UNITED STATES BANKRUPTCY COURT
_________ DISTRICT OF DELAWARE
IN RE Highlands Insurance Group, Inc. et al. CASE NO. 02-13196 through 02-13201
REPORTING PERIOD: 11/30/02
MONTHLY OPERATING REPORT
FILE WITH COURT AND SUBMIT COPY TO UNITED STATES TRUSTEE
WITHIN 20 DAYS AFTER END OF MONTH
Submit copy of report to any official committee appointed in the case
- -------------------------------------------------------------------- --------------- ---------- -------------
DOCUMENT EXPLANATION
REQUIRED DOCUMENTS FORM NO. ATTACHED ATTACHED
- -------------------------------------------------------------------- --------------- ---------- -------------
Schedule of Cash Receipts and Disbursements MOR-1 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Bank Reconciliation (or copies of debtor's bank reconciliations) MOR-1 (CON'T) X
- -------------------------------------------------------------------- --------------- ---------- -------------
Copies of bank statements X
- -------------------------------------------------------------------- --------------- ---------- -------------
Cash disbursements journals
- -------------------------------------------------------------------- --------------- ---------- -------------
Statement of Operations MOR-2 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Balance Sheet MOR-3 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Status of Postpetition Taxes MOR-4 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Copies of IRS Form 6123 or payment receipt
- -------------------------------------------------------------------- --------------- ---------- -------------
Copies of tax returns filed during reporting period
- -------------------------------------------------------------------- --------------- ---------- -------------
Summary of Unpaid Postpetition Debts MOR-4 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Listing of aged accounts payable
- -------------------------------------------------------------------- --------------- ---------- -------------
Accounts Receivable Reconciliation and Aging MOR-5 X
- -------------------------------------------------------------------- --------------- ---------- -------------
Debtor Questionnaire MOR-5 X
- -------------------------------------------------------------------- --------------- ---------- -------------
I declare under penalty of perjury (28 U.S.C. Section 1746) that this report and
the attached documents are true and correct to the best of my knowledge and
belief.
_______________________________________ _______________________________
Signature of Debtor Date
_______________________________________ _______________________________
Signature of Joint Debtor Date
/s/ Stephen L. Kibblehouse 12/19/02
- --------------------------------------- -------------------------------
Signature of Authorized Individual* Date
Chief Executive Officer
Stephen L. Kibblehouse and General Counsel
- --------------------------------------- -------------------------------
Printed Name of Authorized Individual Title of Authorized Individual
* Authorized individual must be an officer, director or shareholder if debtor is
a corporation; a partner if debtor is a partnership; a manager or member if
debtor is a limited liability company.
IN RE Highlands Insurance Group, Inc et al. CASE NO. 02-13196 through 02-13201
REPORTING PERIOD: 11/30/2002
SCHEDULE OF CASH RECEIPTS AND DISBURSMENTS
- --------------------------------------------------------------------------------------------------------------------------------
BANK ACCOUNTS
Operating Payables Money Market Money Market Payables Operating Operating
9102663029 1014315825 4484882 AM1P 3752021910 3750487802 20569113
Chase-HIGI PNC-HIGI Federated-HIGI State Street-HIGI BofAmer-HIGI BofA-HCS BankOne-NNHC
- --------------------------------------------------------------------------------------------------------------------------------
CASH BEGINNING OF MONTH 898 8,075 209,439 30,140 0 175,899 28,894
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
RECEIPTS
- --------------------------------------------------------------------------------------------------------------------------------
Cash Sales - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Accounts Receivable - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Loans & Advances - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Sales Of Assets - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Other (Includes Interest) 66 - 231 2 115 -
- --------------------------------------------------------------------------------------------------------------------------------
Transfers (From DIP ACCTS) 90,116 - - - 50,024 - -
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
TOTAL RECEIPTS 90,182 0 231 2 50,024 115 0
- --------------------------------------------------------------------------------------------------------------------------------
DISBURSEMENTS
- --------------------------------------------------------------------------------------------------------------------------------
Net Payroll - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Payroll Taxes - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Sales, Use & Other Taxes - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Inventory Purchases - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Secured/Rental/Leases - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Insurance - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Adminstrative & Selling - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Selling - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Other (Attach List) - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
Owner Draw - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Transfers (TO DIP ACCOUNTS) - - 110,000 30,140 - - -
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
Professional Fees - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
Court Costs - - - - - - -
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
TOTAL DISBURSEMENTS 0 0 110,000 30,140 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
NET CASH FLOW 90,182 0 (109,769) (30,138) 50,024 115 0
- --------------------------------------------------------------------------------------------------------------------------------
Receipts Less Disbursements
- --------------------------------------------------------------------------------------------------------------------------------
CASH-END OF MONTH 91,080 8,075 99,670 2 50,024 176,014 28,894
- --------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
CURRENT MONTH CUMULATIVE FILING TO DATE
Actual Projected Actual Projected
- ----------------------------------------------------------------------------------------
CASH BEGINNING OF MONTH 453,345 453,345 453,345 453,345
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
RECEIPTS
- ----------------------------------------------------------------------------------------
Cash Sales - - - -
- ----------------------------------------------------------------------------------------
Accounts Receivable - - - -
- ----------------------------------------------------------------------------------------
Loans & Advances - - - -
- ----------------------------------------------------------------------------------------
Sales Of Assets - - - -
- ----------------------------------------------------------------------------------------
Other (Includes Interest) 414 - 414 -
- ----------------------------------------------------------------------------------------
Transfers (From DIP ACCTS) 140,140 - 140,140 -
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
TOTAL RECEIPTS 140,554 0 140,554 0
- ----------------------------------------------------------------------------------------
DISBURSEMENTS
- ----------------------------------------------------------------------------------------
Net Payroll - - - -
- ----------------------------------------------------------------------------------------
Payroll Taxes - - - -
- ----------------------------------------------------------------------------------------
Sales, Use & Other Taxes - - - -
- ----------------------------------------------------------------------------------------
Inventory Purchases - - - -
- ----------------------------------------------------------------------------------------
Secured/Rental/Leases - - - -
- ----------------------------------------------------------------------------------------
Insurance - - - -
- ----------------------------------------------------------------------------------------
Adminstrative & Selling - 1,000 - 1,000
- ----------------------------------------------------------------------------------------
Selling - 3,704 - 3,704
- ----------------------------------------------------------------------------------------
Other (Attach List) - - - -
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
Owner Draw - - - -
- ----------------------------------------------------------------------------------------
Transfers (TO DIP ACCOUNTS) 140,140 - 140,140 -
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
Professional Fees - - - -
- ----------------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees - - - -
- ----------------------------------------------------------------------------------------
Court Costs - - - -
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
TOTAL DISBURSEMENTS 140,140 4,704 140,140 4,704
- ----------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------
NET CASH FLOW 414 (4,704) 414 (4,704)
- ----------------------------------------------------------------------------------------
Receipts Less Disbursements
- ----------------------------------------------------------------------------------------
CASH-END OF MONTH 453,759 448,641 453,759 448,641
- ----------------------------------------------------------------------------------------
DISBURSMENTS FOR CALCULATING U.S. TRUSTEE QUARTERLY FEES: (FROM CURRENT MONTH
ACTUAL COLUMN)
- -----------------------------------------------------------------------------------------------------
TOTAL DISBURSMENTS $140,140
- -----------------------------------------------------------------------------------------------------
LESS:TRANSFERS TO DEBTOR IN POSSESSION ACCOUNTS $140,140
- -----------------------------------------------------------------------------------------------------
PLUS:ESTATE DISBURSMENTS MADE BY OUTSIDE SOURCES (from escrow accounts) $ 0
- -----------------------------------------------------------------------------------------------------
TOTAL DISBURSMENTS FOR CALCULATING U.S. TRUSTEE QUARTERLY FEES $ 0
- -----------------------------------------------------------------------------------------------------
No funds were disbursed on 10/31/02
Highlands Insurance Group, Inc.
30-Nov-02
- ---------------------------------------------------------------------------------------------------------------
Operating Payables Money Market Money Market Payables
9102663029 1014315825 4484882 AM1P 3752021910
------------ ----------- ------------- ------------ ----------------
Chase PNC Federated State Street Bank Of America
Balance Per Books 91,080.02 8,075.14 99,670.00 1.90 5,023.79
===============================================================================================================
Bank Balance 91,080.02 8,075.14 99,670.00 1.90 50,023.79
(+) Deposits in Transit
(-) Outstanding Checks
Other (See Below)
Adjusted Bank Balance 91,080.02 8,075.14 99,670.00 1.90 50,023.79
===============================================================================================================
Deposits in Transit
Checks Outstanding
Other
-----------
Total Other -
- ---------------------------------------------------------------------------------------------------------------
Highlands Claims and Safety
30-Nov-02
- -------------------------------------------------------------------------------------------
Operating
3750487802
------------ ----------- ------------- ------------
Balance Per Books 175,899.30
===========================================================================================
Bank Balance 176,039.03
(+) Deposits in Transit
(-) Outstanding Checks 25.00
Other (See Below)
Adjusted Bank Balance 176,014.03
===========================================================================================
Deposits in Transit
Checks Outstanding
Ck 1092 issued 12/06/01 25.00
Other
Unrecorded Deposit 114.73
Total Other
- -------------------------------------------------------------------------------------------
Northwestern National Holding Company
30-Nov-02
- ------------------------------------------------------------------------------------------------------
Operating
20569113
------------ ------------ ------------ ------------
Bank One
Balance Per Books 28,894.04
======================================================================================================
Bank Balance 28,894.04
(+) Deposits in Transit
(-) Outstanding Checks -
Other (See Below)
Adjusted Bank Balance 28,894.04
======================================================================================================
Deposits in Transit
Checks Outstanding
Other
Total Other
- ------------------------------------------------------------------------------------------------------
Case No ___________
Reporting Period 11/30/2002
STATEMENT OF OPERATIONS
(INCOME STATEMENT)
CASE: 02-13198 CASE: 02-13196
------------------------------------------------------------
NORTHWESTERN NATIONAL HIGHLANDS INSURANCE
HOLDING COMPANY, INC. GROUP, INC
- --------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
REVENUES MONTH FILING TO DATE MONTH FILING TO DATE
- --------------------------------------------------------------------------------------------------------------------------------
Gross Revenues
- --------------------------------------------------------------------------------------------------------------------------------
Less: Returns and Allowances
- --------------------------------------------------------------------------------------------------------------------------------
Net Revenue 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
COST OF GOODS SOLD
- --------------------------------------------------------------------------------------------------------------------------------
Beginning Inventory
- --------------------------------------------------------------------------------------------------------------------------------
Add: Purchases
- --------------------------------------------------------------------------------------------------------------------------------
Add: Cost of Labor
- --------------------------------------------------------------------------------------------------------------------------------
Add: Other Cost (attach schedule)
- --------------------------------------------------------------------------------------------------------------------------------
Less: Ending Inventory
- --------------------------------------------------------------------------------------------------------------------------------
Cost of Goods Sold 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
Gross Profit 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OPERATING EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Insider Compensation *
- --------------------------------------------------------------------------------------------------------------------------------
Insurance (18,682) (18,682)
- --------------------------------------------------------------------------------------------------------------------------------
Management Fees/Bonuses
- --------------------------------------------------------------------------------------------------------------------------------
Taxes - Other
- --------------------------------------------------------------------------------------------------------------------------------
Other (attach schedule) (11,077) (11,077)
- --------------------------------------------------------------------------------------------------------------------------------
Total Operating Expenses Before Depreciation
- --------------------------------------------------------------------------------------------------------------------------------
Depreciation/Depletion/Amortization
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Other Income & Expenses 0 0 (29,759) (29,759)
- --------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME AND EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Other Income (attach schedule) 0 0
- --------------------------------------------------------------------------------------------------------------------------------
Interest Expense (796,187) (796,187)
- --------------------------------------------------------------------------------------------------------------------------------
Other Expense (attach schedule) 0 0
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Reorganization Items 0 0 (825,946) (825,946)
- --------------------------------------------------------------------------------------------------------------------------------
REORGANIZATION ITEMS
- --------------------------------------------------------------------------------------------------------------------------------
Professional Fees (52,370) (52,370)
- --------------------------------------------------------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees
- --------------------------------------------------------------------------------------------------------------------------------
Interest Earned on Accumulated Cash from Chapter 11
(see continuation sheet)
- --------------------------------------------------------------------------------------------------------------------------------
Gain (Loss) from Sale of Equipment
- --------------------------------------------------------------------------------------------------------------------------------
Other Reorganization Expenses (attach schedule)
- --------------------------------------------------------------------------------------------------------------------------------
Total Reorganization Expenses 0 0 (52,370) (52,370)
- --------------------------------------------------------------------------------------------------------------------------------
Income Taxes
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) 0 0 (878,316) (878,316)
- --------------------------------------------------------------------------------------------------------------------------------
* "Insider" is defined in 11 U.S.C. Section 101 (31)
CASE: 02-13201 CASE: 02-13200
-----------------------------------------------------------
HIGHLANDS HIGHLANDS CLAIMS AND
SERVICE CORPORATION SAFETY SERVICES, INC
- --------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
REVENUES MONTH FILING TO DATE MONTH FILING TO DATE
- --------------------------------------------------------------------------------------------------------------------------------
Gross Revenues
- --------------------------------------------------------------------------------------------------------------------------------
Less: Returns and Allowances
- --------------------------------------------------------------------------------------------------------------------------------
Net Revenue 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
COST OF GOODS SOLD
- --------------------------------------------------------------------------------------------------------------------------------
Beginning Inventory
- --------------------------------------------------------------------------------------------------------------------------------
Add: Purchases
- --------------------------------------------------------------------------------------------------------------------------------
Add: Cost of Labor
- --------------------------------------------------------------------------------------------------------------------------------
Add: Other Cost (attach schedule)
- --------------------------------------------------------------------------------------------------------------------------------
Less: Ending Inventory
- --------------------------------------------------------------------------------------------------------------------------------
Cost of Goods Sold 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
Gross Profit 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OPERATING EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Insider Compensation *
- --------------------------------------------------------------------------------------------------------------------------------
Insurance
- --------------------------------------------------------------------------------------------------------------------------------
Management Fees/Bonuses
- --------------------------------------------------------------------------------------------------------------------------------
Taxes - Other
- --------------------------------------------------------------------------------------------------------------------------------
Other (attach schedule)
- --------------------------------------------------------------------------------------------------------------------------------
Total Operating Expenses Before Depreciation
- --------------------------------------------------------------------------------------------------------------------------------
Depreciation/Depletion/Amortization
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Other Income & Expenses 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME AND EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Other Income (attach schedule) 131 131
- --------------------------------------------------------------------------------------------------------------------------------
Interest Expense
- --------------------------------------------------------------------------------------------------------------------------------
Other Expense (attach schedule) 0 0 (118) (118)
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Reorganization Items 0 0 13 13
- --------------------------------------------------------------------------------------------------------------------------------
REORGANIZATION ITEMS
- --------------------------------------------------------------------------------------------------------------------------------
Professional Fees
- --------------------------------------------------------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees
- --------------------------------------------------------------------------------------------------------------------------------
Interest Earned on Accumulated Cash from Chapter 11
(see continuation sheet)
- --------------------------------------------------------------------------------------------------------------------------------
Gain (Loss) from Sale of Equipment
- --------------------------------------------------------------------------------------------------------------------------------
Other Reorganization Expenses (attach schedule)
- --------------------------------------------------------------------------------------------------------------------------------
Total Reorganization Expenses 0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
Income Taxes
- --------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) 0 0 13 13
- --------------------------------------------------------------------------------------------------------------------------------
* "Insider" is defined in 11 U.S.C. Section 101 (31)
CASE: 02-13199 CASE: 02-13197
--------------------------------------------------------------
AMERICAN RELIANCE INC. HIGHLANDS HOLDING COMPANY
- ----------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
REVENUES MONTH FILING TO DATE MONTH FILING TO DATE
- ----------------------------------------------------------------------------------------------------------------------------------
Gross Revenues
- ----------------------------------------------------------------------------------------------------------------------------------
Less: Returns and Allowances
- ----------------------------------------------------------------------------------------------------------------------------------
Net Revenue 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
COST OF GOODS SOLD
- ----------------------------------------------------------------------------------------------------------------------------------
Beginning Inventory
- ----------------------------------------------------------------------------------------------------------------------------------
Add: Purchases
- ----------------------------------------------------------------------------------------------------------------------------------
Add: Cost of Labor
- ----------------------------------------------------------------------------------------------------------------------------------
Add: Other Cost (attach schedule)
- ----------------------------------------------------------------------------------------------------------------------------------
Less: Ending Inventory
- ----------------------------------------------------------------------------------------------------------------------------------
Cost of Goods Sold 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
Gross Profit 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
OPERATING EXPENSES
- ----------------------------------------------------------------------------------------------------------------------------------
Insider Compensation *
- ----------------------------------------------------------------------------------------------------------------------------------
Insurance
- ----------------------------------------------------------------------------------------------------------------------------------
Management Fees/Bonuses
- ----------------------------------------------------------------------------------------------------------------------------------
Taxes - Other
- ----------------------------------------------------------------------------------------------------------------------------------
Other (attach schedule)
- ----------------------------------------------------------------------------------------------------------------------------------
Total Operating Expenses Before Depreciation
- ----------------------------------------------------------------------------------------------------------------------------------
Depreciation/Depletion/Amortization
- ----------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Other Income & Expenses 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME AND EXPENSES
- ----------------------------------------------------------------------------------------------------------------------------------
Other Income (attach schedule)
- ----------------------------------------------------------------------------------------------------------------------------------
Interest Expense
- ----------------------------------------------------------------------------------------------------------------------------------
Other Expense (attach schedule) 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) Before Reorganization Items 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
REORGANIZATION ITEMS
- ----------------------------------------------------------------------------------------------------------------------------------
Professional Fees
- ----------------------------------------------------------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees
- ----------------------------------------------------------------------------------------------------------------------------------
Interest Earned on Accumulated Cash from Chapter 11
(see continuation sheet)
- ----------------------------------------------------------------------------------------------------------------------------------
Gain (Loss) from Sale of Equipment
- ----------------------------------------------------------------------------------------------------------------------------------
Other Reorganization Expenses (attach schedule)
- ----------------------------------------------------------------------------------------------------------------------------------
Total Reorganization Expenses 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
Income Taxes
- ----------------------------------------------------------------------------------------------------------------------------------
Net Profit (Loss) 0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
* "Insider" is defined in 11 U.S.C. Section 101 (31)
------------------------
CONSOLIDATING
- -----------------------------------------------------------------------------------
CUMULATIVE
REVENUES MONTH FILING TO DATE
- -----------------------------------------------------------------------------------
Gross Revenues 0 0
- -----------------------------------------------------------------------------------
Less: Returns and Allowances 0 0
- -----------------------------------------------------------------------------------
Net Revenue 0 0
- -----------------------------------------------------------------------------------
COST OF GOODS SOLD
- -----------------------------------------------------------------------------------
Beginning Inventory 0 0
- -----------------------------------------------------------------------------------
Add: Purchases 0 0
- -----------------------------------------------------------------------------------
Add: Cost of Labor 0 0
- -----------------------------------------------------------------------------------
Add: Other Cost (attach schedule) 0 0
- -----------------------------------------------------------------------------------
Less: Ending Inventory 0 0
- -----------------------------------------------------------------------------------
Cost of Goods Sold 0 0
- -----------------------------------------------------------------------------------
Gross Profit 0 0
- -----------------------------------------------------------------------------------
OPERATING EXPENSES
- -----------------------------------------------------------------------------------
Insider Compensation * 0 0
- -----------------------------------------------------------------------------------
Insurance (18,682) (18,682)
- -----------------------------------------------------------------------------------
Management Fees/Bonuses 0 0
- -----------------------------------------------------------------------------------
Taxes - Other 0 0
- -----------------------------------------------------------------------------------
Other (attach schedule) (11,077) (11,077)
- -----------------------------------------------------------------------------------
Total Operating Expenses Before Depreciation 0 0
- -----------------------------------------------------------------------------------
Depreciation/Depletion/Amortization 0 0
- -----------------------------------------------------------------------------------
Net Profit (Loss) Before Other Income & Expenses (29,759) (29,759)
- -----------------------------------------------------------------------------------
OTHER INCOME AND EXPENSES
- -----------------------------------------------------------------------------------
Other Income (attach schedule) 131 131
- -----------------------------------------------------------------------------------
Interest Expense (796,187) (796,187)
- -----------------------------------------------------------------------------------
Other Expense (attach schedule) (118) (118)
- -----------------------------------------------------------------------------------
Net Profit (Loss) Before Reorganization Items (825,933) (825,933)
- -----------------------------------------------------------------------------------
REORGANIZATION ITEMS
- -----------------------------------------------------------------------------------
Professional Fees (52,370) (52,370)
- -----------------------------------------------------------------------------------
U.S. Trustee Quarterly Fees 0 0
- -----------------------------------------------------------------------------------
Interest Earned on Accumulated Cash from Chapter 11
(see continuation sheet) 0 0
- -----------------------------------------------------------------------------------
Gain (Loss) from Sale of Equipment 0 0
- -----------------------------------------------------------------------------------
Other Reorganization Expenses (attach schedule) 0 0
- -----------------------------------------------------------------------------------
Total Reorganization Expenses (52,370) (52,370)
- -----------------------------------------------------------------------------------
Income Taxes
- -----------------------------------------------------------------------------------
Net Profit (Loss) (930,673) (930,673)
- -----------------------------------------------------------------------------------
* "Insider" is defined in 11 U.S.C. Section 101 (31)
CASE: 02-13198 CASE: 02-13196
------------------------------------------------------------
NORTHWESTERN NATIONAL HIGHLANDS INSURANCE
HOLDING COMPANY, INC. GROUP, INC.
- --------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
BREAKDOWN OF "OTHER" CATEGORY MONTH FILING TO DATE MONTH FILING TO DATE
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
OTHER COSTS
- --------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OTHER OPERATIONAL EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Directors Fees (6,366) (6,366)
- --------------------------------------------------------------------------------------------------------------------------------
Mellon investors services (4,711) (4,711)
- --------------------------------------------------------------------------------------------------------------------------------
0 0 (11,077) (11,077)
- --------------------------------------------------------------------------------------------------------------------------------
0 0 11,077 11,077
- --------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME
- --------------------------------------------------------------------------------------------------------------------------------
Claims Service Fees 0 0
- --------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Claims service expense
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
CASE: 02-13201 CASE: 02-13200
--------------------------------------------------------------
HIGHLANDS HIGHLANDS CLAIMS AND
SERVICE CORPORATION SAFETY SERVICES, INC.
- --------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
BREAKDOWN OF "OTHER" CATEGORY MONTH FILING TO DATE MONTH FILING TO DATE
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
OTHER COSTS
- --------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OTHER OPERATIONAL EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Directors Fees
- --------------------------------------------------------------------------------------------------------------------------------
Mellon investors services
- --------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- --------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME
- --------------------------------------------------------------------------------------------------------------------------------
Claims Service Fees 131 131
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER EXPENSES
- --------------------------------------------------------------------------------------------------------------------------------
Claims service expense (118) (118)
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
CASE: 02-13199 CASE: 02-13197
---------------------------------------------------------------
AMERICAN RELIANCE INC. HIGHLANDS HOLDING COMPANY
- ----------------------------------------------------------------------------------------------------------------------------------
CUMULATIVE CUMULATIVE
BREAKDOWN OF "OTHER" CATEGORY MONTH FILING TO DATE MONTH FILING TO DATE
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER COSTS
- ----------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER OPERATIONAL EXPENSES
- ----------------------------------------------------------------------------------------------------------------------------------
Directors Fees
- ----------------------------------------------------------------------------------------------------------------------------------
Mellon investors services
- ----------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
0 0 0 0
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER INCOME
- ----------------------------------------------------------------------------------------------------------------------------------
Claims Service Fees
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
OTHER EXPENSES
- ----------------------------------------------------------------------------------------------------------------------------------
Claims service expense
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
-----------------------
CONSOLIDATING
- -------------------------------------------------------------------------------------------
CUMULATIVE
BREAKDOWN OF "OTHER" CATEGORY MONTH FILING TO DATE
- -------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------------------
OTHER COSTS
- -------------------------------------------------------------------------------------------
0 0
- -------------------------------------------------------------------------------------------
OTHER OPERATIONAL EXPENSES
- -------------------------------------------------------------------------------------------
Directors Fees
- -------------------------------------------------------------------------------------------
Mellon investors services
- -------------------------------------------------------------------------------------------
0 0
- -------------------------------------------------------------------------------------------
0 0
- -------------------------------------------------------------------------------------------
OTHER INCOME
- -------------------------------------------------------------------------------------------
Claims Service Fees
- -------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------------------
OTHER EXPENSES
- -------------------------------------------------------------------------------------------
Claims service expense
- -------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------------------
CONSOLIDATING BALANCE SHEET Reporting Date 11/30/2002
The Balance Sheet is to be completed on an accrual basis only.
Pre-petition liabilities must be classified separately from
postpetition obligations.
CASE: 02-13198 CASE: 02-13196
-------------------------------------------------------------------------
Northwestern National Holding Highlands Insurance Group, Inc.
Company, Inc.
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- -----------------------------------------------------------------------------------------------------------------------------------
CURRENT ASSETS
- -----------------------------------------------------------------------------------------------------------------------------------
Unrestricted Cash and Equivalents
- -----------------------------------------------------------------------------------------------------------------------------------
Restricted Cash and Cash Equivalents
(see continuation sheet) 28,894 28,894 248,850 248,567
- -----------------------------------------------------------------------------------------------------------------------------------
Accounts Receivable (Net)
- -----------------------------------------------------------------------------------------------------------------------------------
Notes Receivable
- -----------------------------------------------------------------------------------------------------------------------------------
Inventories
- -----------------------------------------------------------------------------------------------------------------------------------
Prepaid Legal Expenses 45,920 98,290
- -----------------------------------------------------------------------------------------------------------------------------------
Professional Retainers
- -----------------------------------------------------------------------------------------------------------------------------------
Other Current Assets (attach schedule) 1,983,370 1,983,370 (22,686,308) (22,667,626)
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL CURRENT ASSETS 2,012,264 2,012,264 $ (22,391,538) $ (22,320,769)
- -----------------------------------------------------------------------------------------------------------------------------------
PROPERTY AND EQUIPMENT
- -----------------------------------------------------------------------------------------------------------------------------------
Real Property and Improvements
- -----------------------------------------------------------------------------------------------------------------------------------
Machinery and Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Furniture, Fixtures and Office Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Leasehold Improvements
- -----------------------------------------------------------------------------------------------------------------------------------
Vehicles
- -----------------------------------------------------------------------------------------------------------------------------------
Less Accumulated Depreciation
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL PROPERTY & EQUIPMENT - - $ - $ -
- -----------------------------------------------------------------------------------------------------------------------------------
OTHER ASSETS
- -----------------------------------------------------------------------------------------------------------------------------------
Loans to Insiders*
- -----------------------------------------------------------------------------------------------------------------------------------
Other Assets (attach schedule)
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL OTHER ASSETS - - $ - $ -
===================================================================================================================================
TOTAL ASSETS 2,012,264 2,012,264 $ (22,391,538) $ (22,320,769)
===================================================================================================================================
LIABILITIES AND OWNER EQUITY
- ---------------------------------------------------
LIABILITIES NOT SUBJECT TO COMPROMISE
(POSTPETITION)
- -----------------------------------------------------------------------------------------------------------------------------------
Accounts Payable 4,711
- -----------------------------------------------------------------------------------------------------------------------------------
Taxes Payable (refer to FORM MOR-4)
- -----------------------------------------------------------------------------------------------------------------------------------
Wages Payable
- -----------------------------------------------------------------------------------------------------------------------------------
Notes Payable
- -----------------------------------------------------------------------------------------------------------------------------------
Rent / Leases - Building/Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Secured Debt / Adequate Protection Payments
- -----------------------------------------------------------------------------------------------------------------------------------
Professional Fees
- -----------------------------------------------------------------------------------------------------------------------------------
Amounts Due to Insiders* 6,366
- -----------------------------------------------------------------------------------------------------------------------------------
Other Postpetition Liabilities (accrued interest) 796,188
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL POSTPETITION LIABILITIES - - $ 807,265 $ -
- -----------------------------------------------------------------------------------------------------------------------------------
LIABILITIES SUBJECT TO COMPROMISE (PRE-PETITION)
- -----------------------------------------------------------------------------------------------------------------------------------
Secured Debt 47,504,390 47,504,390
- -----------------------------------------------------------------------------------------------------------------------------------
Priority Debt
- -----------------------------------------------------------------------------------------------------------------------------------
Unsecured Debt 1,124 1,124 75,702,166 75,701,885
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL PRE-PETITION LIABILITIES 1,124 1,124 $ 123,206,556 $ 123,206,275
- -----------------------------------------------------------------------------------------------------------------------------------
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL LIABILITIES 1,124 1,124 $ 124,013,821 $ 123,206,275
- -----------------------------------------------------------------------------------------------------------------------------------
OWNER EQUITY
- -----------------------------------------------------------------------------------------------------------------------------------
Capital Stock 10,000 10,000 137,181 137,181
- -----------------------------------------------------------------------------------------------------------------------------------
Additional Paid-In Capital 120,543,607 120,543,607 228,871,789 228,871,789
- -----------------------------------------------------------------------------------------------------------------------------------
Partner's Capital Account
- -----------------------------------------------------------------------------------------------------------------------------------
Owner's Equity Account
- -----------------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Pre-Petition (118,542,467) (118,542,467)
- -----------------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Postpetition (388,024,225) (387,145,910)
- -----------------------------------------------------------------------------------------------------------------------------------
Adjustments to Owner Equity (attach schedule) 12,609,896 12,609,896
- -----------------------------------------------------------------------------------------------------------------------------------
Postpetition Contributions (Distributions)
(Draws) (attach schedule)
- -----------------------------------------------------------------------------------------------------------------------------------
NET OWNER EQUITY 2,011,140 2,011,140 $ (146,405,359) $(145,527,044)
===================================================================================================================================
TOTAL LIABILITIES AND OWNER'S EQUITY 2,012,264 2,012,264 (22,391,538) $ (22,320,769)
===================================================================================================================================
**Insider* is defined in 11 U.S.C. Section 101(31) FORM MOR-3 (9/99)
CASE: 02-13201 CASE: 02-13200
--------------------------------------------------------------------------
Highlands Service Corporation Higlands Claims and Safety
Services Inc.
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- -----------------------------------------------------------------------------------------------------------------------------------
CURRENT ASSETS
- -----------------------------------------------------------------------------------------------------------------------------------
Unrestricted Cash and Equivalents 176,014 175,899
- -----------------------------------------------------------------------------------------------------------------------------------
Restricted Cash and Cash Equivalents
(see continuation sheet)
- -----------------------------------------------------------------------------------------------------------------------------------
Accounts Receivable (Net) 34,614 34,614 203 176
- -----------------------------------------------------------------------------------------------------------------------------------
Notes Receivable
- -----------------------------------------------------------------------------------------------------------------------------------
Inventories
- -----------------------------------------------------------------------------------------------------------------------------------
Prepaid Legal Expenses
- -----------------------------------------------------------------------------------------------------------------------------------
Professional Retainers
- -----------------------------------------------------------------------------------------------------------------------------------
Other Current Assets (attach schedule) 3,742 3,742
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL CURRENT ASSETS $ 34,614 $ 34,614 $ 179,959 $ 179,817
- -----------------------------------------------------------------------------------------------------------------------------------
PROPERTY AND EQUIPMENT
- -----------------------------------------------------------------------------------------------------------------------------------
Real Property and Improvements
- -----------------------------------------------------------------------------------------------------------------------------------
Machinery and Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Furniture, Fixtures and Office Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Leasehold Improvements
- -----------------------------------------------------------------------------------------------------------------------------------
Vehicles
- -----------------------------------------------------------------------------------------------------------------------------------
Less Accumulated Depreciation
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL PROPERTY & EQUIPMENT $ - $ - $ - $ -
- -----------------------------------------------------------------------------------------------------------------------------------
OTHER ASSETS
- -----------------------------------------------------------------------------------------------------------------------------------
Loans to Insiders*
- -----------------------------------------------------------------------------------------------------------------------------------
Other Assets (attach schedule)
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL OTHER ASSETS $ - $ - $ - $ -
===================================================================================================================================
TOTAL ASSETS $ 34,614 $ 34,614 $ 179,959 $ 179,817
===================================================================================================================================
LIABILITIES AND OWNER EQUITY
- ---------------------------------------------------
LIABILITIES NOT SUBJECT TO COMPROMISE
(POSTPETITION)
- -----------------------------------------------------------------------------------------------------------------------------------
Accounts Payable
- -----------------------------------------------------------------------------------------------------------------------------------
Taxes Payable (refer to FORM MOR-4)
- -----------------------------------------------------------------------------------------------------------------------------------
Wages Payable
- -----------------------------------------------------------------------------------------------------------------------------------
Notes Payable
- -----------------------------------------------------------------------------------------------------------------------------------
Rent / Leases - Building/Equipment
- -----------------------------------------------------------------------------------------------------------------------------------
Secured Debt / Adequate Protection Payments
- -----------------------------------------------------------------------------------------------------------------------------------
Professional Fees
- -----------------------------------------------------------------------------------------------------------------------------------
Amounts Due to Insiders*
- -----------------------------------------------------------------------------------------------------------------------------------
Other Postpetition Liabilities (accrued interest)
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL POSTPETITION LIABILITIES $ - $ - $ - $ -
- -----------------------------------------------------------------------------------------------------------------------------------
LIABILITIES SUBJECT TO COMPROMISE (PRE-PETITION)
- -----------------------------------------------------------------------------------------------------------------------------------
Secured Debt
- -----------------------------------------------------------------------------------------------------------------------------------
Priority Debt
- -----------------------------------------------------------------------------------------------------------------------------------
Unsecured Debt 23,464 23,464 3,129 3,000
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL PRE-PETITION LIABILITIES $ 23,464 $ 23,464 $ 3,129 $ 3,000
- -----------------------------------------------------------------------------------------------------------------------------------
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL LIABILITIES $ 23,464 $ 23,464 $ 3,129 $ 3,000
- -----------------------------------------------------------------------------------------------------------------------------------
OWNER EQUITY
- -----------------------------------------------------------------------------------------------------------------------------------
Capital Stock 1,000 1,000
- -----------------------------------------------------------------------------------------------------------------------------------
Additional Paid-In Capital
- -----------------------------------------------------------------------------------------------------------------------------------
Partner's Capital Account
- -----------------------------------------------------------------------------------------------------------------------------------
Owner's Equity Account
- -----------------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Pre-Petition 11,150 11,150 175,830 175,817
- -----------------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Postpetition
- -----------------------------------------------------------------------------------------------------------------------------------
Adjustments to Owner Equity (attach schedule)
- -----------------------------------------------------------------------------------------------------------------------------------
Postpetition Contributions (Distributions)
(Draws) (attach schedule)
- -----------------------------------------------------------------------------------------------------------------------------------
NET OWNER EQUITY $ 11,150 $ 11,150 $ 176,830 $ 176,817
===================================================================================================================================
TOTAL LIABILITIES AND OWNER'S EQUITY 34,614 34,614 179,959 179,817
===================================================================================================================================
**Insider* is defined in 11 U.S.C. Section 101(31) FORM MOR-3 (9/99)
CASE: 02-13199 CASE: 02-13197
------------------------------------------------------------------------
American Reliance, Inc. Highlands Holding Company
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- ---------------------------------------------------------------------------------------------------------------------------
CURRENT ASSETS
- ---------------------------------------------------------------------------------------------------------------------------
Unrestricted Cash and Equivalents
- ---------------------------------------------------------------------------------------------------------------------------
Restricted Cash and Cash Equivalents
(see continuation sheet)
- ---------------------------------------------------------------------------------------------------------------------------
Accounts Receivable (Net)
- ---------------------------------------------------------------------------------------------------------------------------
Notes Receivable
- ---------------------------------------------------------------------------------------------------------------------------
Inventories
- ---------------------------------------------------------------------------------------------------------------------------
Prepaid Legal Expenses
- ---------------------------------------------------------------------------------------------------------------------------
Professional Retainers
- ---------------------------------------------------------------------------------------------------------------------------
Other Current Assets (attach schedule) 2,151,856 2,151,856 (12,000,000) (12,000,000)
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL CURRENT ASSETS $ 2,151,856 $ 2,151,856 $ (12,000,000) $ (12,000,000)
- ---------------------------------------------------------------------------------------------------------------------------
PROPERTY AND EQUIPMENT
- ---------------------------------------------------------------------------------------------------------------------------
Real Property and Improvements
- ---------------------------------------------------------------------------------------------------------------------------
Machinery and Equipment
- ---------------------------------------------------------------------------------------------------------------------------
Furniture, Fixtures and Office Equipment
- ---------------------------------------------------------------------------------------------------------------------------
Leasehold Improvements
- ---------------------------------------------------------------------------------------------------------------------------
Vehicles
- ---------------------------------------------------------------------------------------------------------------------------
Less Accumulated Depreciation
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL PROPERTY & EQUIPMENT $ - $ - $ - $ -
- ---------------------------------------------------------------------------------------------------------------------------
OTHER ASSETS
- ---------------------------------------------------------------------------------------------------------------------------
Loans to Insiders*
- ---------------------------------------------------------------------------------------------------------------------------
Other Assets (attach schedule)
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL OTHER ASSETS $ - $ - $ - $ -
===========================================================================================================================
TOTAL ASSETS $ 2,151,856 $ 2,151,856 $ (12,000,000) $ (12,000,000)
===========================================================================================================================
LIABILITIES AND OWNER EQUITY
- ---------------------------------------------------
LIABILITIES NOT SUBJECT TO COMPROMISE
(POSTPETITION)
- ---------------------------------------------------------------------------------------------------------------------------
Accounts Payable
- ---------------------------------------------------------------------------------------------------------------------------
Taxes Payable (refer to FORM MOR-4)
- ---------------------------------------------------------------------------------------------------------------------------
Wages Payable
- ---------------------------------------------------------------------------------------------------------------------------
Notes Payable
- ---------------------------------------------------------------------------------------------------------------------------
Rent / Leases - Building/Equipment
- ---------------------------------------------------------------------------------------------------------------------------
Secured Debt / Adequate Protection Payments
- ---------------------------------------------------------------------------------------------------------------------------
Professional Fees
- ---------------------------------------------------------------------------------------------------------------------------
Amounts Due to Insiders*
- ---------------------------------------------------------------------------------------------------------------------------
Other Postpetition Liabilities (accrued interest)
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL POSTPETITION LIABILITIES $ - $ - $ - $ -
- ---------------------------------------------------------------------------------------------------------------------------
LIABILITIES SUBJECT TO COMPROMISE (PRE-PETITION)
- ---------------------------------------------------------------------------------------------------------------------------
Secured Debt
- ---------------------------------------------------------------------------------------------------------------------------
Priority Debt
- ---------------------------------------------------------------------------------------------------------------------------
Unsecured Debt 3,470,447 3,470,447 394 394
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL PRE-PETITION LIABILITIES $ 3,470,447 $ 3,470,447 $ 394 $ 394
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
TOTAL LIABILITIES $ 3,470,447 $ 3,470,447 $ 394 $ 394
- ---------------------------------------------------------------------------------------------------------------------------
OWNER EQUITY
- ---------------------------------------------------------------------------------------------------------------------------
Capital Stock 272 272
- ---------------------------------------------------------------------------------------------------------------------------
Additional Paid-In Capital 164,095,489 164,095,489
- ---------------------------------------------------------------------------------------------------------------------------
Partner's Capital Account
- ---------------------------------------------------------------------------------------------------------------------------
Owner's Equity Account
- ---------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Pre-Petition (165,414,352) (165,414,352) (12,000,394) (12,000,394)
- ---------------------------------------------------------------------------------------------------------------------------
Retained Earnings - Postpetition
- ---------------------------------------------------------------------------------------------------------------------------
Adjustments to Owner Equity (attach schedule)
- ---------------------------------------------------------------------------------------------------------------------------
Postpetition Contributions (Distributions)
(Draws) (attach schedule) - -
- ---------------------------------------------------------------------------------------------------------------------------
NET OWNER EQUITY $ (1,318,591) $ (1,318,591) $ (12,000,394) $ (12,000,394)
===========================================================================================================================
TOTAL LIABILITIES AND OWNER'S EQUITY $ 2,151,856 $ 2,151,856 $ (12,000,000) $ (12,000,000)
===========================================================================================================================
**Insider* is defined in 11 U.S.C. Section 101(31) FORM MOR-3 (9/99)
-----------------------------------
CONSOLIDATING
Book Value at
End of Current Book Value on
ASSETS Reporting Period Petition Date
- ---------------------------------------------------------------------------------------
CURRENT ASSETS
- ---------------------------------------------------------------------------------------
Unrestricted Cash and Equivalents 176,014 175,899
- ---------------------------------------------------------------------------------------
Restricted Cash and Cash Equivalents
(see continuation sheet) 277,744 277,461
- ---------------------------------------------------------------------------------------
Accounts Receivable (Net) 34,817 34,790
- ---------------------------------------------------------------------------------------
Notes Receivable - -
- ---------------------------------------------------------------------------------------
Inventories - -
- ---------------------------------------------------------------------------------------
Prepaid Legal Expenses 45,920 98,290
- ---------------------------------------------------------------------------------------
Professional Retainers - -
- ---------------------------------------------------------------------------------------
Other Current Assets (attach schedule) (30,547,340) (30,528,658)
- ---------------------------------------------------------------------------------------
TOTAL CURRENT ASSETS $ (30,012,845) $ (29,942,218)
- ---------------------------------------------------------------------------------------
PROPERTY AND EQUIPMENT
- ---------------------------------------------------------------------------------------
Real Property and Improvements - -
- ---------------------------------------------------------------------------------------
Machinery and Equipment - -
- ---------------------------------------------------------------------------------------
Furniture, Fixtures and Office Equipment - -
- ---------------------------------------------------------------------------------------
Leasehold Improvements - -
- ---------------------------------------------------------------------------------------
Vehicles - -
- ---------------------------------------------------------------------------------------
Less Accumulated Depreciation - -
- ---------------------------------------------------------------------------------------
TOTAL PROPERTY & EQUIPMENT $ - $ -
- ---------------------------------------------------------------------------------------
OTHER ASSETS
- ---------------------------------------------------------------------------------------
Loans to Insiders* - -
- ---------------------------------------------------------------------------------------
Other Assets (attach schedule) - -
- ---------------------------------------------------------------------------------------
TOTAL OTHER ASSETS $ - $ -
=======================================================================================
TOTAL ASSETS $ (30,012,845) $ (29,942,218)
=======================================================================================
LIABILITIES AND OWNER EQUITY
- ---------------------------------------------------
LIABILITIES NOT SUBJECT TO COMPROMISE
(POSTPETITION)
- ---------------------------------------------------------------------------------------
Accounts Payable 4,711 -
- ---------------------------------------------------------------------------------------
Taxes Payable (refer to FORM MOR-4) - -
- ---------------------------------------------------------------------------------------
Wages Payable - -
- ---------------------------------------------------------------------------------------
Notes Payable - -
- ---------------------------------------------------------------------------------------
Rent / Leases - Building/Equipment - -
- ---------------------------------------------------------------------------------------
Secured Debt / Adequate Protection Payments - -
- ---------------------------------------------------------------------------------------
Professional Fees - -
- ---------------------------------------------------------------------------------------
Amounts Due to Insiders* 6,366 -
- ---------------------------------------------------------------------------------------
Other Postpetition Liabilities (accrued interest) 796,188 -
- ---------------------------------------------------------------------------------------
TOTAL POSTPETITION LIABILITIES $ 807,265 $ -
- ---------------------------------------------------------------------------------------
LIABILITIES SUBJECT TO COMPROMISE (PRE-PETITION)
- ---------------------------------------------------------------------------------------
Secured Debt 47,504,390 47,504,390
- ---------------------------------------------------------------------------------------
Priority Debt - -
- ---------------------------------------------------------------------------------------
Unsecured Debt 79,200,724 79,200,314
- ---------------------------------------------------------------------------------------
TOTAL PRE-PETITION LIABILITIES $ 126,705,114 $ 126,704,704
- ---------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------
TOTAL LIABILITIES $ 127,512,379 $ 126,704,704
- ---------------------------------------------------------------------------------------
OWNER EQUITY
- ---------------------------------------------------------------------------------------
Capital Stock 148,453 148,453
- ---------------------------------------------------------------------------------------
Additional Paid-In Capital 513,510,885 513,510,885
- ---------------------------------------------------------------------------------------
Partner's Capital Account - -
- ---------------------------------------------------------------------------------------
Owner's Equity Account - -
- ---------------------------------------------------------------------------------------
Retained Earnings - Pre-Petition (295,770,233) (295,770,246)
- ---------------------------------------------------------------------------------------
Retained Earnings - Postpetition (388,024,225) (387,145,910)
- ---------------------------------------------------------------------------------------
Adjustments to Owner Equity (attach schedule) 12,609,896 12,609,896
- ---------------------------------------------------------------------------------------
Postpetition Contributions (Distributions)
(Draws) (attach schedule) - -
- ---------------------------------------------------------------------------------------
NET OWNER EQUITY $(157,525,224) $(156,646,922)
=======================================================================================
TOTAL LIABILITIES AND OWNER'S EQUITY $ (30,012,845) $ (29,942,218)
=======================================================================================
**Insider* is defined in 11 U.S.C. Section 101(31) FORM MOR-3 (9/99)
---------------------------------------------------------------------------------
Northwestern National Holding Company, Inc. Highlands Insurance Group, Inc.
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Current Assets
- ----------------------------------------------------------------------------------------------------------------------------------
Investment in Subs 1,986,370 1,986,370 (22,723,671) (22,723,671)
- ----------------------------------------------------------------------------------------------------------------------------------
Prepaid Insurance 37,363 56,045
- ----------------------------------------------------------------------------------------------------------------------------------
Taxes Recoverable
- ----------------------------------------------------------------------------------------------------------------------------------
Receivables from affiliates
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Assets
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
LIABILITIES AND OWNER EQUITY Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
Other Pospetition Liabilities
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Adjustment to Owner Equity
- ----------------------------------------------------------------------------------------------------------------------------------
Treasury Stock - - 3,999,394 3,999,394
- ----------------------------------------------------------------------------------------------------------------------------------
Deferred Comp on Restricted Stock - 313,189 313,189
- ----------------------------------------------------------------------------------------------------------------------------------
Preferred Stock - - (16,922,520) (16,922,520)
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Pospetition Contributions (Distributions) (Draws)
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
==================================================================================================================================
------------------------------------------------------------------------------
Highlands Service Corporation Higlands Claims and Safety Services Inc
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Current Assets
- ----------------------------------------------------------------------------------------------------------------------------------
Investment in Subs - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Prepaid Insurance
- ----------------------------------------------------------------------------------------------------------------------------------
Taxes Recoverable 3,742 3,742
- ----------------------------------------------------------------------------------------------------------------------------------
Receivables from affiliates
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Assets
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
LIABILITIES AND OWNER EQUITY Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
Other Pospetition Liabilities
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Adjustment to Owner Equity
- ----------------------------------------------------------------------------------------------------------------------------------
Treasury Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Deferred Comp on Restricted Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Preferred Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Pospetition Contributions (Distributions) (Draws)
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
==================================================================================================================================
------------------------------------------------------------------------------
American Reliance Inc. Highlands Holding Company
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
ASSETS Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Current Assets
- ----------------------------------------------------------------------------------------------------------------------------------
Investment in Subs 2,074,519 2,074,519 (12,000,394) (12,000,394)
- ----------------------------------------------------------------------------------------------------------------------------------
Prepaid Insurance
- ----------------------------------------------------------------------------------------------------------------------------------
Taxes Recoverable
- ----------------------------------------------------------------------------------------------------------------------------------
Receivables from affiliates 77,337 77,337
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Other Assets
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Book Value at Book Value at
End of Current Book Value on End of Current Book Value on
LIABILITIES AND OWNER EQUITY Reporting Period Petition Date Reporting Period Petition Date
- ----------------------------------------------------------------------------------------------------------------------------------
Other Pospetition Liabilities
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Adjustment to Owner Equity
- ----------------------------------------------------------------------------------------------------------------------------------
Treasury Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Deferred Comp on Restricted Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
Preferred Stock - - - -
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Pospetition Contributions (Distributions) (Draws)
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
==================================================================================================================================
----------------------------------
CONSOLIDATING
Book Value at
End of Current Book Value on
ASSETS Reporting Period Petition Date
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
Other Current Assets
- ------------------------------------------------------------------------------------
Investment in Subs (30,663,176) (30,663,176)
- ------------------------------------------------------------------------------------
Prepaid Insurance 37,363 56,045
- ------------------------------------------------------------------------------------
Taxes Recoverable 3,742 3,742
- ------------------------------------------------------------------------------------
Receivables from affiliates 77,337 77,337
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
Other Assets - -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
Book Value at
End of Current Book Value on
LIABILITIES AND OWNER EQUITY Reporting Period Petition Date
- ------------------------------------------------------------------------------------
Other Pospetition Liabilities
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- -
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
Adjustment to Owner Equity
- ------------------------------------------------------------------------------------
Treasury Stock 3,999,394 3,999,394
- ------------------------------------------------------------------------------------
Deferred Comp on Restricted Stock 313,189 313,189
- ------------------------------------------------------------------------------------
Preferred Stock (16,922,520) (16,922,520)
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
Pospetition Contributions (Distributions) (Draws)
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------
====================================================================================
Restricted Cash: cash that is restricted for a specific use and not available
to fund operations. Typically, restricted cash is segregated
into a separate account, such as an escrow account.
IN RE Highlands Insurance Group, Inc. et al. CASE NO. 02-13196 through 02-13201
Debtor REPORTING PERIOD 11/30/02
STATUS OF POSTPETITION TAXES
The beginning tax liability should be the ending liability from the prior month
or, if this is the first report, the amount should be zero
Attach photocopies of IRS Form 6123 or payment receipt to verify payment or
deposit of federal payroll taxes
Attach photocopies of any tax returns filed during the reporting period
================================================================================================================================
Beginning Amount Ending
Tax Withheld or Amount Date Check No. Tax
Liability Accrued Paid Paid or EFT Liability
================================================================================================================================
FEDERAL
================================================================================================================================
Withholding
- --------------------------------------------------------------------------------------------------------------------------------
FICA-Employee
- --------------------------------------------------------------------------------------------------------------------------------
FICA-Employer
- --------------------------------------------------------------------------------------------------------------------------------
Unemployment
- --------------------------------------------------------------------------------------------------------------------------------
Income
- --------------------------------------------------------------------------------------------------------------------------------
Other:
- --------------------------------------------------------------------------------------------------------------------------------
Total Federal Taxes -0- -0-
================================================================================================================================
STATE AND LOCAL
================================================================================================================================
Withholding
- --------------------------------------------------------------------------------------------------------------------------------
Sales
- --------------------------------------------------------------------------------------------------------------------------------
Excise
- --------------------------------------------------------------------------------------------------------------------------------
UNEMPLOYMENT
- --------------------------------------------------------------------------------------------------------------------------------
REAL PROPERTY
- --------------------------------------------------------------------------------------------------------------------------------
PERSONAL PROPERTY
- --------------------------------------------------------------------------------------------------------------------------------
OTHER:
================================================================================================================================
TOTAL STATE AND LOCAL -0- -0-
================================================================================================================================
TOTAL TAXES -0- -0-
================================================================================================================================
*Debtors have no employees
SUMMARY OF UNPAID POSTPETITION DEBTS
ATTACH AGED LISTING OF ACCOUNTS PAYABLE.
================================================================================================================================
NUMBER OF DAYS PAST DUE
==================================================================================
Current 0-30 31-60 61-90 Over 90 Total
================================================================================================================================
Accounts Payable 4,711 4,711
- --------------------------------------------------------------------------------------------------------------------------------
Wages Payable --
- --------------------------------------------------------------------------------------------------------------------------------
Taxes Payable --
- --------------------------------------------------------------------------------------------------------------------------------
Rent/Leases-Building --
- --------------------------------------------------------------------------------------------------------------------------------
Rent/Leases-Equipment --
- --------------------------------------------------------------------------------------------------------------------------------
Secured Debt/Adequate Protection Payments --
- --------------------------------------------------------------------------------------------------------------------------------
Professional Fees
- --------------------------------------------------------------------------------------------------------------------------------
Amounts Due to Insiders* (Directors Fees) 6,366 6,366
- --------------------------------------------------------------------------------------------------------------------------------
Other: (Accrued Interest) 796,188 796,188
- --------------------------------------------------------------------------------------------------------------------------------
Other:
================================================================================================================================
TOTAL POSTPETITION DEBTS 807,265 807,265
================================================================================================================================
EXPLAIN HOW AND WHEN THE DEBTOR INTENDS TO PAY ANY PAST-DUE POSTPETITION DEBTS.
Liabilities, other than accrued interest, will be paid from remaining cash of
Debtor.
Accrued interest will not be paid currently.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
* "Insider" is defined in 11 U.S.C. Section 101(31). FORM MOR-4
(9/99)
IN RE Highlands Insurance Group, Inc. et al. CASE NO. 02-13196 through 02-13201
Debtor REPORTING PERIOD 11/30/02
ACCOUNTS RECEIVABLE RECONCILIATION AND AGING
- ------------------------------------------------------------------------------------------------- -----------------------------
ACCOUNTS RECEIVABLE RECONCILIATION AMOUNT
- ------------------------------------------------------------------------------------------------- -----------------------------
Total Accounts Receivable at the beginning of the reporting period $34,790
- ------------------------------------------------------------------------------------------------- -----------------------------
+ Amounts billed during the period 27
- ------------------------------------------------------------------------------------------------- -----------------------------
- - Amounts collected during the period
- ------------------------------------------------------------------------------------------------- -----------------------------
Total Accounts Receivable at the end of the reporting period 34,817
- ------------------------------------------------------------------------------------------------- -----------------------------
- ------------------------------------------------------------------------------------------------- -----------------------------
ACCOUNTS RECEIVABLE AGING AMOUNT
- ------------------------------------------------------------------------------------------------- -----------------------------
0 - 30 days old 27
- ------------------------------------------------------------------------------------------------- -----------------------------
31 - 60 days old 176
- ------------------------------------------------------------------------------------------------- -----------------------------
61 - 90 days old
- ------------------------------------------------------------------------------------------------- -----------------------------
91+ days old 34,614
- ------------------------------------------------------------------------------------------------- -----------------------------
TOTAL ACCOUNTS RECEIVABLE 34,817
- ------------------------------------------------------------------------------------------------- -----------------------------
AMOUNT CONSIDERED UNCOLLECTIBLE (BAD DEBT) --
- ------------------------------------------------------------------------------------------------- -----------------------------
ACCOUNTS RECEIVABLE (NET) 34,817
- ------------------------------------------------------------------------------------------------- -----------------------------
DEBTOR QUESTIONNAIRE
- ------------------------------------------------------------------------------------------------ ------------- --------------
MUST BE COMPLETED EACH MONTH YES NO
- ------------------------------------------------------------------------------------------------ ------------- --------------
1. Have any assets been sold or transferred outside the normal course of business X
this reporting period? If yes, provide an explanation below.
- ------------------------------------------------------------------------------------------------ ------------- --------------
2. Have any funds been disbursed from any account other than a debtor in
possession account X this reporting period? If yes, provide an explanation below. X
- ------------------------------------------------------------------------------------------------ ------------- --------------
3. Have all postpetition tax returns been timely filed? If no, provide an explanation X
below.
- ------------------------------------------------------------------------------------------------ ------------- --------------
4. Are workers compensation, general liability and other necessary insurance X
coverages in effect? If no, provide an explanation below.
- ------------------------------------------------------------------------------------------------ --- ------------- --------------
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
FORM MOR-5
(9/99)