Form 425B Worksheet - Disclosure Statement for Small Business Under Chapter 11

Worksheet only. Not the official form. Must substantially conform to Official Form 425B (FRBP 3016(d)). Confirm local requirements; some Subchapter V cases proceed without a disclosure statement.

United States Bankruptcy Court
District of [District]

In re: [Debtor Name]
Case No.: [ ]
Chapter 11 (Small Business Debtor)

Introduction and Disclaimer to Creditors

• Purpose of disclosure statement; not a solicitation until court-approved.
• Voting deadlines, objection deadline, confirmation hearing date/time/location: [ ]
• Recommendation of the plan proponent (if any): [ ]

Background

• Description of debtor’s business, ownership, and management: [ ]
• Events leading to bankruptcy filing: [ ]
• Significant events during the case (financing, cash collateral, key orders): [ ]

The Plan (summary; attach plan as Exhibit A)

• Classification of claims/interests and impairment summary: [ ]
• Treatment of each impaired class; estimated recovery: [ ]
• Means for implementation (funding, sales, refinancing, new value): [ ]
• Management/ownership changes under the plan: [ ]
• Treatment of executory contracts/leases (assume/reject list): [ ]

Required Tables (mirror Form 425B)

• Secured claims table (class, collateral, treatment, interest rate if applicable, estimated recovery):
  | Class | Collateral | Impaired? (Y/N) | Treatment (payment terms/interest) | Est. recovery % |
  | --- | --- | --- | --- | ---: |
  | [ ] | [ ] | [ ] | [ ] | [ ] |
• Priority claims table (including priority taxes):
  | Claim type | Amount | Impaired? (Y/N) | Treatment | Est. recovery % |
  | --- | ---: | --- | --- | ---: |
  | [ ] | $[ ] | [ ] | [ ] | [ ] |
• General unsecured claims table:
  | Class | Estimated amount | Impaired? (Y/N) | Treatment | Est. recovery % |
  | --- | ---: | --- | --- | ---: |
  | [ ] | $[ ] | [ ] | [ ] | [ ] |
• Interests: describe treatment of equity/interests, if any: [ ]

Plan Feasibility and Funding

• Cash on hand as of [date]: $[ ]
• Post-confirmation cash flow projections summary (attach Exhibit G): [ ]
• Sources of funding (operations, sale, refinance, new value): [ ]
• Conditions to effectiveness: [ ]

Risk Factors

• Key business risks, litigation/claim risks, feasibility risks: [ ]

Liquidation Analysis and Alternatives

• Liquidation analysis summary (attach Exhibit E): [ ]
• Alternatives if plan not confirmed (conversion, dismissal, competing plan): [ ]

Avoidable Transfers

• Summary of any avoidable transfers and projected recoveries (if any): [ ]

Tax and Other Consequences

• Brief summary of material tax consequences to debtor, creditors, equity (consult tax advisors): [ ]

Solicitation and Voting

• Who may vote; impaired vs unimpaired; acceptance requirements; treatment of disputed/estimated claims for voting: [ ]

Confirmation Requirements (overview)

• Good faith, best interests test, feasibility, cramdown standards, and any releases/exculpation proposed (ensure consistency with local requirements): [ ]

Unclassified Claims (not in classes)

• Administrative expenses (professional fees, U.S. Trustee fees, adequate protection, etc.): [ ]
• Priority taxes (if unclassified per plan/local practice): [ ]
• Other unclassified claims (if any): [ ]

Claims Objections

• Describe process/timing for resolving claim objections and any reserves: [ ]

Effect of Confirmation

• Discharge and injunction provisions: [ ]
• Plan modification and revesting statements: [ ]
• Final decree/closing expectations: [ ]

Exhibits Checklist (mirror Official Form 425B)

• Exhibit A: Copy of the proposed plan (425A)
• Exhibit B: Identity and value of material assets
• Exhibit C: Prepetition financial statements (balance sheet, income statement, cash flow)
• Exhibit D: Postpetition financial summary/operating report
• Exhibit E: Liquidation analysis
• Exhibit F: Cash on hand on the effective date
• Exhibit G: Post-confirmation cash flow projections

Contacts for More Information

• Debtor/Plan Proponent contact: [ ]
• Attorney contact: [ ]
• Data room/website (if any): [ ]

Signature

Debtor/Plan Proponent: [ ]
Signature: __________________________ Date: __________
Printed Name/Title: [ ]
Attorney for Debtor (if any): [ ] Signature: __________________________ Date: __________