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IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF TENNESSEE NASHVILLE DIVISION -----------------------------------------------------------------------IN RE: ) ) Chapter

11 CHURCH STREET HEALTH MANAGEMENT, LLC, ) 1 et al. ) Case No. 12-01573 ) Debtors ) Jointly Administered -----------------------------------------------------------------------GLOBAL NOTES AND STATEMENT OF LIMITATIONS, METHODOLOGY, AND DISCLAIMER REGARDING THE DEBTORS' SCHEDULES OF ASSETS AND LIABILITIES AND STATEMENTS OF FINANCIAL AFFAIRS Church Street Health Management LLC and its subsidiaries, as debtors and debtors in possession (collectively, the "Debtors"), have filed their respective Schedules of Assets and Liabilities (the "Schedules") and Statements of Financial Affairs (the "SOFAs", and collectively with the "Schedules," the "Schedules and Statements") in the United States Bankruptcy Court for the Middle District of Tennessee (the "Bankruptcy Court"). The Debtors, with the assistance of their advisors, prepared the Schedules and Statements in accordance with section 521 of title 11 of the United States Code (the "Bankruptcy Code") and Rule 1007 of the Federal Rules of Bankruptcy Procedure (the "Bankruptcy Rules"). Rodney Cawood, the Chief Financial Officer of the Debtors, has signed the Schedules and Statements. In reviewing and signing the Schedules and Statements, Mr. Cawood has necessarily relied upon the efforts, statements, and representations of various personnel of the Debtors. Mr. Cawood has not (and could not have) personally verified the accuracy of each such statement and representation, including statements and representations concerning amounts owed to creditors. These Global Notes and Statement of Limitations, Methodology, and Disclaimer Regarding the Schedules and Statements (the "Global Notes") pertain to, are incorporated by reference in, and comprise an integral part of all of the Schedules and Statements. The Global Notes should be referred to and reviewed in connection with any review of the Schedules and

The Debtors (with the last four digits of each Debtors federal tax identification number and chapter 11 case number), are: Church Street Health Management, LLC (2335; Case No. 12-01573), Small Smiles Holding Company, LLC (4993; Case No. 12-01574), FORBA NY, LLC (8013; Case No. 12-01575), FORBA Services, Inc. (6506; Case No. 12-01577), EEHC, Inc. (4973; Case No. 12-01576).

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Statements.2 In the event that the Schedules and Statements differ from any of the foregoing Global Notes, the Global Notes shall control. The Schedules and Statements do not purport to represent financial statements prepared in accordance with Generally Accepted Accounting Principles in the United States ("GAAP"), nor are they intended to be fully reconciled to the Debtors financial statements. The Schedules and Statements contain unaudited information that is subject to further review and potential adjustment. In preparing the Schedules and Statements, the Debtors relied on financial data derived from their books and records that was available at the time of such preparation. The Debtors have made reasonable and good faith efforts to ensure the accuracy and completeness of such financial information, but further research or discovery may identify subsequent information that may necessitate material amendments to the Schedules and Statements. As a result, the Debtors are unable to warrant or represent that the Schedules and Statements are without inadvertent errors, omissions, or inaccuracies and may be amended in the future. Nothing contained in the Schedules and Statements shall constitute a waiver of any of the Debtors' rights or an admission with respect to their chapter 11 cases, including, without limitation, any issues involving substantive consolidation, equitable subordination, offsets or defenses, and/or causes of action arising under the provisions of chapter 5 of the Bankruptcy Code and any other relevant applicable laws to recover assets or avoid transfers. 1. Summary of Significant Reporting Policies. The following is a summary of significant reporting policies: a) Allocation of Liabilities. The Debtors allocated liabilities between the prepetition and postpetition periods based on research conducted in connection with the preparation of the Schedules and Statements. As additional information becomes available and further research is conducted, the allocation of liabilities between the prepetition and postpetition periods may change. The Debtors reserve all rights to modify, amend, and supplement the Schedules and Statements as is necessary and appropriate. b) Amendments and Supplements. While the Debtors made reasonable and good faith efforts to file complete and accurate Schedules and Statements, inadvertent errors or omissions may exist. The Debtors reserve all rights to amend or supplement the Schedules and Statements as is necessary and appropriate. c) Bankruptcy Court Orders. Pursuant to various orders entered or to be entered by the Bankruptcy Court (collectively, the "Pre-petition Payment Orders"), the

These Global Notes are in addition to the specific notes contained in each Debtor's Schedules and Statements. The fact that the Debtors have prepared a "Specific Note" with respect only to specific Schedules and Statements should not be interpreted as a decision by the Debtors to exclude the applicability of such Specific Note to any of the Debtors' remaining Schedules and Statements, as appropriate.

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Debtors were or will be authorized to pay certain outstanding pre-petition claims, including, without limitation, certain claims of employees for wages, salaries and benefits and certain tax claims. As a result, and as detailed herein, the Debtors have not listed these claims in the Schedules. To the extent such claims are listed on the Schedules and Statements, inadvertently or otherwise, the Debtors do not waive any right to amend the Schedules and Statements and/or subsequently object to such claims on any basis, including that such claims have already been satisfied through payments with respect to the Pre-petition Payment Orders. d) Claims Description. Any failure to designate a claim on a given Debtor's Schedules and Statements as "disputed," "contingent," or "unliquidated" does not constitute an admission by the Debtor that such amount is not "disputed," "contingent," or "unliquidated." The Debtors reserve all rights to dispute any claim, whether reflected on their respective Schedules and Statements or asserted pursuant to a filed proof of claim, on any grounds, including, without limitation, amount, liability or classification, or to otherwise subsequently designate such claims as "disputed," "contingent," or "unliquidated." e) Classifications. Listing a claim or contract (i) on Schedule D as "secured," (ii) on Schedule F as "unsecured," or (iii) on Schedule G as "executory" or "unexpired," does not constitute an admission by the Debtors of the legal rights of the claimant, or a waiver of the Debtors' right to recharacterize or reclassify such claim or contract. f) Causes of Action. Despite reasonable and good faith efforts, the Debtors may not have identified and/or set forth all of their causes of action (filed or potential) against third parties as assets in their Schedules and Statements. The Debtors reserve all rights with respect to any causes of action and nothing in the Global Notes or the Schedules and Statements shall be deemed a waiver of any such causes of action. Similarly, in instances where the Debtors are defendants in pending causes of action, nothing in the Global Notes or the Schedules and Statements shall be deemed as an admission or determination with respect to, or a waiver of any defense or objection to, such causes of action, and all of the Debtors defenses, objection and other rights with respect to such causes of action are hereby preserved. g) Confidential, Private, and Commercially Sensitive Information. In certain instances, the Debtors may have intentionally altered, revised, redacted or consolidated certain information in the Schedules and Statements due to the nature of an agreement between a Debtor and a third party, concerns about the confidential or commercially sensitive nature of certain information or concerns for the privacy of an individual. In addition, in certain instances, the sensitivity of such information may require its omission from the Schedules and Statements. To the extent possible, the alterations, redactions, consolidations and omissions have been limited to the extent determined by the Debtors to be necessary or appropriate to protect the Debtors or third parties while also providing interested parties with sufficient information in response to the Schedules and Statements.

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The Debtors have not included addresses of current and former employees or directors in the Schedules and Statements. h) Entity Classification Issues. The Debtors have endeavored in good faith to identify the assets owned by each Debtor and the liabilities owed by each Debtor. While the Schedules reflect the results of this effort, several factors may impact the ability of the Debtors precisely to assign assets and liabilities to particular Debtor entities, including but not limited to (i) certain assets may be primarily used by a Debtor other than the entity which holds title to such assets according to the Debtors books and records; (ii) certain liabilities may have been nominally incurred by one Debtor, yet such liabilities may have actually been incurred by, or the invoices related to such liabilities may have been issued to or in the name of, another Debtor; and (iii) certain creditors of the Debtors may have treated one or more of the Debtors as a consolidated entity rather than as differentiated entities. i) Estimates and Assumptions. In preparing the Schedules and Statements, the Debtors were required to make certain estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure and potential values of contingent assets and liabilities on the date the Schedules and Statements were filed and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates, perhaps materially. j) Excluded Assets and Liabilities. The Debtors have excluded certain categories of assets and liabilities from the Schedules and Statements such as de minimis deposits, and accrued liabilities including, without limitation, tax accruals and accrued accounts payable. Other immaterial assets and liabilities may also have been excluded. Finally, certain deferred charges, accounts, or reserves recorded for GAAP reporting purposes only are not included in the Debtors Schedules. k) Executory Contracts and Unexpired Leases. The Debtors have not necessarily set forth executory contracts and unexpired leases as assets in the Schedules and Statements, even though these contracts may have some value to the Debtors' estates. The Debtors' executory contracts and unexpired leases have been set forth in Schedule G. The Debtors rejection of executory contracts and unexpired leases will result in the assertion of rejection damages claims; however, the Schedules and Statements do not reflect any rejection damages claims. The Debtors reserve the right to make any arguments and objections with respect to the assertion of any such claims. l) Insiders. For purposes of the Schedules and Statements, the Debtors define "insiders" pursuant to section 101(31) of the Bankruptcy Code as: (i) directors; (ii) officers; (iii) persons in control of the Debtors; (iv) relatives of directors, officers, or persons in control of the Debtors; and (v) affiliates. Persons listed as "insiders" have been included for informational purposes only. The Debtors do not take any position with respect to: (i) such person's influence over the control of the Debtors; (ii) the management responsibilities or functions

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of such individual; (iii) the decision-making or corporate authority of such individual; or (iv) whether such individual could successfully argue that he or she is not an "insider" under applicable law, including, without limitation, the federal securities laws, or with respect to any theories of liability, or for any other purpose. The listing of a party as an insider is not intended to be nor should it be construed as a legal characterization of such party as an insider, nor should it be construed as an admission that such party is an insider, all such rights, claims and defenses are expressly reserved. m) Intercompany Claims. Receivables and payables among the Debtors in these cases (each an "Intercompany Receivable" or "Intercompany Payable" and, collectively, the "Intercompany Claims") are reported on Schedule B(16) or Schedule F as a receivable or payable due to or from the applicable Debtor to or from the other Debtors. Where no balance is listed, the Debtors do not believe, based on information currently available, that the applicable Debtor has any Intercompany Receivables or Intercompany Payables. n) Litigation. The Debtors have listed on Schedule F all known claimants related to any pending or threatened litigation action as contingent, unliquidated and disputed with unknown amounts. Although claim amounts were not estimated, allowed claims, if any, for these claimants may be substantial. For confidentiality reasons and in compliance with the HIPAA requirements, the Debtors have not included the names and other personal information of the litigants. o) Net Book Value. In certain instances, market valuations are neither maintained by, nor readily available to, the Debtors. In other instances, market valuations are available but they are out-of-date. It would be prohibitively expensive, unduly burdensome and an inefficient use of estate assets for the Debtors to obtain current market valuations of all of their assets. Accordingly, unless otherwise indicated, the Debtors' Schedules and Statements reflect the Debtors assets at net book values. Market values of these assets may vary, at some times materially, from the net book value of such assets. As applicable, assets that have been fully depreciated or were expensed for accounting purposes have no net book value. p) Petition Date. Financial information for Church Street Health Management LLC is, unless otherwise noted herein or in the Schedules and Statements, provided as of February 20, 2012. Financial information for all remaining Debtors is as of February 21, 2012. q) Recharacterization. Notwithstanding that the Debtors have made reasonable efforts to correctly characterize, classify, categorize, or designate certain claims, assets, executory contracts, unexpired leases, and other items reported in the Schedules and Statements, the Debtors nonetheless may have improperly characterized, classified, categorized, or designated certain items. Thus, the Debtors reserve all rights to recharacterize, reclassify, recategorize, or redesignate items reported in the Schedules and Statements at a later time as is necessary and appropriate as additional information becomes available.

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r) Third-Party Property. In the ordinary course of their business, the Debtors lease equipment from certain third-party lessors for use in the daily operation of their business and otherwise use and hold property owned by third-parties pursuant to contracts and leases with such parties. Such leases or contracts are set forth in Schedule G. The property subject to any such leases or contracts is not reflected in either Schedule A or Schedule B as either owned property or assets of the Debtors. Neither is the property subject to any such leases or contracts reflected in the Debtors SOFAs as property or assets of third-parties within the control of the Debtors. Nothing contained in the Schedules and Statements is or shall be construed as an admission or determination as to the legal status of any lease (including, but not limited to, whether any lease is a true lease or a financing arrangement) or contract (including, but not limited to, whether the contract is, in fact, an executory contract), and the Debtors reserve all rights with respect to any such issues. s) Totals. All totals that are included in the Schedules and Statements represent totals of all known amounts included in the Debtors' books and records as of the Petition Date. To the extent there are unknown or undetermined amounts, the actual total may be different than the listed total. t) Undetermined Amounts. The description of an amount as unknown, TBD, or undetermined is not intended to reflect upon the materiality of such amount. 2. Specific Schedules and Statements Disclosures a) Schedule B(23) Other general intangible assets. Certain contracts that have recognized book values under GAAP but which are not readily convertible to cash are not reflected on Schedule B(23). These contracts are included in Schedule G. b) Schedule D - Creditors Holding Secured Claims. Except as otherwise agreed pursuant to a stipulation and agreed order or general order entered by the Bankruptcy Court that is or becomes final, the Debtors and/or their estates reserve the right to dispute or challenge the validity, perfection or immunity from avoidance of any lien purported to be granted or perfected in any specific asset to a creditor listed on Schedule D of any Debtor. Moreover, although the Debtors may have scheduled claims of various creditors as secured claims for informational purposes, no current valuation of the Debtors assets in which such creditors may have a lien has been undertaken. The Debtors reserve all rights to dispute or challenge the secured nature of any such creditors claim or the characterization of the structure of any such transaction or any document or instrument (including, without limitation, any intercompany agreement) related to such creditors claim. In certain instances, a Debtor may be a co-obligor or guarantor with respect to scheduled claims of other Debtors, and no claim set forth on Schedule D of any Debtor is intended to acknowledge claims of creditors that are otherwise satisfied or discharged by other entities. The descriptions in Schedule D are intended only to be a summary.

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Reference to the applicable loan agreements and related documents and a determination of the creditors compliance with applicable law is necessary for a complete description of the collateral and the nature, extent and priority of any liens. Nothing in the Global Notes or the Schedules and Statements shall be deemed a modification or interpretation of the terms of such agreements or related documents. The claims listed on Schedule D arose or were incurred on various dates and a determination of each date upon which each claim arose or was incurred would be unduly burdensome and cost prohibitive. Accordingly, not all such dates are included for each claim. All claims listed on Schedule D, however, appear to have arisen or to have been incurred prior to the Petition Date. Real property lessors, utility companies, and other parties that may hold security deposits have not been listed on Schedule D. The Debtors have not included on Schedule D parties that may believe their claims are secured through setoff rights, deposit posted by, or on behalf of, the Debtors, or inchoate statutory liens rights. c) Schedule E - Creditors Holding Unsecured Priority Claims. Pursuant to an order entered by the Bankruptcy Court on February 22, 2012, the Debtors have the authority to pay certain prepetition obligations, including employee wages and other employee benefits in the ordinary course of business (the "Employee Wage and Benefit Order"). As a result of the Employee Wage and Benefit Order, the Debtors believe that any employee claims for prepetition amounts related to ongoing payroll, benefits, and expense reimbursements whether allowable as a priority or nonpriority claim, have been or will be satisfied, and such satisfied amounts are listed on Schedule E as Contingent. Pursuant to a separate order entered by the Bankruptcy Court on March 13, 2012, the Debtors have the authority to pay certain prepetition taxes (the "Tax Order"). Pursuant to the Tax Order, the Debtors believe that any claims on account of such taxes have been or will be satisfied, and such satisfied amounts are listed on Schedule E as Contingent. Out of abundance of caution and in an effort to provide notice to holders of potential priority tax claims, the Debtors have listed holders of potential priority tax claims on Schedule E except to the extent such claims have been or will be satisfied pursuant to the Tax Order. The listing of a taxing authority on a Debtors Schedule E is not an acknowledgement that such taxing authority holds a valid claim against a particular Debtor or that a particular tax claim is entitled to priority under 11 U.S.C. 507(a)(8) or otherwise. The Debtors reserve the right to take the position that any claim listed on Schedule E is a secured claim, an unsecured or a subordinated claim. Further, certain potential or actual priority claims may be subject to audit and the Debtors are otherwise unable to determine with certainty the amount of many, if not all, of these claims. Therefore, the Debtors have listed all such claims as

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unknown in amount, pending final resolution of ongoing audits or other outstanding issues. d) Schedule F - Creditors Holding Unsecured Claims. Schedule F contains information regarding threatened or pending litigation or administrative action involving the Debtors. The amounts of these potential claims are listed as unknown and marked as contingent, unliquidated, and disputed in the Schedules. The Debtors expressly incorporate by reference into Schedule F all parties to pending and potential litigation, if any, listed in each Debtors SOFA 4(a) as contingent, unliquidated, and disputed claims, to the extent not already listed on Schedule F. Schedule F also reflects prepetition amounts owed to counterparties to executory contracts and unexpired leases. Such prepetition amounts, however, may be paid in connection with the assumption or assumption and assignment of an executory contract or unexpired lease. Schedule F does not include additional rejection damages claims, if any, of the counterparties to executory contracts and unexpired leases that may be rejected after the Petition Date. Nothing in the Global Notes or the Schedules and Statements shall be deemed a modification or interpretation of the terms of any agreement entered into by and between the Debtors and their creditors. The claims of creditors for, among other things, merchandise, goods, services, or taxes are listed on the Debtors' books and records and may not reflect credits or allowances due from such creditor. The Debtors reserve all of their rights respecting such credits and allowances. In addition, the amounts of claims listed on Schedule F may be exclusive of contingent and unliquidated amounts. Schedule F does not include certain deferred charges, deferred liabilities, accruals or general reserves. Such amounts are, however, reflected on the Debtors books and records as required in accordance with GAAP. Such accruals are general estimates of liabilities and do not represent specific claims as of the Petition Date. e) Schedule G - Executory contracts and unexpired leases. Although reasonable efforts have been made to ensure the accuracy of Schedule G regarding executory contracts and unexpired leases, the Debtors review is ongoing and inadvertent errors, omissions, or over-inclusion may have occurred. Any and all of the Debtors rights, claims, and causes of action with respect to the contracts, agreements, and leases listed on Schedule G are hereby reserved and preserved, and, as such, the Debtors hereby reserve all of their rights to dispute the validity, status, or enforceability of any contracts, agreements, or leases set forth on Schedule G and to amend or supplement such Schedule as necessary. The placing of a contract or lease onto Schedule G shall not be deemed an admission that such contract is an executory contract or unexpired lease, or that it

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is necessarily a binding, valid and enforceable contract. The Debtors hereby expressly reserve the right to assert that any claim listed on Schedule G does not constitute an executory contract within the meaning of section 365 of the Bankruptcy Code. Omission of a contract, agreement or lease from Schedule G does not constitute an admission that such omitted contract, agreement or lease is not an executory contract or unexpired lease. The Debtors rights under the Bankruptcy Code with respect to any such omitted contracts, agreements and leases are not impaired by their omission. Schedule G may be amended at any time to add any omitted contract, agreement or lease. The Debtors may have entered into various other types of agreements in the ordinary course of their business, such as indemnity agreements, supplemental agreements, amendments/letter agreements, and confidentiality agreements. Such documents may not be set forth in Schedule G. Moreover, the contracts, agreements, and leases listed on Schedule G may have expired or may have been modified, amended, or supplemented from time to time by various amendments, restatements, waivers, estoppels certificates, letters, or other documents, instruments, and agreements that may not be listed on Schedule G. Portions of some contracts and leases that are listed on Schedule G may have been fully performed, while other portions of the same contracts and leases may remain executory or unexpired. Certain of the contracts, agreements, and leases listed on Schedule G may contain renewal options, guarantees of payments, options to purchase, rights of first refusal, rights to lease additional space and other miscellaneous rights. Such rights, powers, duties and obligations may not be set forth on Schedule G. Certain of the agreements listed on Schedule G may be in the nature of conditional sales agreements or secured financings. The presence of these agreements or any other agreements on Schedule G does not constitute an admission that any such agreement is an executory contract or unexpired lease. The Debtors reserve all of their rights, claims and causes of action with respect to the contracts and agreements listed on Schedule G, including the right to dispute or challenge the characterization or the structure of any transaction, document, or instrument. Certain executory agreements may not have been memorialized in writing and could be subject to dispute. Further, the Debtors may be parties to various other agreements concerning real property, such as easements, rights of way, subordination, non-disturbance, supplemental agreements, amendments/letter agreements, title documents, consents, site plans, maps and other miscellaneous agreements. Such agreements, if any, are not set forth in Schedule G.

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The Debtors have attempted to list the appropriate Debtor parties to each contract, agreement, and lease on Schedule G. However, there may be instances in which other Debtor entities that are not parties to the contracts, agreements, and leases have been the primary entities conducting business in connection with these contracts, agreements, and leases. Accordingly, the Debtors have listed certain contracts, agreements, and leases on Schedule G of the Debtor entity corresponding to the applicable contracting entity on which may, upon further review, differ from the primary entity conducting business with the counterparty to that particular contract, agreement, or lease. Additionally, certain of the contracts, agreements, and leases listed on Schedule G may have been entered into by more than one of the Debtors. f) Schedule H - Co-Debtors. Although the Debtors have made every effort to ensure the accuracy of Schedule H, inadvertent errors, omissions or inclusion may have occurred. The Debtors hereby reserve all rights to dispute the validity, status or enforceability of any obligations set forth on Schedule H and to further amend or supplement such Schedule as necessary. The Debtors further reserve all rights, claims and causes of action with respect to the obligations listed on Schedule H, including the right to dispute or challenge the characterization or the structure of any transaction, document or instrument related to a creditors claim. The listing of a contract, guarantee or other obligation on Schedule H shall not be deemed an admission that such obligation is binding, valid or enforceable. g) SOFA Question 3(b) - Payments to Creditors within 90 days. The Debtors have made reasonable and good faith efforts to include all payments made to creditors within the 90 days preceding the Petition Date in their responses to SOFA 3(b). To the extent the Debtors become aware that they have omitted any such payments, they will amend the SOFAs accordingly. All amounts that remain outstanding to any creditor listed on Statement Question 3 are reflected on Schedules D, E, and F as applicable. Any creditor wishing to verify any outstanding indebtedness should review those schedules. Certain payments made to creditors were made via corporate credit cards. Those payments to creditors will not be reflected in the Debtors responses to Question 3b. Certain intercompany transactions are accounted for through transfers of cash to and from appropriate bank accounts in and out of the Debtors cash management system after certain adjustments are made to intercompany accounts receivable and accounts payable among the Debtor and its Debtor and non-Debtor affiliates. These payments and transactions have not been listed. However, readers of the Schedules and Statements wishing to verify any outstanding Intercompany Payables and Intercompany Receivables should refer to Schedules B16, D or F, as applicable.

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h) SOFA Question 3(c) Payments to Insiders within 1 year. All payments to insiders have been reported under SOFA 23. The Debtors have made reasonable and good faith efforts to include all payments made to insiders within 1 year preceding the Petition Date in their responses to SOFA 23. To the extent the Debtors become aware that they have omitted any such payments, they will amend the SOFAs accordingly. i) SOFA Question 4(a) - Suits and Administrative Proceedings. The Debtors have made reasonable and good faith efforts to include in their responses to SOFA 4(a) a complete list of all lawsuits and litigation proceedings to which the Debtors were a party within the one (1) year period immediately preceding the Petition Date. To the extent the Debtors become aware that they have omitted any such lawsuits or proceedings, they will amend the SOFAs accordingly. For confidentiality reasons and in compliance with the HYPAA requirements, the Debtors have not included the names and other personal information of the litigants. j) SOFA Question 23 - Withdrawals from a partnership or distributions by a corporation within one year. SOFA 23 includes payments to insiders in the form of checks, wire transfers and other similar disbursements made from bank accounts historically used for payroll and other employee-related disbursements. In addition, for confidentiality reasons, the Debtors have not included the names or relationships of the individual to the Debtors. The information will be shared with the Bankruptcy Court, the US Trustees office and other appropriate parties upon request.

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B7 (Official Form 7) (04/10)

United States Bankruptcy Court


Middle District of Tennessee
In re Church Street Health Management, LLC Debtor(s) Case No. Chapter 12-01573 (KML) 11

STATEMENT OF FINANCIAL AFFAIRS


This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information for both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all such activities as well as the individual's personal affairs. To indicate payments, transfers and the like to minor children, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. 112; Fed. R. Bankr. P. 1007(m). Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question. DEFINITIONS "In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "in business" for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any of the following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be "in business" for the purpose of this form if the debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from the debtor's primary employment. "Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives; corporations of which the debtor is an officer, director, or person in control; officers, directors, and any owner of 5 percent or more of the voting or equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11 U.S.C. 101.

1. Income from employment or operation of business


None

State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor's business, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the two years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT $1,535,257.00 $32,981,946.00 $38,103,803.00 SOURCE YTD 02/21/12 - Net Revenue FYE 2011 - Net Revenue FYE 2010 - Net Revenue

2. Income other than from employment or operation of business


None

State the amount of income received by the debtor other than from employment, trade, profession, or operation of the debtor's business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE

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Best Case Bankruptcy

3. Payments to creditors
None

Complete a. or b., as appropriate, and c. a. Individual or joint debtor(s) with primarily consumer debts. List all payments on loans, installment purchases of goods or services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR


None

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $5,850*. If the debtor is an individual, indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments and other transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATES OF PAYMENTS/ TRANSFERS AMOUNT PAID OR VALUE OF TRANSFERS

NAME AND ADDRESS OF CREDITOR See Attachment 3b

AMOUNT STILL OWING

None

c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF PAYMENT AMOUNT PAID AMOUNT STILL OWING

NAME AND ADDRESS OF CREDITOR AND RELATIONSHIP TO DEBTOR See SoFA 23

4. Suits and administrative proceedings, executions, garnishments and attachments


None

a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NATURE OF PROCEEDING COURT OR AGENCY AND LOCATION STATUS OR DISPOSITION

CAPTION OF SUIT AND CASE NUMBER See Attachment 4a


None

b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF SEIZURE DESCRIPTION AND VALUE OF PROPERTY

NAME AND ADDRESS OF PERSON FOR WHOSE BENEFIT PROPERTY WAS SEIZED

Amount subject to adjustment on 4/01/13, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

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5. Repossessions, foreclosures and returns


None

List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF REPOSSESSION, FORECLOSURE SALE, TRANSFER OR RETURN DESCRIPTION AND VALUE OF PROPERTY

NAME AND ADDRESS OF CREDITOR OR SELLER 6. Assignments and receiverships


None

a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF ASSIGNMENT TERMS OF ASSIGNMENT OR SETTLEMENT

NAME AND ADDRESS OF ASSIGNEE


None

b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAME AND LOCATION OF COURT CASE TITLE & NUMBER DATE OF ORDER DESCRIPTION AND VALUE OF PROPERTY

NAME AND ADDRESS OF CUSTODIAN 7. Gifts


None

List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) RELATIONSHIP TO DEBTOR, IF ANY DATE OF GIFT DESCRIPTION AND VALUE OF GIFT

NAME AND ADDRESS OF PERSON OR ORGANIZATION See Attachment 7

8. Losses
None

List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DESCRIPTION OF CIRCUMSTANCES AND, IF LOSS WAS COVERED IN WHOLE OR IN PART BY INSURANCE, GIVE PARTICULARS

DESCRIPTION AND VALUE OF PROPERTY

DATE OF LOSS

9. Payments related to debt counseling or bankruptcy


None

List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt consolidation, relief under the bankruptcy law or preparation of the petition in bankruptcy within one year immediately preceding the commencement of this case. DATE OF PAYMENT, NAME OF PAYOR IF OTHER THAN DEBTOR AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY

NAME AND ADDRESS OF PAYEE See Attachment 9

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10. Other transfers


None

a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security within two years immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE DESCRIBE PROPERTY TRANSFERRED AND VALUE RECEIVED

NAME AND ADDRESS OF TRANSFEREE, RELATIONSHIP TO DEBTOR


None

b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settled trust or similar device of which the debtor is a beneficiary. AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY OR DEBTOR'S INTEREST IN PROPERTY

NAME OF TRUST OR OTHER DEVICE

DATE(S) OF TRANSFER(S)

11. Closed financial accounts


None

List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (Married debtors filing under chapter 12 or chapter 13 must include information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) TYPE OF ACCOUNT, LAST FOUR DIGITS OF ACCOUNT NUMBER, AND AMOUNT OF FINAL BALANCE Checking-2213032804 4Q 2011 AMOUNT AND DATE OF SALE OR CLOSING No balance

NAME AND ADDRESS OF INSTITUTION Associated Bank 330 East Kilbourn Avenue Milwaukee, WI 53202 12. Safe deposit boxes
None

List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) NAMES AND ADDRESSES OF THOSE WITH ACCESS TO BOX OR DEPOSITORY DESCRIPTION OF CONTENTS DATE OF TRANSFER OR SURRENDER, IF ANY

NAME AND ADDRESS OF BANK OR OTHER DEPOSITORY 13. Setoffs


None

List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF SETOFF AMOUNT OF SETOFF

NAME AND ADDRESS OF CREDITOR 14. Property held for another person
None

List all property owned by another person that the debtor holds or controls.

NAME AND ADDRESS OF OWNER

DESCRIPTION AND VALUE OF PROPERTY

LOCATION OF PROPERTY

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15. Prior address of debtor


None

If the debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate address of either spouse. NAME USED FORBA Dental Management DATES OF OCCUPANCY 09/26/06 to 02/28/09

ADDRESS 415 N. Grand Avenue Pueblo, CO 81003 16. Spouses and Former Spouses
None

If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight years immediately preceding the commencement of the case, identify the name of the debtors spouse and of any former spouse who resides or resided with the debtor in the community property state.

NAME 17. Environmental Information. For the purpose of this question, the following definitions apply: "Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination, releases of hazardous or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium, including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes, or material. "Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or formerly owned or operated by the debtor, including, but not limited to, disposal sites. "Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, or contaminant or similar term under an Environmental Law
None

a. List the name and address of every site for which the debtor has received notice in writing by a governmental unit that it may be liable or potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the notice, and, if known, the Environmental Law: NAME AND ADDRESS OF GOVERNMENTAL UNIT DATE OF NOTICE ENVIRONMENTAL LAW

SITE NAME AND ADDRESS


None

b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice. NAME AND ADDRESS OF GOVERNMENTAL UNIT DATE OF NOTICE ENVIRONMENTAL LAW

SITE NAME AND ADDRESS


None

c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and the docket number. DOCKET NUMBER STATUS OR DISPOSITION

NAME AND ADDRESS OF GOVERNMENTAL UNIT

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18 . Nature, location and name of business


None

a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six years immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities within six years immediately preceding the commencement of this case. If the debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within six years immediately preceding the commencement of this case. If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within six years immediately preceding the commencement of this case. LAST FOUR DIGITS OF SOCIAL-SECURITY OR OTHER INDIVIDUAL TAXPAYER-I.D. NO. (ITIN)/ COMPLETE EIN

NAME FORBA NY, LLC

ADDRESS 618 Church Street Suite 520 Nashville, TN 37219 618 Church Street Suite 520 Nashville, TN 37219 618 Church Street Suite 520 Nashville, TN 37219

NATURE OF BUSINESS Dental Practice Management Services

BEGINNING AND ENDING DATES 09/13/06

FORBA Services, Inc.

Inactive

09/11/06

EEHC, Inc.

Dental Practice Management Services

05/07/09

None

b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as defined in 11 U.S.C. 101.

NAME

ADDRESS

The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or has been, within six years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, or owner of more than 5 percent of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership, a sole proprietor, or self-employed in a trade, profession, or other activity, either full- or part-time. (An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as defined above, within six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should go directly to the signature page.) 19. Books, records and financial statements
None

a. List all bookkeepers and accountants who within two years immediately preceding the filing of this bankruptcy case kept or supervised the keeping of books of account and records of the debtor. DATES SERVICES RENDERED 02/20/10 to Present

NAME AND ADDRESS Brad Gardner Senior Vice President and Controller 618 Church Street, Suite 520 Nashville, TN 37219 Rodney Cawood Chief Financial Officer 618 Church Street, Suite 520 Nashville, TN 37219

02/20/10 to Present

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7 None

b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the books of account and records, or prepared a financial statement of the debtor. ADDRESS 150 4th Avenue N #1400 Nashville, TN 37219 3310 West End Ave #550 Nashville, TN 37203 DATES SERVICES RENDERED FYE 2007 to 2010 (Financial Audit) FYE 2008 to 2010 (Audit of Employee 401K Benefit Plan)

NAME Ernst & Young Frasier Dean & Howard

None

c. List all firms or individuals who at the time of the commencement of this case were in possession of the books of account and records of the debtor. If any of the books of account and records are not available, explain. ADDRESS 618 Church Street, Suite 520 Nashville, TN 37219 618 Church Street, Suite 520 Nashville, TN 37219

NAME Brad Gardner Rodney Cawood

None

d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a financial statement was issued by the debtor within two years immediately preceding the commencement of this case. DATE ISSUED

NAME AND ADDRESS See Attachment 19d

20. Inventories
None

a. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each inventory, and the dollar amount and basis of each inventory. INVENTORY SUPERVISOR DOLLAR AMOUNT OF INVENTORY (Specify cost, market or other basis)

DATE OF INVENTORY
None

b. List the name and address of the person having possession of the records of each of the two inventories reported in a., above.

DATE OF INVENTORY

NAME AND ADDRESSES OF CUSTODIAN OF INVENTORY RECORDS

21 . Current Partners, Officers, Directors and Shareholders


None

a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership.

NAME AND ADDRESS


None

NATURE OF INTEREST

PERCENTAGE OF INTEREST

b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly or indirectly owns, controls, or holds 5 percent or more of the voting or equity securities of the corporation. TITLE NATURE AND PERCENTAGE OF STOCK OWNERSHIP

NAME AND ADDRESS See Attachment 21b

22 . Former partners, officers, directors and shareholders


None

a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding the commencement of this case. ADDRESS DATE OF WITHDRAWAL

NAME

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8 None

b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one year immediately preceding the commencement of this case. TITLE Chief Compliance Officer Chief Operating Officer Senior Vice President - Human Resources Senior Vice President South/West Region Chief Executive Officer Manager Senior Vice President Development Executive Vice President Regional Operations DATE OF TERMINATION 04/29/11 12/02/11 06/10/11 12/09/11 11/08/11 2011 12/31/11 12/15/11

NAME AND ADDRESS Allison Luke Al J. Smith Brandon Dyson Jason Owen Michael Lindley Susan Kasser Todd Cruse William Nash

23 . Withdrawals from a partnership or distributions by a corporation


None

If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensation in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding the commencement of this case. DATE AND PURPOSE OF WITHDRAWAL AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY

NAME & ADDRESS OF RECIPIENT, RELATIONSHIP TO DEBTOR See Attachment 23

24. Tax Consolidation Group.


None

If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any consolidated group for tax purposes of which the debtor has been a member at any time within six years immediately preceding the commencement of the case. TAXPAYER IDENTIFICATION NUMBER (EIN)

NAME OF PARENT CORPORATION See Attachment 24 25. Pension Funds.


None

If the debtor is not an individual, list the name and federal taxpayer-identification number of any pension fund to which the debtor, as an employer, has been responsible for contributing at any time within six years immediately preceding the commencement of the case. TAXPAYER IDENTIFICATION NUMBER (EIN) 20-4762335

NAME OF PENSION FUND Forba Holdings Retirement Plan September 2007 to Present

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B7 (Official Form 7) (04/10)

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP


I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they are true and correct to the best of my knowledge, information and belief.

Date March 22, 2012

Signature

/s/ Rodney Cawood Rodney Cawood Executive Vice President and Chief Financial Officer

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]
Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. 152 and 3571

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

200 SOUTH BROADWAY, LLC ATTN: SCOTT M. LUINSTRA (ALI'I MANAGEMENT, LLC) 201 W 8TH ST STE 300 PUEBLO CO 81003 11/23/11 01/05/12 02/02/12 ADVENTURE 3 PROPERTIES LP ATTN MICHAEL SHMERLING 618 CHURCH STREET SUITE 220 NASHVILLE TN 37219 11/23/11 12/01/11 01/05/12 01/26/12 ALTAIR DATA RESOURCES INC. ATTN STEVEN COLLINS 730 COOL SPRINGS BLVD. SUITE 130 FRANKLIN TN 37067 12/01/11 01/12/12 02/09/12 02/16/12 ALVAREZ & MARSAL HEALTHCARE ATTN: MARTIN J. MCGAHAN, CRO 600 LEXINGTON AVE, 6TH FLOOR NEW YORK NY 10022 12/21/11 01/12/12 02/09/12 ALVAREZ & MARSAL LLC 600 LEXINGTON AVE 6TH FLOOR NEW YORK NY 10022 02/17/12

$4,514.14 $4,514.14 $400.00 $9,428.28

$33,760.98 $106.48 $33,760.98 $33,760.98 $101,389.42

$12,667.00 $12,667.00 $12,667.00 $20,167.00 $58,168.00

$348,423.32 $270,996.55 $386,755.10 $1,006,174.97

$218,000.00

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

AMERICAN EXPRESS TRS COMPANY, INC. PO BOX 650448 DALLAS TX 75265

12/05/11 12/08/11 12/08/11 12/08/11 12/15/11 12/29/11 01/12/12 01/12/12 01/17/12 02/02/12 02/06/12 02/15/12 AMERIS HEALTH SYSTEMS LLC 1114 17TH AVENUE SOUTH SUITE 205 NASHVILLE TN 37212 12/05/11 APPLIANCE THERAPY GROUP P.O. BOX 4184 VAN NUYS CA 91409-4184

$11,662.74 $33,586.94 $18.51 $1,365.49 $68,554.02 $6,248.68 $2,732.37 $1,176.80 $68,802.40 $1,979.66 $27,623.35 $58,349.81 $282,100.77

$7,134.85

12/01/11 01/05/12 02/02/12 AUTONOMY INC. PO BOX 8374 PASADENA CA 91109-8374

$12,990.95 $10,003.65 $9,269.45 $32,264.05

12/08/11 01/12/12 02/09/12 02/16/12

$11,754.77 $10,820.00 $12,008.00 $12,043.64 $46,626.41

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

AXIS DIRECT INC. ATTN MATT WILSON 1631 LEBANON PIKE CIRCLE NASHVILLE TN 37210 11/23/11 12/08/11 12/29/11 01/05/12 02/09/12 BENEFITS BROKER ATTN DAVID VECCHIO 503 NORTH MAIN STREET #107-LL PUEBLO CO 81003 12/08/11 01/12/12 02/09/12 02/16/12 BERKELEY RESEARCH GROUP LLC 2200 POWELL ST. SUITE 1200 EMERYVILLE CA 94608 $13,064.00 $12,936.00 $12,456.00 $12,256.00 $50,712.00 $454.20 $4,247.87 $7,460.87 $12,393.51 $5,270.52 $29,826.97

01/19/12 BERNARD HODES GROUP INC P.O. BOX 751741 CHARLOTTE NC 28275-1741

$6,930.00

11/23/11 12/08/11 12/21/11 12/29/11 01/12/12 02/02/12 02/09/12 02/16/12

$224.25 $1,647.12 $1,000.00 $150.00 $1,367.92 $410.30 $750.00 $435.30 $5,984.89

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

BERNAT, JOSEPH DDS 3435 MAIN STREET NEW YORK NY 14214

02/17/12 BRADLEY B WILLIAMS ADDRESS WITHHELD

$6,000.00

11/23/11 12/01/11 12/08/11 12/15/11 12/21/11 12/29/11 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12 BRENTWOOD COMMUNICATIONS, INC. ATTN: CHUCK SNYDER 215 JAMESTOWN PARK ROAD SUITE 203 BRENTWOOD TN 37027 11/23/11 12/28/11 01/05/12 01/12/12 01/26/12 CDW DIRECT LLC ATTN JIM GALIVAN P.O. BOX 75723 CHICAGO IL 60675-5723 11/23/11 12/01/11 12/08/11 12/21/11 01/05/12 01/19/12

$2,845.56 $8,749.81 $3,531.91 $9,375.84 $9,663.50 $1,261.62 $36.89 $419.00 $1,773.45 $724.02 $581.06 $1,498.81 $7,069.71 $47,531.18

$71,785.04 $71,785.04 $229.01 $131.10 $48,300.00 $192,230.19

$196.25 $455.15 $263.93 $58.68 $235.95 $322.24

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

CDW DIRECT LLC ATTN JIM GALIVAN P.O. BOX 75723 CHICAGO IL 60675-5723 01/26/12 02/02/12 02/16/12 CENTRAL PARKING SYSTEM PO BOX 790402 ST. LOUIS MO 63179-0402 $1,500.77 $314.60 $4,428.81 $7,776.38

11/23/11 12/21/11 01/19/12 CIGNA (LINA) PO BOX 13701 PHILADELPHIA PA 19101-3701

$2,466.00 $1,575.50 $1,918.00 $5,959.50

12/02/11 12/02/11 12/19/11 12/19/11 12/19/11 01/04/12 01/18/12 01/18/12 01/18/12 02/02/12 02/17/12 02/17/12 02/17/12 02/17/12 CO DEPT OF PUBLIC HEALTH & ENVIRONMENT 4300 CHERRY CREEK DR S DENVER CO 80246-1530

$6,486.35 $554.45 $792.47 $414.17 $643.95 $279.58 $837.25 $76.46 $122.53 $24.68 $755.87 $147.00 $5.10 $2,872.52 $14,012.38

12/30/11

$29,316.26

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

COMCAST SPOTLIGHT PO BOX 8500-53003 ATTN: BUSINESS OPERATIONS PHILADELPHIA PA 19178 12/01/11 COREY GOLD DBA : ADVANCED CONTINUING EDUCATION SYST 85 MARBELLA SAN CLEMENTE CA 92673-2756 12/01/11 01/12/12 02/02/12 COVERALL NORTH AMERICA, INC. ATTN: JAYNE LEE 5201 CONGRESS AVENUE SUITE 275 BOCA RATON FL 33487 11/23/11 01/05/12 02/02/12 02/16/12 DANSEREAU HEALTH PRODUCTS INC 1581 COMMERCE STREET CORONA CA 92880 $105,355.09 $104,617.35 $104,667.94 $97,842.14 $412,482.52 $4,000.00 $4,000.00 $4,000.00 $12,000.00 $7,474.90

12/01/11 12/08/11 12/15/11 01/12/12 01/26/12 02/02/12 02/16/12 DE LAGE LANDEN FINANCIAL SERVICES P.O. BOX 41602 PHILADELPHIA PA 19101-1602

$1,306.51 $394.78 $3,472.11 $1,145.87 $822.73 $546.82 $382.15 $8,070.97

11/23/11 12/08/11 12/29/11

$551.33 $2,088.31 $551.33

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

DE LAGE LANDEN FINANCIAL SERVICES P.O. BOX 41602 PHILADELPHIA PA 19101-1602

01/12/12 01/26/12 02/09/12 DELL MARKETING L.P. C/O DELL USA L.P. ATTN CALEB CARTER P.O. BOX 534118 ATLANTA GA 30353-4118 12/01/11 12/29/11 01/12/12 02/16/12 DENTSPLY INTERNATIONAL INC PO BOX 536935 ATLANTA GA 30353

$2,088.31 $551.33 $2,088.31 $7,918.92

$12,474.98 $12,480.72 $373.64 $1,304.67 $26,634.01

12/01/11 12/29/11 02/09/12 DR BILAL AHMED ADDRESS WITHHELD

$9,538.64 $16,432.27 $5,633.78 $31,604.69

12/15/11 01/19/12 02/16/12 DR CYNTHIA C LOYD BALDWIN ADDRESS WITHHELD

$2,884.06 $3,860.63 $1,243.75 $7,988.44

12/15/11 01/19/12 02/16/12

$3,376.76 $4,277.23 $1,208.79 $8,862.78

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

DR DAVID SCHLEICHER ADDRESS WITHHELD

12/15/11 12/29/11 01/12/12 01/26/12 02/09/12 DR JAMES L MANN ADDRESS WITHHELD

$2,192.58 $2,125.85 $17.78 $2,362.57 $925.81 $7,624.59

12/15/11 01/19/12 02/16/12 DR JODI KUHN ADDRESS WITHHELD

$5,475.38 $2,714.34 $1,144.32 $9,334.04

12/14/11 12/15/11 01/19/12 02/16/12 DR KEVIN F KINGRY ADDRESS WITHHELD

$60.00 $2,090.06 $4,521.17 $2,589.05 $9,260.28

12/15/11 01/19/12 02/16/12 DR KEVIN M REILLY ADDRESS WITHHELD

$2,220.64 $3,372.07 $488.75 $6,081.46

12/01/11 12/21/11 12/29/11

$3,869.20 $4,459.86 $379.98

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

DR KEVIN M REILLY ADDRESS WITHHELD

01/12/12 02/02/12 02/09/12 DR LESLEE S HUGGINS ADDRESS WITHHELD

$3,804.19 $786.16 $3,228.05 $16,527.44

11/23/11 12/01/11 12/08/11 12/15/11 12/21/11 12/29/11 01/12/12 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12 DR MARLENE NAVEDO ADDRESS WITHHELD

$596.28 $30.86 $128.60 $845.42 $289.94 $266.60 $174.65 $654.55 $268.62 $223.70 $483.68 $2,877.69 $6,840.59

11/23/11 12/15/11 12/21/11 01/05/12 01/12/12 02/02/12 02/09/12 02/16/12 DR OLIVIA D CROOM ADDRESS WITHHELD

$998.44 $1,196.19 $3,234.57 $2,052.72 $1,987.40 $3,320.69 $3,317.23 $2,042.35 $18,149.59

12/15/11 01/19/12

$766.19 $1,062.03

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

DR OLIVIA D CROOM ADDRESS WITHHELD

02/16/12 DR PATRICIA NICKLAS ADDRESS WITHHELD

$4,421.77 $6,249.99

12/14/11 12/15/11 01/19/12 02/16/12 DR RABI ALTATARI ADDRESS WITHHELD

$75.00 $2,297.10 $3,217.61 $1,481.52 $7,071.23

12/15/11 01/19/12 02/16/12 DR RANDALL W ELLIS ADDRESS WITHHELD

$1,462.21 $2,591.53 $1,940.86 $5,994.60

12/01/11 12/14/11 12/21/11 01/05/12 01/05/12 01/26/12 DR ROBERT STONE ADDRESS WITHHELD

$2,229.74 $40.00 $824.74 $1,100.61 $1,000.00 $1,318.84 $6,513.93

12/01/11 12/15/11 12/29/11 01/12/12

$3,383.89 $3,115.52 $2,019.11 $3,368.85

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

DR ROBERT STONE ADDRESS WITHHELD

01/26/12 02/09/12 DR STEVEN CHASE DIGHTON ADDRESS WITHHELD

$2,962.35 $2,710.78 $17,560.50

12/14/11 12/15/11 01/19/12 02/16/12 DR TARIQ SAWAQED ADDRESS WITHHELD

$200.00 $8,554.86 $8,304.71 $2,625.83 $19,685.40

12/15/11 01/19/12 02/16/12 EDWARD J KARBAN, DMD ADDRESS WITHHELD

$1,430.87 $3,209.14 $1,300.79 $5,940.80

12/01/11 12/15/11 12/29/11 01/12/12 01/26/12 02/09/12 ERICA M NUSS ADDRESS WITHHELD

$7,632.27 $12,699.11 $7,487.48 $6,491.15 $10,672.97 $9,945.05 $54,928.03

12/15/11 12/29/11 01/19/12

$1,575.76 $1,214.91 $1,618.87

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

ERICA M NUSS ADDRESS WITHHELD

01/26/12 02/02/12 02/09/12 02/16/12 ERNST & YOUNG US LLP 150 4TH AVE N SUITE 1400 NASHVILLE TN 37219 12/21/11 FEDEX PO BOX 660481 DALLAS TX 75266-0481

$1,646.05 $1,226.52 $1,511.93 $377.77 $9,171.81

$8,800.00

12/08/11 12/29/11 01/19/12 02/09/12 02/16/12 FOCUS SEARCH PARTNERS LLC 104 WOODMONT BOULEVARD, SUITE 210 NASHVILLE TN 37205

$107.83 $19,498.86 $11,440.92 $13,874.64 $27.91 $44,950.16

01/05/12 02/02/12 FOCUSONE SERVICES, INC. ATTN: RAY HINES 209 10TH AVENUE SOUTH SUITE 514 NASHVILLE TN 37203 11/23/11 12/01/11 12/08/11 12/15/11 12/21/11 12/29/11

$39,647.28 $256.91 $39,904.19

$2,201.79 $20,552.22 $20,235.64 $9,701.92 $8,388.39 $16,644.62

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

FOCUSONE SERVICES, INC. ATTN: RAY HINES 209 10TH AVENUE SOUTH SUITE 514 NASHVILLE TN 37203 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12 FOLEY HOAG LLP SEAPORT WORLD TRADE CENTER WEST 155 SEAPORT BLVD. BOSTON MA 02210-2600 01/23/12 02/02/12 02/02/12 02/16/12 02/17/12 FUN EXPRESS INC. 10525 J STREET OMAHA NE 68127-1021 $100,000.00 $39,859.44 $27,390.60 $29,834.27 $7,584.79 $204,669.10 $23,325.75 $9,177.04 $8,269.15 $7,801.99 $18,208.70 $60,083.79 $14,617.64 $219,208.64

11/23/11 12/08/11 12/15/11 12/21/11 12/29/11 01/12/12 01/19/12 01/26/12 02/09/12 02/16/12 GA DEPT OF COMMUNITY HEALTH 2 PEACHTREE STREET, NW ATLANTA GA 30303

$3,706.63 $5,000.00 $5,000.00 $5,000.00 $6,381.36 $10,000.00 $5,000.00 $5,192.97 $10,000.00 $6,817.65 $62,098.61

12/28/11

$13,747.43

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

GCG, INC. 1985 MARCUS AVENUE LAKE SUCCESS NY 11042

02/17/12 GLENN ENTERPRISES 3626 TROUSDALE DR SUITE C&D NASHVILLE TN 37204 12/21/11 01/12/12 02/16/12 GLOBAL COMPLIANCE SERVICES, INC. ATTN: ALLISON MALIN 13950 BALLANTYNE CORPORATE PLACE SUITE 300 CHARLOTTE NC 28277 12/01/11 12/15/11 GOLDEN DENTAL SERVICES, LLC ATTN: CORY FISHER 112 CRAWFORD CIRCLE GOLDEN CO 80401 11/23/11 12/08/11 12/15/11 12/21/11 12/29/11 01/05/12 01/12/12 01/19/12 02/02/12 02/09/12 02/16/12 HARTFORD CASUALTY INSURANCE COMPANY ONE HARTFORD PLAZA HARTFORD CT 06115

$20,000.00

$5,861.68 $5,785.00 $14,250.00 $25,896.68

$4,100.00 $6,300.00 $10,400.00

$5,931.99 $2,500.00 $2,500.00 $2,500.00 $1,494.60 $2,500.00 $2,500.00 $2,415.71 $2,500.00 $2,500.00 $10,678.95 $38,021.25

12/15/11

$2,788.05

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

HARTFORD CASUALTY INSURANCE COMPANY ONE HARTFORD PLAZA HARTFORD CT 06115

01/12/12 02/09/12 HENRY SCHEIN INC. DEPT. CH 10241 PALATINE IL 60055-0241

$2,788.05 $6,372.96 $11,949.06

11/29/11 12/06/11 12/13/11 12/20/11 12/30/11 01/06/12 01/13/12 01/20/12 01/27/12 02/03/12 02/10/12 02/17/12 HOMEWOOD SUITES CHURCH ST LODGING LLP 706 CHURCH STREET NASHVILLE TN 37203

$150,000.00 $175,000.00 $175,000.00 $175,000.00 $175,000.00 $250,000.00 $250,000.00 $250,000.00 $215,000.00 $207,000.00 $217,000.00 $241,000.00 $2,480,000.00

12/21/11 01/05/12 02/16/12 INFORMATION TECHNOLOGY EXPERTS CHEROKEE NATION TECHNOLOGIES LLC NETWORK SECURITY MANAGER 2120 S. COLLEGE AVENUE FORT COLLINS CO 80525 12/01/11 01/12/12 01/19/12 01/26/12 02/09/12

$8,306.95 $13,324.92 $17,429.85 $39,061.72

$1,011.38 $148.75 $1,717.32 $2,642.64 $8,815.92 $14,336.01

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

INFOSURV, INC. ATTN: SCOTT PURDIE 3340 PEACHTREE ROAD NE SUITE 475 ATLANTA GA 30326 12/01/11 01/05/12 02/09/12 02/16/12 INSTANT WEB INC. DBA: IWCO DIRECT PO BOX 1521 MINNEAPOLIS MN 55480-1521 11/23/11 12/01/11 12/15/11 12/22/11 01/05/12 01/26/12 INTERO OFFICE SOLUTIONS ATTN JOHN PECORARO 101 N. MAIN STREET PUEBLO CO 81003 11/23/11 12/01/11 12/08/11 12/15/11 12/21/11 12/29/11 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12 JASON P OWEN ADDRESS WITHHELD $22,084.61 $32,424.82 $22,709.25 $22,189.71 $16,136.69 $30,422.65 $24,513.34 $17,066.76 $21,112.85 $10,059.53 $33,774.18 $23,258.79 $21,490.97 $297,244.15 $44,966.29 $2,807.18 $4,324.06 $160,567.40 $14,007.50 $42,478.32 $269,150.75 $4,459.02 $4,774.86 $4,640.88 $4,925.64 $18,800.40

11/23/11 12/08/11

$2,573.81 $1,530.52

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

JASON P OWEN ADDRESS WITHHELD

12/15/11 KENDRICK FINANCIAL SERVICES LLC ATTN SCOTT KENDRICK 2324 GOLF CLUB LANE NASHVILLE TN 37215 11/23/11 12/08/11 12/21/11 01/05/12 01/19/12 02/09/12 KERRY L LESTER ADDRESS WITHHELD

$3,717.65 $7,821.98

$12,039.50 $10,188.00 $12,899.00 $9,825.00 $12,562.50 $17,025.00 $74,539.00

12/08/11 12/15/11 01/05/12 01/19/12 01/26/12 02/09/12 02/16/12 KING & SPALDING LLP P.O. BOX 116133 ATLANTA GA 30368-6133

$162.36 $25.00 $752.36 $1,725.90 $2,500.00 $1,688.07 $3,968.85 $10,822.54

12/12/11 01/05/12 02/09/12 02/16/12 02/16/12

$300,000.00 $200,000.00 $200,000.00 $269,661.46 $230.00 $969,891.46

Case 3:12-bk-01573

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

LAKE TRAVIS ORAL & MAXILLOFACIAL SURG 1921 LOHMANS CROSSING SUITE 208 LAKEWAY TX 78734 12/01/11 12/29/11 01/26/12 LBMC TECHNOLOGIES, LLC 5250 VIRGINIA WAY THIRD FLOOR BRENTWOOD TN 37027 12/08/11 12/15/11 01/05/12 01/12/12 02/09/12 LELLYETT & ROGERS CO. ATTN BRIAN BOWMAN 1717 LEBANON ROAD NASHVILLE TN 37210-3206 12/01/11 01/05/12 02/02/12 02/16/12 LIFE INSURANCE COMPANY OF NORTH AMERICA PO BOX 13701 PHILADELPHIA PA 19101-3701 $68,470.69 $36,725.30 $77,907.73 $51,528.88 $234,632.60 $5,770.26 $7,538.25 $4,896.95 $1,638.75 $3,027.59 $22,871.80 $2,819.67 $2,368.30 $2,675.02 $7,862.99

02/09/12 LINDA ZOELLER ADDRESS WITHHELD

$45,738.90

12/15/11 02/09/12 02/16/12

$1,486.67 $1,990.52 $3,074.75 $6,551.94

Case 3:12-bk-01573

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

LITTLE DARLINGS DENTAL, PLLC 2102 N COUNTRY CLUB STE A TUCSON AZ 85716 02/17/12 LOCKTON COMPANIES LLC P.O. BOX 671410 DALLAS TX 75267-1410 $25,000.00

11/23/11 01/12/12 02/09/12 02/16/12 LORING R. HELFRICH JR. DBA: LRH CONSULTING ATTN LORING R. HELFRICH, JR. 302 PAGE ROAD NASHVILLE TN 37205 12/05/11 LORRI STEINER ADDRESS WITHHELD

$14,583.33 $14,583.37 $14,583.33 $14,583.33 $58,333.36

$11,000.00

12/01/11 12/21/11 02/02/12 02/09/12 02/16/12 LYDIA'S PROFESSIONAL UNIFORMS ATTN: ACCOUNTS RECEIVABLE 2547 THREE MILE ROAD N.W. SUITE F GRAND RAPIDS MI 49534-1358 12/01/11 12/29/11 01/26/12

$1,606.99 $4,250.46 $4,345.35 $5,008.91 $2,547.85 $17,759.56

$21,235.54 $14,933.18 $7,944.52 $44,113.24

Case 3:12-bk-01573

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

MARSH USA, INC. 3560 LENOX RD SUITE 2400 ATLANTA GA 30326 02/17/12 MCBH CHURCH SQUARE LLC ATTN DAVID FREDERICK 2701 NORTH CHARLES STREET SUITE 404 BALTIMORE MD 21218 11/23/11 MD DEPT OF HEALTH AND MENTAL HYGIENE 201 WEST PRESTON STREET BALTIMORE MD 21201 $7,598.32 $170,517.00

12/28/11 MELISSA GREEN ADDRESS WITHHELD

$13,124.27

11/23/11 12/08/11 12/29/11 01/26/12 02/09/12 02/16/12 MELISSA L SHEALY ADDRESS WITHHELD

$880.66 $113.87 $793.02 $5,915.76 $919.40 $4,654.36 $13,277.07

12/01/11 12/15/11 12/21/11 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12

$1,123.22 $279.78 $2,266.17 $3,021.40 $733.75 $744.37 $630.15 $855.64

Case 3:12-bk-01573

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

MELISSA L SHEALY ADDRESS WITHHELD

02/09/12 METROPOLITAN LIFE INS CO DEPT LA 21296 PASADENA CA 91185

$1,143.26 $10,797.74

12/08/11 02/09/12 METROPOLITAN TRUSTEE PERSONALTY TAX DEPARTMENT P.O. BOX 305012 NASHVILLE TN 37230-5012 02/16/12 MFCU OF NEW YORK ATTN: MONICA HICKEY-MARTIN, DIRECTOR 120 BROADWAY 13TH FL NEW YORK NY 10271 12/30/11 MOTION PICTURE LICENSING CORP ATTN: SALVATORE A. LAUDICINA 5455 CENTINELA AVENUE LOS ANGELES CA 90066 01/19/12 NM ATTORNEY GENERAL'S OFFICE 111 LOMAS BLVD NW, SUITE 300 MEDICAID FRAUD AND ELDER ABUSE DIVISION ATTN GRANT ADMINISTRATOR ALBUQUERQUE NM 87102 12/28/11

$76,355.50 $34,428.86 $110,784.36

$7,386.14

$15,029.27

$12,978.21

$8,678.12

Case 3:12-bk-01573

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Desc Main

Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

NUSMILE PRIMARY CROWNS 5524 CORNISH ST HOUSTON TX 77007

12/08/11 01/05/12 02/09/12 O.C. TANNER RECOGNITION COMPANY ATTN AMY GREENHALGH 1930 S. STATE STREET SALT LAKE CITY UT 84115 12/01/11 12/29/11 01/26/12 OFFICE OF THE ATTORNEY GENERAL 1412 MAIN STREET, SUITE 810 DALLAS TX 75202

$21,414.46 $14,785.40 $23,425.57 $59,625.43

$3,004.84 $2,951.17 $3,542.27 $9,498.28

12/28/11 12/30/11 OHIO ATTORNEY GENERAL ATTN: MIKE DEWINE STATE OFFICE TOWER 30 E. BROAD STREET 14TH FLOOR COLUMBUS OH 43215 12/28/11 OKLAHOMA ATTORNEY GENERAL ATTN: E. SCOTT PRUITT 313 NE 21ST STREET OKLAHOMA CITY OK 73105 12/28/11 PATTERSON 1031 MENDOTA HEIGHTS ROAD ST. PAUL MN 55120

$12,417.89 $34,547.43 $46,965.32

$23,895.79

$16,911.78

12/01/11 12/29/11

$57,456.37 $47,924.83

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

PATTERSON 1031 MENDOTA HEIGHTS ROAD ST. PAUL MN 55120

02/02/12 PATTI COX-SUNDAY 4121 NORTH 10TH #139 MCALLEN TX 78504 01/05/12 PINNACLE NATIONAL BANK 150 THIRD AVE S STE 800 NASHVILLE TN 37201 02/17/12 02/17/12 PINNACLE NATIONAL BANK 150 THIRD AVENUE S SUITE 800 NASHVILLE TN 37201 01/04/12 PROVIDERTRUST LLC ATTN MICHAEL ROSEN 2300 CHARLOTTE AVE STE 103 NASHVILLE TN 37203-1877 12/15/11 01/12/12 02/09/12 R DAVID ROBINSON 5509 HILL COURT NASHVILLE TN 37220

$46,923.72 $152,304.92

$5,950.00

$4,590.01 $2,990.00 $7,580.01

$13,800.04

$4,089.50 $4,059.80 $3,944.35 $12,093.65

12/08/11

$8,043.75

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

R.H. DONNELLEY INC. DBA: DEX ONE MANAGER, NATIONAL BUSINESS DEVELOPMENT 25364 NETWORK PLACE CHICAGO IL 60673-1253 12/15/11 02/09/12 RANDSTAD NORTH AMERICA LP PO BOX 105046 MAIL CODE 5602 ATLANTA GA 30348-5046 12/29/11 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12 02/16/12 ROBERT B. BENDER PH.D. ADDRESS WITHHELD

$25,344.30 $24,035.21 $49,379.51

$395.24 $438.62 $586.40 $555.84 $811.20 $1,614.40 $1,614.60 $6,016.30

11/23/11 12/01/11 12/29/11 ROBERT S DAYSE 2340 EVIAN COURT DISTRICT HEIGHTS MD 20747

$2,187.50 $12,468.75 $2,187.50 $16,843.75

12/01/11 12/15/11 01/12/12 01/26/12 RUBIN MEYER LLC ATTN DONALD MEYER 3210 GRACE STREET NW SUITE F WASHINGTON DC 20007-3628 12/29/11 02/02/12

$890.05 $5,343.98 $6,166.34 $2,981.42 $15,381.79

$11,948.51 $7,898.88

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

RUBIN MEYER LLC ATTN DONALD MEYER 3210 GRACE STREET NW SUITE F WASHINGTON DC 20007-3628 02/09/12 SAGE SOFTWARE INC ATTN STEPHANIE BANKEN P.O. BOX 849887 DALLAS TX 75284-9887 02/09/12 SANDERS MARKETING GROUP 1422 LEBANON ROAD NASHVILLE TN 37210 $7,496.47 $15,550.00 $35,397.39

01/05/12 SHAWN M NICHOLSON ADDRESS WITHHELD

$23,814.32

12/01/11 12/08/11 12/15/11 12/29/11 01/05/12 01/12/12 01/26/12 02/02/12 02/09/12 02/16/12 SHEILA W SAWYER ADDRESS WITHHELD

$966.66 $725.68 $433.29 $1,514.06 $1,393.29 $590.24 $1,910.45 $1,130.07 $1,415.47 $1,090.07 $11,169.28

11/23/11 12/01/11 01/19/12 02/16/12

$2,198.51 $1,631.78 $5,143.35 $5,847.48 $14,821.12

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

SHERRI R GARDNER ADDRESS WITHHELD

11/23/11 12/15/11 01/05/12 01/12/12 01/19/12 02/02/12 02/09/12 SNAGAJOBCOM INC 4880 COX ROAD SUITE 200 GLEN ALLEN VA 23060 12/01/11 12/29/11 01/26/12 02/16/12 STAPLES BUSINESS ADVANTAGE DEPT ATL P.O. BOX 530621 ATLANTA GA 30353-0621 12/01/11 01/05/12 02/09/12 STATE OF INDIANA DEPARTMENT OF REVENUE 100 N SENATE AVE INDIANAPOLIS IN 46204-2253 12/30/11 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE CORPORATION RETURN COLUMBIA SC 29214-0033 12/30/11

$920.50 $3,228.62 $1,099.61 $1,465.29 $1,150.41 $2,428.36 $1,235.19 $11,527.98

$3,173.12 $3,173.12 $2,958.72 $2,701.11 $12,006.07

$80,973.24 $95,037.82 $71,912.46 $247,923.52

$16,584.56

$22,449.00

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

STERICYCLE, INC. ATTN: TY YOUNG 4010 COMMERCIAL AVENUE NORTHBROOK IL 60062 12/08/11 01/19/12 02/09/12 02/16/12 STEVEN M ADAIR ADDRESS WITHHELD $11,515.78 $11,346.03 $4,959.29 $5,465.69 $33,286.79

11/23/11 12/08/11 12/21/11 01/12/12 02/09/12 02/16/12 STRATEGIC HEALTH SOLUTIONS, LLC ATTN: LESLIE SHAW 10040 REGENCY CIRCLE SUITE 150 OMAHA NB 88114 12/15/11 12/22/11 01/12/12 02/16/12 TCN CONSULTING, LLC ADDRESS WITHHELD

$3,228.41 $1,996.61 $1,603.67 $540.98 $1,343.80 $2,319.01 $11,032.48

$100,718.76 $175,000.00 $152,659.88 $93,895.16 $522,273.80

12/01/11 12/08/11 12/29/11 01/05/12 01/26/12 02/02/12 02/16/12

$32,000.00 $8,945.36 $32,000.00 $6,980.63 $32,000.00 $6,238.60 $48,000.00 $166,164.59

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

THE NATIONAL ASSOCIATION OF C/O BARBARA ZELNER, EXEC DIRECTOR 2030 M STREET NW 8TH FLOOR WASHINGTON DC 20036 02/16/12 TMG CO LLC ATTN DERRICK CAUDLE 1718 BRIARCREST DRIVE SUITE 100 BRYAN TX 77802 12/01/11 12/29/11 01/26/12 02/16/12 TOLLESONMCCOY ATTN ASHLEY TOLLESON 125 SOUTH 11TH STREET NASHVILLE TN 37206 12/01/11 12/08/11 12/29/11 01/12/12 02/02/12 02/16/12 TOWNE PARK AT 0139 SHERATON ATTN: ANTHONY JOHNSTON 623 UNION ST NASHVILLE TN 37219 12/05/11 01/04/12 02/03/12 UMR INC. 75 REMITTANCE DR. SUITE 91454 CHICAGO IL 60675 $6,995.17 $6,995.17 $6,995.17 $20,985.51 $2,733.63 $402.00 $965.94 $117.20 $332.50 $1,525.00 $6,076.27 $18,820.29 $19,074.64 $17,348.46 $17,712.30 $72,955.69 $6,345.19

11/29/11 12/05/11 12/12/11 12/15/11

$41,083.18 $101,101.99 $111,257.41 $45,385.96

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

UMR INC. 75 REMITTANCE DR. SUITE 91454 CHICAGO IL 60675

12/15/11 12/19/11 12/27/11 01/03/12 01/09/12 01/17/12 01/23/12 01/23/12 01/23/12 01/30/12 02/06/12 02/13/12 02/17/12 02/17/12 02/17/12 UNITED STATES DEPARTMENT OF JUSTICE OFFICE OF ATTORNEY GENERAL 950 PENNSYLVANIA AVE, NW WASHINGTON DC 20530-0001 12/30/11 VA OFFICE OF THE ATTORNEY GENERAL 900 E MAIN STREET 5TH FLOOR RICHMOND VA 23219

$25,119.10 $123,389.49 $123,915.13 $101,275.63 $75,717.87 $72,648.63 $87,521.74 $57,739.96 $25,034.80 $44,727.02 $51,638.80 $92,805.02 $64,535.81 $57,516.98 $24,688.80 $1,327,103.32

$373,324.11

12/30/11 VACO, LLC ATTN: JENNIE DICE D/B/A FINANCIAL 5410 MARYLAND WAY, STE 460 NASHVILLE TN 37027 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12

$10,878.42

$2,112.50 $2,730.00 $2,665.00 $2,665.00 $2,080.00 $12,252.50

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

VISION SERVICE PLAN PO BOX 60000 SAN FRANCISCO CA 94160

12/01/11 01/05/12 01/26/12 VISUAL DATA SOFTWARE CORPORATION 3110 MESA WAY SUITE B LAWRENCE KS 66049-4204

$6,271.48 $6,666.94 $6,451.33 $19,389.75

11/23/11 12/01/11 12/08/11 12/15/11 12/29/11 01/05/12 01/12/12 01/19/12 02/02/12 02/09/12 02/16/12 WALLER LANSDEN DORTCH & DAVIS PLLC 511 UNION ST, STE 2700 NASHVILLE TN 32719

$1,595.50 $17,407.69 $2,373.05 $1,734.95 $4,257.15 $20,376.30 $2,144.70 $1,919.30 $2,616.90 $5,303.60 $26,248.39 $85,977.53

12/21/11 01/12/12 02/09/12 02/17/12 WASTE MANAGEMENT INC P.O. BOX 930580 ATLANTA GA 31193

$77,199.28 $171,297.63 $178,203.73 $250,000.00 $676,700.64

11/23/11 12/29/11 01/26/12 02/09/12

$7,246.46 $7,568.87 $7,199.63 $7,145.37 $29,160.33

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Case No.: 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 3b (3b) Payments to Creditors within 90 days
Note: For "Amount Still Owing" as of the petition date, please refer to Schedules D, E and F of the Debtor's Bankruptcy Schedules.

NAME AND ADDRESS OF CREDITOR

DATES OF PAYMENTS

AMOUNT PAID

AMOUNT STILL OWING

WILLIAM C TRIVETT ADDRESS WITHHELD

11/23/11 12/01/11 12/08/11 12/15/11 01/19/12 02/02/12

$978.30 $2,085.11 $2,184.05 $294.05 $1,905.37 $5,557.94 $13,004.82

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 4a (4a) Suits and Administrative Proceedings Within One Year
STATUS OR DISPOSITION

CLAIMANT

PRACTICE

CLAIMANT ATTORNEY

Litigation - Filed Litigant(s) No. 0001 Small Smiles of South Bend, LLC Michael P. Misch Anderson Agostino & Keller 131 South Taylor South Bend, IN 46601 Patrick J. Higgins Powers & Santola LLP 39 North Pearl Street Albany, NY 12207 P. Kevin Leyendecker Moriarty Leyendecker PC 4203 Montrose Blvd., Suite 150 Houston, TX 77006 Hackerman Frankel PC 4203 Montrose Blvd., Suite 600 Houston, TX 77006 Patrick J. Higgins Powers & Santola LLP 39 North Pearl Street Albany, NY 12207 P. Kevin Leyendecker Moriarty Leyendecker PC 4203 Montrose Blvd., Suite 150 Houston, TX 77006 Hackerman Frankel PC 4203 Montrose Blvd., Suite 600 Houston, TX 77006 Patrick J. Higgins Powers & Santola LLP 39 North Pearl Street Albany, NY 12207 P. Kevin Leyendecker Moriarty Leyendecker PC 4203 Montrose Blvd., Suite 150 Houston, TX 77006 Hackerman Frankel PC 4203 Montrose Blvd., Suite 600 Houston, TX 77006 Pending

Litigant(s) No. 0002

Albany Access Dentistry, PLLC

Pending

Litigant(s) Nos. 0003 - 0012

Albany Access Dentistry, PLLC

Pending

Litigant(s) Nos. 0013 - 0022

Small Smiles Dentistry of Rochester, LLC

Pending

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 4a (4a) Suits and Administrative Proceedings Within One Year
STATUS OR DISPOSITION

CLAIMANT

PRACTICE

CLAIMANT ATTORNEY

Litigant(s) Nos. 0023 - 0032

Small Smiles Dentistry of Syracuse, LLC

Patrick J. Higgins Powers & Santola LLP 39 North Pearl Street Albany, NY 12207 P. Kevin Leyendecker Moriarty Leyendecker PC 4203 Montrose Blvd., Suite 150 Houston, TX 77006 Hackerman Frankel PC 4203 Montrose Blvd., Suite 600 Houston, TX 77006 Wesley D. Merillat Zoll Kranz & Borgess LLC Suite 100 6620 W. Central Avenue Toledo, OH 43617 Steve T. Horton Brent L. Neighbors Horton & Neighbors, P.C. 114 N.W. 6th Street, Suite 201 Oklahoma City, OK 73102

Pending

Litigant(s) Nos. 0033 - 0034

Small Smiles of Toledo, LLC

Pending

Litigant(s) Nos. 0035 - 0077

Childrens Dental Clinic of Oklahoma City, PLLC

Pending

Litigation - Threatened Litigant(s) Nos. 0078 - 0422 Estimated Number of Litigants: 0345 Steve T. Horton Brent L. Neighbors Horton & Neighbors, P.C. 114 N.W. 6th Street, Suite 201 Oklahoma City, OK 73102 Wesley D. Merillat Zoll Kranz & Borgess LLC Suite 100 6620 W. Central Avenue Toledo, OH 43617 Patrick J. Higgins Powers & Santola LLP 39 North Pearl Street Albany, NY 12207 P. Kevin Leyendecker Moriarty Leyendecker PC 4203 Montrose Blvd., Suite 150 Houston, TX 77006 Hackerman Frankel PC 4203 Montrose Blvd., Suite 600 Houston, TX 77006 Pending

Litigant(s) Nos. 0423 - 0499

Pending

Litigant(s) Nos. 0500 - 1091

Pending

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 4a (4a) Suits and Administrative Proceedings Within One Year
STATUS OR DISPOSITION

CLAIMANT

PRACTICE

CLAIMANT ATTORNEY

Equal Employment Opportunity Commission Cases - Filed Alma Shoopman Small Smiles Dental Center of Muncie, LLC David Carr Ice Miller LLP One American Square, Suite 2900 Indianapolis, IN 46282-0200 David Carr Ice Miller LLP One American Square, Suite 2900 Indianapolis, IN 46282-0200 Pro Se 461 Sixty-six Road Hannibal, NY 13074 Casey Crumbley Wigger Law Firm Inc. 8086 Rivers Avenue, Suite A North Charleston, SC 29406 Casey Crumbley Wigger Law Firm Inc. 8086 Rivers Avenue, Suite A North Charleston, SC 29406 Pending

Stacey Foster

Small Smiles Dental Center of Muncie, LLC

Pending

Paul Masuicca

Albany Access Dentistry, PLLC

Pending

Helen Fortner

Childrens Dental Clinic of Charleston, LLC

Pending

Leigh LaPlante

Childrens Dental Clinic of Charleston, LLC

Pending

Equal Employment Opportunity Commission Cases - Threatened Toccarra Robinson Small Smiles of Atlanta, P.C. Michael Cohen Barrett & Farahany LLP 1100 Peachtree Street NE, Suite 500 Atlanta, GA 30309 Michael Cohen Barrett & Farahany LLP 1100 Peachtree Street NE, Suite 500 Atlanta, GA 30309 Carlos E. Herandez, Jr. 200 E. Cano Street Edinburg, TX 78539 Pending

Katina Kemp

Small Smiles of Atlanta, P.C.

Pending

Renee Hanna

Texas Smiles Dental Center of Mission, PLLC

Pending

Colorado Department of Labor Audit In February 2012, the Colorado Department of Labor notified the Practice located in Thornton, Colorado that it was the subject of a random audit. As a result, the Practice must submit certain written affirmations and proof of the legal work status of each employee by March 1, 2012. If such affirmations and proof are not provided, a fine of $5,000 per incident could result.

Litigation - Closed Litigant(s) No. 011 Children's Dental Clinic of Oklahoma City, PLLC Michael Brooks-Jiminez Closed

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 4a (4a) Suits and Administrative Proceedings Within One Year
STATUS OR DISPOSITION

CLAIMANT

PRACTICE

CLAIMANT ATTORNEY

Litigant(s) No. 012

FORBA Holdings, LLC

Kevin Flaherty

Closed

Litigant(s) No. 013

Small Smiles Dentistry for Children, Albuquerque, PC

Steven Granberg

Closed

Litigant(s) No. 014

Small Smiles of East Albuquerque, PC

Jerald Roehl

Closed

Litigant(s) No. 015

Small Smiles of Washington D.C., PC

No Attorney

Closed

Equal Employment Opportunity Commission Cases - Closed Dr. Angel Ramos FORBA Holdings, LLC Jose Perez Closed

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 7 (7) Gifts and Charitable Contributions Within One Year
NAME AND ADDRESS OF PERSON OR ORGANIZATION RELATIONSHIP TO DEBTOR, IF ANY

DATE OF GIFT

DESCRIPTION OF GIFT

VALUE OF GIFT

American Heart Association Greater Southeast Affiliate PO Box 4002900 Des Moines, IA 50340-2900 Backfield in Motion 920 Woodland Street Nashville, TN 37206 Childrens Dental Health Project 1020 19th Street NW, Suite 400 Washington, DC 20036

02/21/11

Cash Gift

$5,000.00 $5,000.00

08/28/11

Cash Gift

$1,250.00 $1,250.00

01/20/11 02/17/11 03/24/11 04/21/11 05/19/11 06/23/11 07/21/11 08/18/11 11/10/11

$8,333.00 $8,333.00 $8,333.00 $8,333.00 $8,333.00 $8,333.00 $8,333.00 $8,333.00 $8,333.00 $74,997.00 Cash Gift $400.00 $400.00

Dismas House 1513 16th Avenue South Nashville, TN 37212 Iroquois Steeplechase Hospitality Village PO Box 129 Franklin, TN 37065 Martha OBryan Center 711 South Seventh Street Nashville, TN 37206 Vanderbilt University 2301 Vanderbilt Place Nashville, TN 37240-7727

09/16/11

02/21/11 05/03/11

Cash Gift Cash Gift

$10,000.00 $1,200.00 $11,200.00

06/02/11

Cash Gift

$10,000.00 $10,000.00

07/09/11

Cash Gift

$15,000.00 $15,000.00

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 9 (9) Payments Related to Bankruptcy Within One Year
NOTE: The following payments were made by Church Street Health Management, LLC on behalf of itself and related debtors EEHC, Inc., Forba NY, LLC, Forba Services, Inc., and Small Smiles Holding Company, LLC
NAME AND ADDRESS OF PAYEE NAME OF PAYOR, IF OTHER THAN DEBTOR DATE OF PAYMENT AMOUNT PAID

American Capital Financial Services Inc. 5225 Wisconsin Ave., 6th Floor Washington, DC 20815

02/24/11 03/17/11 07/14/11 07/21/11 10/06/11

$4,527.91 $18,190.40 $3,000.53 $37,859.63 $2,216.70 $65,795.17 $100,000.00 $180,564.12 $211,644.44 $348,423.32 $270,996.55 $386,755.10 $218,000.00 $1,716,383.53 $200,000.00 $753,764.32 $953,764.32 $75,085.26 $50,319.41 $50,000.00 $100,000.00 $100,018.84 $375,423.51 $100,000.00 $39,859.44 $27,390.60 $29,834.27 $7,584.79 $204,669.10 $9,363.64 $5,780.73 $382.34 $15,526.71 $20,000.00 $20,000.00

Alvarez & Marsal North America, LLC 600 Lexington Avenue, 6th Floor New York, NY 10022

09/15/11 10/06/11 10/27/11 12/21/11 01/12/12 02/09/12 02/17/12

CIT Healthcare LLC 11 W 42nd St., Fl 7 New York, NY 10036 Conway Del Genio Gries & Co., LLC 645 5th Ave, Suite 1100 New York, NY 10022

04/28/11 04/28/11

03/10/11 04/21/11 07/14/11 10/20/11 10/27/11

Foley Hoag LLP 155 Seaport Boulevard Boston, MA 02210

01/23/12 02/02/12 02/02/12 02/16/12 02/17/12

Fulbright & Jaworski L.L.P. 2200 Ross Avenue, Suite 2800 Dallas, TX 75201

05/26/11 07/14/11 11/17/11

GCG, Inc. 1985 Marcus Avenue, Suite 200 Lake Success, NY 11042

02/17/12

Patton Boggs LLP 2001 Ross Avenue Suite 1700 Dallas, TX 75201-1858

04/28/11

$69,342.83 $69,342.83

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 9 (9) Payments Related to Bankruptcy Within One Year
NOTE: The following payments were made by Church Street Health Management, LLC on behalf of itself and related debtors EEHC, Inc., Forba NY, LLC, Forba Services, Inc., and Small Smiles Holding Company, LLC
NAME AND ADDRESS OF PAYEE NAME OF PAYOR, IF OTHER THAN DEBTOR DATE OF PAYMENT AMOUNT PAID

Shearman & Sterling LLP 599 Lexington Avenue New York, NY 10022

03/17/11 04/14/11 04/28/11 07/21/11 08/04/11 08/11/11 10/20/11 11/03/11

$24,559.75 $46,381.80 $51,005.00 $18,601.85 $6,066.80 $3,909.42 $81,670.93 $84,399.04 $316,594.59 $100,000.00 $2,953.57 $8,549.78 $50,000.00 $110,845.90 $76,269.43 $77,199.28 $171,297.63 $178,203.73 $250,000.00 $1,025,319.32

Waller Lansden Dortch & Davis, LLP Attn: Robert P. Sweeter 511 Union Street, Suite 2700 Nashville, TN 37219

09/28/11 10/06/11 10/13/11 10/18/11 11/03/11 11/17/11 12/21/11 01/12/12 02/09/12 02/17/12

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 19d (19d) Financial Institutions, Creditors and Other Parties to Whom a Financial Statement Was Issued Within Two Years
NAME AND ADDRESS DATE ISSUED

Alvarez & Marsal 600 Lexington Avenue, 5th Floor New York, NY 10022 American Capital, Ltd. 5425 Wisconsin Ave, 6th Floor Washington, DC 20815 Arcapita 75 14th Street Atlanta, GA 30309 Capital Strategies Advisors Fund I, LLC 2501 Twentieth Place South, Suite 275 Birmingham, Alabama 35223 Carlyle Mezzanine Partners LP 520 Madison Avenue, 39th Floor New York, NY 10022 CIT Healthcare LLC 505 Fifth Avenue New York, NY 10017 Conway Del Genio Gries & Co. LLC 645 Fifth Avenue New York, NY 10022 Garrison Investment Group 1350 Avenue of The Americas, 9th Floor New York, NY 10019 Global Securitization Services, Inc. 114 West 47th Street, Suite 2310 New York, NY 10036 Patton Boggs LLP 2001 Ross Avenue, Suite 1700 Dallas, TX 75201 Sanus Blocking Corp. c/o Red River Ventures 6657 Virginia Parkway, Suite 400 McKinney, TX 75071

Various

Various

Various

Various

Various

Various

Various

Various

Various

Various

Various

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 19d (19d) Financial Institutions, Creditors and Other Parties to Whom a Financial Statement Was Issued Within Two Years
NAME AND ADDRESS DATE ISSUED

US Dept of Health & Human Services Office of Inspector General 330 Independence Avenue, S.W. Washington, DC 20201 US Department of Justice Office of the Attorney General 950 Pennsylvania Avenue, NW Washington, DC 20530

Various

Various

In addition, the Debtor provided or may have provided financial statements or certain financial information to potential customers, lenders, investors, ratings agencies or other parties in the ordinary course of business.

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 21b (21b) Current Partners, Officers, Directors, and Shareholders
NATURE AND PERCENTAGE OF STOCK OWNERSHIP

NAME AND ADDRESS

TITLE

Brad Gardner 618 Chruch Street, Suite 520 Nashville, TN 37219 Brad Williams 618 Church Street, Suite 520 Nashville, TN 37219 Bret Bero 618 Chruch Street, Suite 520 Nashville, TN 37219 Charles Griffith 618 Church Street, Suite 520 Nashville, TN 37219 Chris Moore 618 Church Street, Suite 520 Nashville, TN 37219 Daniel Dunn 618 Church Street, Suite 520 Nashville, TN 37219 Douglas Kelley 618 Chruch Street, Suite 520 Nashville, TN 37219 Dr. Ghassan Souri 618 Church Street, Suite 520 Nashville, TN 37219 Dr. Kevin M. Reilly 618 Church Street, Suite 520 Nashville, TN 37219 Dr. Marlene Navedo 618 Church Street, Suite 520 Nashville, TN 37219 Dr. Steven M. Adair 618 Church Street, Suite 520 Nashville, TN 37219 Jacob Kochenberger 618 Church Street, Suite 520 Nashville, TN 37219

Senior Vice President and Controller

Senior Vice President, Tax and Treasury

Manager

Manager

Assistant Vice President, Compliance

Assistant Vice President, Development and Analysis

Manager

Chief Dental Officer

Executive Vice President Dental Center Operations

Senior Vice President, North/East Region

Director of Clinical Quality Initiatives and Education

Assistant Vice President, Dentist Recruitment

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 21b (21b) Current Partners, Officers, Directors, and Shareholders
NATURE AND PERCENTAGE OF STOCK OWNERSHIP

NAME AND ADDRESS

TITLE

Linda Zoeller 618 Church Street, Suite 520 Nashville, TN 37219 Lorri Steiner 618 Church Street, Suite 520 Nashville, TN 37219 Mike McCulla 618 Church Street, Suite 520 Nashville, TN 37219 Moni Cook 618 Church Street, Suite 520 Nashville, TN 37219 Olivia Croom 618 Church Street, Suite 520 Nashville, TN 37219 Paige Mulvihill 618 Church Street, Suite 520 Nashville, TN 37219 Rodney Cawood 618 Church Street, Suite 520 Nashville, TN 37219 Scott A. Buschmann 618 Chruch Street, Suite 520 Nashville, TN 37219 Shelia W. Sawyer 618 Chruch Street, Suite 520 Nashville, TN 37219 Small Smiles Holding Company, LLC 618 Church Street, Suite 520 Nashville, TN 37219 Stockton Croft 618 Chruch Street, Suite 520 Nashville, TN 37219 Tammy Green 618 Church Street, Suite 520 Nashville, TN 37219

Assistant Vice President, Legal

Senior Vice President and Chief Compliance Officer

Senior Vice President, Marketing/Dentist Recruiting

Vice President, Internal Audit

Senior Vice President Operations

Vice Presidentt, Financial Operations

Executive Vice President and Chief Financial Officer

Manager

Manager, General Counsel, Chief Administrative Officer and Secretary Member 100% Common Interest

Manager

Vice President, Training

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 21b (21b) Current Partners, Officers, Directors, and Shareholders
NATURE AND PERCENTAGE OF STOCK OWNERSHIP

NAME AND ADDRESS

TITLE

Tim Richter 618 Church Street, Suite 520 Nashville, TN 37219 Tore Nelson 618 Church Street, Suite 520 Nashville, TN 37219 William C. Miller 618 Chruch Street, Suite 520 Nashville, TN 37219

Senior Vice President, Information Technology

Chief Executive Officer

Manager

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

American Capital Financial Services Inc. 5425 Wisconsin Ave., 6th Floor Washington, DC 20815

Affiliate

02/24/11 03/17/11 07/14/11 07/21/11 10/06/11

Disbursement Disbursement Disbursement Disbursement Disbursement

$4,527.91 $18,190.40 $3,000.53 $37,859.63 $2,216.70 $65,795.17 $3,365.56 $5,790.06 $715.05 $8,206.52 $7,609.75 $6,488.93 $7,408.19 $9,009.12 $9.00 $9,273.44 $18.51 $57,894.13 $481.99 $141.59 $77.29 $1,407.98 $1,607.85 $847.85 $4,564.55 $213.98 $949.63 $353.30 $28.55 $1,477.50 $200.09 $182.00 $1,558.79 $750.94 $170.48 $291.94 $815.86 $12,729.19 $291.94

Officer No. 1

03/03/11 04/07/11 05/05/11 06/02/11 07/07/11 08/04/11 09/01/11 10/06/11 10/29/11 10/29/11 12/03/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 2

02/24/11 03/03/11 03/17/11 03/31/11 04/28/11 05/05/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 3

03/03/11 03/24/11 04/07/11 04/14/11 04/21/11 04/28/11 05/12/11 05/19/11 05/26/11 06/16/11 06/30/11 07/14/11 07/21/11 08/04/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 3

08/18/11 09/08/11 09/29/11 10/13/11 10/20/11 11/10/11 12/01/11 12/08/11 01/12/12 01/19/12 01/26/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$173.56 $906.83 $291.94 $60.67 $486.20 $14,944.69 $611.94 $399.00 $130.25 $100.00 $486.20 $125.85 $38,731.32 $2,698.02 $2,886.50 $1,806.00 $15,679.73 $13,448.06 $316.33 $2,266.27 $96.00 $763.27 $3,698.00 $3,111.20 $876.95 $3,571.04 $1,776.00 $1,698.77 $4,701.00 $742.44 $990.40 $20,004.00 $11,409.90 $2,179.60 $3,114.03 $2,233.50 $1,967.50 $732.08 $591.50 $351.05 $4,331.07 $4,191.91 $2,629.59 $14,897.06

Officer No. 4

02/24/11 03/03/11 03/10/11 03/17/11 03/31/11 04/07/11 04/14/11 04/21/11 04/28/11 05/05/11 05/12/11 05/19/11 05/26/11 06/02/11 06/09/11 06/16/11 06/23/11 06/30/11 07/14/11 07/21/11 07/28/11 08/04/11 08/11/11 08/18/11 08/25/11 09/01/11 09/08/11 09/15/11 09/22/11 09/29/11 10/06/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 4

10/13/11 10/20/11 10/27/11 11/03/11 11/10/11 11/17/11 11/23/11 12/01/11 12/08/11 12/15/11 12/21/11 12/29/11 01/05/12 01/12/12 01/19/12 01/26/12 02/02/12 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$2,755.00 $1,116.80 $555.57 $3,245.93 $1,397.00 $3,757.85 $2,845.56 $8,749.81 $3,531.91 $9,375.84 $9,663.50 $1,261.62 $36.89 $419.00 $1,773.45 $724.02 $581.06 $1,498.81 $7,069.71 $190,118.10 $775.00 $147.17 $899.72 $365.01 $25.00 $1,060.81 $2,308.58 $977.21 $2,133.16 $1,265.37 $9,957.03 $445.77 $804.54 $520.00 $917.49 $683.23 $364.14 $155.73 $1,804.56 $742.30 $265.20 $146.50 $3,346.13

Officer No. 7

05/19/11 06/02/11 06/16/11 06/30/11 07/14/11 08/11/11 11/03/11 12/08/11 01/26/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 8

03/03/11 03/10/11 03/17/11 03/24/11 04/07/11 04/28/11 05/05/11 05/26/11 06/23/11 07/14/11 08/11/11 09/08/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 8

10/06/11 10/20/11 11/17/11 12/15/11 12/29/11 02/09/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$267.02 $104.20 $1,108.64 $120.94 $645.94 $213.75 $12,656.08 $3,248.98 $3,248.98 $1,547.11 $1,550.77 $2,352.06 $1,497.11 $1,847.16 $2,726.05 $4,428.51 $2,218.58 $631.52 $2,538.86 $3,832.46 $6,096.15 $7,741.41 $1,676.32 $4,455.15 $3,869.20 $4,459.86 $379.98 $3,804.19 $786.16 $3,228.05 $61,666.66 $4,252.86 $1,777.41 $2,149.06 $2,968.90 $1,320.66 $1,588.93 $882.27 $2,492.41 $3,063.81 $1,117.94 $1,773.10

Officer No. 10

02/16/12

Expense Reimburesements

Officer No. 11

02/24/11 03/10/11 03/24/11 03/31/11 04/14/11 04/21/11 04/28/11 05/19/11 06/09/11 07/07/11 07/28/11 09/01/11 10/13/11 10/27/11 11/10/11 12/01/11 12/21/11 12/29/11 01/12/12 02/02/12 02/09/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 12

04/14/11 04/21/11 04/28/11 05/12/11 05/19/11 05/26/11 06/02/11 06/23/11 06/30/11 07/07/11 07/14/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 12

07/21/11 07/28/11 08/04/11 08/11/11 09/01/11 09/08/11 09/15/11 09/22/11 09/29/11 10/13/11 10/27/11 11/03/11 11/10/11 11/17/11 11/23/11 12/15/11 12/21/11 01/05/12 01/12/12 02/02/12 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$951.27 $2,183.65 $604.44 $4,276.34 $1,325.23 $2,444.02 $1,005.44 $1,544.99 $978.58 $1,071.98 $3,392.88 $1,874.60 $872.17 $2,578.64 $998.44 $1,196.19 $3,234.57 $2,052.72 $1,987.40 $3,320.69 $3,317.23 $2,042.35 $66,641.17 $2,213.72 $2,268.01 $857.62 $1,548.08 $1,481.47 $767.82 $2,386.13 $869.65 $691.11 $3,051.97 $2,387.50 $1,287.56 $925.07 $796.85 $1,212.99 $743.95 $1,732.53

Officer No. 13

03/03/11 03/17/11 03/24/11 03/31/11 04/07/11 04/14/11 04/21/11 04/28/11 05/12/11 05/26/11 06/09/11 06/16/11 06/23/11 06/30/11 07/07/11 07/14/11 07/21/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 13

07/28/11 08/11/11 08/18/11 08/25/11 09/08/11 09/22/11 10/06/11 10/13/11 10/20/11 10/27/11 11/03/11 11/23/11 12/08/11 12/21/11 01/12/12 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$680.42 $145.81 $458.96 $944.66 $1,923.07 $2,650.29 $1,063.00 $1,353.09 $1,164.25 $1,300.07 $1,530.21 $3,228.41 $1,996.61 $1,603.67 $540.98 $1,343.80 $2,319.01 $49,468.34 $818.81 $4,751.08 $3,089.57 $505.59 $1,037.90 $4,716.51 $656.20 $1,111.15 $2,204.76 $2,026.17 $2,781.00 $23,698.74 $4,379.16 $5,644.67 $1,201.92 $6,678.13 $1,249.39 $7,771.56 $9,203.61 $8,183.92 $5,956.12 $3,695.46 $5,842.88 $11,579.93 $8,145.17 $636.31 $2,573.81 $1,530.52 $3,717.65 $87,990.21 $1,063.55 $248.56 $2,175.89 $135.43 $582.26 $176.80

Officer No. 14

02/24/11 03/31/11 05/26/11 07/07/11 07/28/11 08/25/11 09/01/11 09/22/11 11/17/11 12/15/11 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 15

Officer No. 15

03/03/11 03/17/11 03/31/11 04/21/11 04/28/11 05/12/11 06/09/11 07/07/11 08/11/11 08/25/11 09/15/11 10/13/11 11/10/11 11/17/11 11/23/11 12/08/11 12/15/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 16

03/17/11 03/24/11 04/07/11 05/12/11 07/07/11 07/14/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

08/11/11 09/01/11 09/15/11 10/06/11 10/20/11 11/17/11 12/15/11 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$287.23 $353.05 $618.44 $967.62 $947.33 $800.28 $1,486.67 $1,990.52 $3,074.75 $14,908.38 $278.85 $7,796.79 $1,653.80 $225.00 $3,077.68 $833.88 $377.26 $2,737.25 $117.68 $699.88 $117.58 $149.00 $417.84 $273.15 $1,356.00 $2,362.93 $1,770.55 $612.47 $1,606.99 $4,250.46 $4,345.35

Officer No. 17

03/03/11 05/19/11 05/26/11 06/02/11 06/09/11 06/23/11 06/30/11 07/14/11 07/28/11 08/11/11 08/18/11 09/01/11 09/22/11 10/06/11 10/13/11 10/27/11 11/03/11 11/10/11 12/01/11 12/21/11 02/02/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 17

02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements

$5,008.91 $2,547.85 $42,617.15 $10,947.07 $19,011.00 $1,680.00 $3,350.60 $5,237.00 $5,189.37 $21,222.47 $3,628.09 $6,246.41 $65.00 $1,647.38 $78,224.39 $5,888.11 $4,264.20 $923.09 $2,678.99 $452.86 $2,157.04 $695.01 $2,250.09 $1,959.61 $1,428.37 $1,341.10 $75.24 $1,067.70 $32.58 $2,109.60 $131.39 $700.00 $964.96 $169.74 $163.70 $162.99 $29,616.37 $415.12 $1,003.94 $2,295.10 $2,552.95 $582.25 $1,722.54 $701.80 $2,507.76 $4,208.46 $2,927.85 $1,381.06 $1,597.61 $809.16 $555.84 $1,021.48 $158.55 $24,441.47

Officer No. 18

02/28/11 03/30/11 04/29/11 05/29/11 06/30/11 07/02/11 07/28/11 08/28/11 09/28/11 10/20/11 10/29/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 19

04/14/11 05/05/11 05/19/11 05/26/11 06/16/11 06/23/11 07/28/11 08/11/11 09/01/11 09/08/11 09/15/11 10/13/11 10/27/11 11/03/11 12/01/11 12/08/11 12/21/11 01/12/12 01/26/12 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 20

Officer No. 20

02/24/11 03/17/11 03/31/11 04/28/11 07/14/11 07/28/11 08/11/11 09/15/11 09/29/11 10/13/11 11/03/11 11/10/11 12/15/11 01/12/12 02/09/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Filed 03/23/12 Entered 03/23/12 00:30:25 Page 8 of 12 Document Page 71 of 76

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 21

03/17/11 04/14/11 05/19/11 06/16/11 07/14/11 08/11/11 09/15/11 10/20/11 11/17/11 12/15/11 01/19/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$496.70 $725.39 $159.36 $962.45 $648.28 $652.93 $420.35 $606.31 $954.23 $766.19 $1,062.03 $4,421.77 $11,875.99 $344.53 $493.24 $322.86 $520.90 $471.00 $2,152.53 $714.67 $106.97 $96.00 $207.38 $673.54 $325.68 $62.70 $264.93 $285.46 $356.36 $883.26 $298.69 $1,432.55 $1,365.49 $2,732.37 $1,979.66 $70.60 $11,856.31 $2,495.75 $5,097.19 $211.83 $3,947.51 $2,198.51 $1,631.78 $5,143.35 $5,847.48 $26,573.40 $268.95 $1,220.86 $57.86 $180.52 $257.84 $1,135.95

Officer No. 22

05/05/11 06/02/11 06/30/11 08/04/11 12/08/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 23

Officer No. 23

02/28/11 02/28/11 03/03/11 03/30/11 04/29/11 05/29/11 06/09/11 07/02/11 08/04/11 08/11/11 08/28/11 09/28/11 10/29/11 12/03/11 12/28/11 01/28/12 02/02/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 25

08/18/11 09/15/11 10/20/11 11/17/11 11/23/11 12/01/11 01/19/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 27

02/24/11 03/10/11 03/17/11 04/07/11 04/14/11 04/21/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Filed 03/23/12 Entered 03/23/12 00:30:25 Page 9 of 12 Document Page 72 of 76

Desc Main

Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

05/12/11 05/19/11 05/26/11 06/16/11 06/30/11 07/07/11 07/21/11 07/28/11 08/11/11 08/18/11 09/01/11 09/15/11 09/22/11 10/06/11 10/13/11 10/20/11 10/27/11 11/03/11 11/10/11 11/17/11 11/23/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$190.57 $329.72 $100.48 $727.71 $950.90 $438.55 $396.23 $861.57 $624.51 $567.43 $2,160.71 $2,727.44 $395.41 $991.70 $1,072.69 $391.30 $988.69 $528.05 $1,004.83 $744.25 $367.55

Case 3:12-bk-01573

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Filed 03/23/1212 Entered 03/23/12 00:30:25 Page 10 of Document Page 73 of 76

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Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 27

12/15/11 12/21/11 12/29/11 01/05/12 01/12/12 01/19/12 02/16/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$279.31 $848.57 $282.79 $586.80 $566.74 $504.70 $881.98 $23,633.16 $747.49 $5,881.77 $4,467.86 $732.55 $233.44 $387.24 $362.99 $1,360.13 $175.84 $255.52 $1,097.80 $1,218.91 $2,728.96 $2,820.78 $1,147.25 $831.61 $890.46 $279.23 $1,611.68 $776.25 $1,299.22 $1,932.59 $1,067.83 $161.88 $499.08 $32,968.36 $5,979.70 $11,849.83 $90.00 $3,831.13 $178.79 $7,547.10 $6,390.01 $40.00 $4,659.40

Officer No. 28

Officer No. 28

03/03/11 03/10/11 03/17/11 03/31/11 04/07/11 04/28/11 05/12/11 05/19/11 05/26/11 06/09/11 07/28/11 08/04/11 08/18/11 09/01/11 09/15/11 09/22/11 10/06/11 10/13/11 11/03/11 11/10/11 11/23/11 12/21/11 01/19/12 01/26/12 02/09/12

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 29

02/28/11 03/30/11 04/14/11 04/29/11 05/19/11 05/29/11 06/28/11 07/07/11 07/28/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Case 3:12-bk-01573

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Filed 03/23/1212 Entered 03/23/12 00:30:25 Page 11 of Document Page 74 of 76

Desc Main

Case No. 12-01573 (KML) Church Street Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 23 (23) Withdrawals/Distributions to Insiders 1

NAME AND ADDRESS OF RECIPIENT

RELATIONSHIP TO DEBTOR, IF ANY

DATE OF PAYMENTS

PURPOSE OF PAYMENT

AMOUNT PAID

Officer No. 29

08/18/11 08/28/11 09/28/11 10/29/11 12/03/11 12/08/11 12/28/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

$696.00 $8,297.42 $6,239.03 $13,735.96 $33,586.94 $71.41 $1,176.80 $104,369.52 $18,133.33 $5,000.00 $32,000.00 $8,945.36 $32,000.00 $6,980.63 $32,000.00 $6,238.60 $48,000.00 $189,297.92 $400.00 $400.00 $200.00 $800.00 $1,800.00 $204.80 $976.02 $2,113.81 $2,023.18 $1,975.38 $7,293.19 $110.00 $50.00 $250.00 $100.00 $1,000.00 $30.00 $175.00 $456.00 $50.00 $2,500.00 $12,000.00 $12,000.00 $39,780.48 $284.00 $987.00 $31,796.73 $101,569.21

Officer No. 30

11/21/11 11/21/11 12/01/11 12/08/11 12/29/11 01/05/12 01/26/12 02/02/12 02/16/12

Expense Reimburesements Expense Reimburesements Monthly Compensation Expense Reimburesements Monthly Compensation Expense Reimburesements Monthly Compensation Expense Reimburesements Monthly Compensation

Officer No. 32

07/28/11 08/09/11 09/22/11 10/06/11 03/24/11 04/21/11 05/05/11 05/26/11 06/02/11

Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements Expense Reimburesements

Officer No. 33

SS Holding Company, Inc. 618 Church Street, Suite 520 Nashville, TN 37219

Affiliate

Small Smiles Holding Company, Inc. 618 Church Street, Suite 520 Nashville, TN 37219

Affiliate

03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/14/11 03/19/11 04/28/11 08/01/11 09/17/11 10/19/11

Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions Tax Distributions

1 For confidentiality reasons, the Debtors have not included the names or relationships of the individual to the Debtors for Question 23. The information will be shared with the Bankruptcy Court, the US Trustees office and other appropriate parties upon request.

Case 3:12-bk-01573

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Case No. 12-01573 (KML) Church Street Health Management, LLC STATEMENT OF FINANCIAL AFFAIRS ATTACHMENT 24 (24) Tax Consolidation Group
TAXPAYER IDENTIFICATION NUMBER

NAME OF PARENT CORPORATION

The Debtors do not file any consolidated federal or state income tax returns. A consolidated return applies only to corporations. Further, a consolidated return includes the combined activity of entities required to file separate returns that are aggregated into one return. The ultimate Debtors' parent entity Small Smiles Holding Company, LLC is a partnership and, therefore, cannot file a consolidated return. It does, however, include the activity of disregarded entities (Church Street Health Management, LLC and FORBA Services/FORBA NY/EEHC) that are treated as divisions of Small Smiles Holding Company, LLC. for federal and state income tax purposes (i.e., Church Street Health Management, LLC and FORBA Services/FORBA NY/EEHC may be separate legal entities, but for tax purposes they are disregarded and considered a part of Small Smiles Holding Company, LLC).

Case 3:12-bk-01573

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