipment
   
Furniture, Fixtures and Office Equipment
   
Leasehold Improvements
   
Vehicles
   
Less Accumulated Depreciation
   
TOTAL PROPERTY & EQUIPMENT
   
OTHER ASSETS
   
Loans to Insiders
   
Other Assets (attach schedule)
   
TOTAL OTHER ASSETS
   
TOTAL ASSETS
   
     
LIABILITIES AND OWNER EQUITY
BOOK VALUE AT END OF
CURRENT REPORTING MONTH
BOOK VALUE ON
PETITION DATE
LIABILITIES NOT SUBJECT TO COMPROMISE (Post-Petition)
   
Accounts Payable
   
Taxes Payable (refer to …)
   
Wages Payable
   
Notes Payable
   
Rent / Leases - Building/Equipment
   
Secured Debt / Adequate Protection Payments
   
Professional Fees
   
Amounts Due to Insiders
   
Other Postpetition Liabilities (attach schedule)
   
TOTAL POST-PETITION LIABILITIES
   
LIABILITIES SUBJECT TO COMPROMISE (Pre-Petition)
   
Secured Debt
   
Priority Debt
   
Unsecured Debt
   
TOTAL PRE-PETITION LIABILITIES
   
     
TOTAL LIABILITIES
   
OWNER EQUITY
   
Capital Stock
   
Additional Paid-In Capital
   
Partners' Capital Account
   
Owner's Equity Account
   
Retained Earnings - Pre-Petition
   
Retained Earnings - Postpetition
   
Adjustments to Owner Equity (attach schedule)
   
Post-Petition Contributions (Distributions) (Draws) (attach schedule)
   
Net Owner Equity
   
     
TOTAL LIABILITIES AND OWNERS' EQUITY
   
 
Insider is defined in 11 U.S.C. Section 101(31)
MOR-4
 
9/04

Note - Regarding the MOR-4, the Debtor’s Balance Sheet is reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-4 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

BALANCE SHEET - continuation sheet - See Note Below
ASSETS
BOOK VALUE AT END OF
CURRENT REPORTING MONTH
BOOK VALUE ON
PETITION DATE
Other Current Assets
     
 
     
 
     
 
     
Other Assets
     
 
     
 
     
 
     
LIABILITIES AND OWNER EQUITY
BOOK VALUE AT END OF
CURRENT REPORTING MONTH
BOOK VALUE ON
PETITION DATE
Other Postpetition Liabilities
     
 
     
 
     
 
     
 
     
Adjustments to Owner Equity
     
 
     
 
     
 
     
Postpetition Contributions (Distributions) (Draws)
 
 
Restricted Cash: cash that is restricted for a specific use and not available to fund operations.
MOR-4
Typically, restricted cash is segregated into a separate account, such as an escrow account.
9/04

Note - Regarding the MOR-4, the Debtor’s Balance Sheet is reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-4 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

STATUS OF POST-PETITION TAXES - See Note Below
The beginning tax liability should be the ending liability from the prior month or, if this is the first report, the amount should be zero. Attach photocopies of IRS Form 6123 and all applicable state and local forms and/or all federal, state, and local payment receipts to verify payment of taxes.  Attach photocopies of any tax returns filed during the reporting period.

 
Beginning
Tax
Liability
Amount
Withheld or
Accrued
Amount
Paid
Date
Paid
Check No.
or EFT
Ending
Tax
Liability
             
Federal
           
Income Tax Withholding
           
FICA-Employee
           
FICA-Employer
           
Unemployment
           
Income
           
Other:
           
Total Federal Taxes
           
State and Local
           
Income Tax Withholding
           
Sales
           
Excise
           
Unemployment
           
Real Property
           
Personal Property
           
Other:
           
Total State and Local
           
Withholding for Employee Healthcare
           
Premiums, Pensions & Other Benefits
           
Total Taxes
           
             
SUMMARY OF UNPAID POST-PETITION DEBTS - See Note Below
Attach aged listing of accounts payables
           
             
 
Number of Days Past Due
 
Current
0-30
31-60
61-90
Over 90
Total
Accounts Payable
           
Wages Payable
           
Taxes Payable
           
Rent/Leases-Building
           
Rent/Leases-Equipment
           
Secured Debt/Adequate Protection Payments
           
Professional Fees
           
Amounts Due to Insiders*
           
Other:
           
Other:
           
Total Postpetition Debts
           
 
Explain how and when the Debtor intends to pay any past-due post-petition debts.
 
 
 
 
 
 
 
 
 
 
*"Insider" is defined in 11 U.S.C. Section 101(31).
MOR-5
 
9/04

Note - Regarding the MOR-5, the Debtor’s Status of Post-Petition Taxes and Summary of Post-Petition Unpaid Debts are reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-5 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16

ACCOUNTS RECEIVABLE RECONCILIATION AND AGING - See Note Below
   
       
ACCOUNTS RECEIVABLE RECONCILIATION
Amount
   
Total Accounts Receivable at the beginning of the reporting period
     
+ Amounts billed during the period
     
- Amounts collected during the period
     
Total Accounts Receivable at the end of the reporting period
     
       
Accounts Receivable Aging
Amount
   
0 - 30 days old
     
31 - 60 days old
     
61 - 90 days old
     
91+ days old
     
Total Accounts Receivable
     
Amount considered uncollectible (Bad Debt)
     
Accounts Receivable (Net)
     

 
MOR-6
 
9/04

Note - Regarding the MOR-6, the Debtor’s Accounts Receivable Reconciliation and Aging is reported on a consolidated basis with its parent company, Cosi, Inc.  The Cosi, Inc. MOR-6 has been submitted herewith.
 

Hearthstone Associates, LLC.
Case No.
16-13707-MSH
Debtor
Reporting Period
10/25/16-11/28/16
 
SUPPLEMENTAL SCHEDULE OF CASH RECEIPTS AND DISBURSEMENTS

Amounts reported should be per the debtor's books, not the bank statement.  The beginning cash should be the ending cash from the prior month or, if this is the first report, the amount should be the balance on the date the petition was filed.  Attach copies of the bank statements and the cash disbursements journal.  The total disbursements listed in the disbursements journal must equal the total disbursements reported on this page.  A bank reconciliation must be attached for each account.
 
 
BANK ACCOUNTS
 
Bank of
America
Bank of
America
     
 
004610087435
004610087435
   
Total
CASH BEGINNING OF MONTH
3,171
2,977
-
-
6,148
           
RECEIPTS
         
CASH SALES
   
-
-
-
ACCOUNTS RECEIVABLE
5,019
-
-
-
5,019
LOANS AND ADVANCES
-
-
-
-
-
SALE OF ASSETS
-
-
-
-
-
OTHER (ATTACH LIST)
-
-
-
-
-
TRANSFERS (FROM DIP ACCTS)
-
-
-
-
-
           
TOTAL RECEIPTS
5,019
-
-
-
5,019
           
DISBURSEMENTS
         
NET PAYROLL
-
-
-
-
-
PAYROLL TAXES
-
-
-
-
-
SALES, USE & OTHER TAXES
-
-
-
-
-
INVENTORY PURCHASES
-
-
-
-
-
SECURED/RENTAL/LEASES
-
-
-
-
-
INSURANCE
-
-
-
-
-
ADMINISTRATIVE
-
-
-
-
-
SELLING
-
-
-
-
-
BANK FEES
51
-
-
-
51
______________________________
         
OWNER DRAW *
-
-
-
-
-
TRANSFERS (TO DIP ACCTS)
-
-
-
-
-
______________________________
         
PROFESSIONAL FEES
-
-
-
-
-
U.S. TRUSTEE QUARTERLY FEES
-
 
-
-
-
COURT COSTS
-
-
-
-
-
TOTAL DISBURSEMENTS
51
-
-
-
51
           
NET CASH FLOW
         
(RECEIPTS LESS DISBURSEMENTS)
4,968
-
-
-
4,968
CASH - END OF MONTH
8,138
2,977
-
-
11,115
CASH BALANCE PER BANK
11,689
2,977
   
14,666
Variance
(3,551)
-
-
-
(3,551)
         
*COMPENSATION TO SOLE PROPRIETORS FOR SERVICES RENDERED TO BANKRUPTCY ESTATE 
SUPPLEMENT TO MOR-2
9/04
 
 


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