Fill in this information to identify your case:

Debtor 1 Paul Wigoda

First Name Middle Name Last Name

Debtor 2

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number 19-22567

(if known)  Check if this is an

amended filing

B 104 

For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest

Unsecured Claims Against You and Are Not Insiders 12/15

If you are an individual filing for bankruptcy under Chapter 11, you must fill out this form. If you are filing under Chapter 7, Chapter 12, or

Chapter 13, do not fill out this form. Do not include claims by anyone who is an insider. Insiders include your relatives; any general partners;

relatives of any general partners; partnerships of which you are a general partner; corporations of which you are an officer, director, person

in control, or owner of 20 percent or more of their voting securities; and any managing agent, including one for a business you operate as a

sole proprietor. 11 U.S.C. § 101. Also, do not include claims by secured creditors unless the unsecured claim resulting from inadequate

collateral value places the creditor among the holders of the 20 largest unsecured claims.

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct

information.

Part 1: List the 20 Unsecured Claims in Order from Largest to Smallest. Do Not Include Claims by Insiders.

Unsecured claim

1 What is the nature of the claim? Personal Loan $ $1,045,000.00

1439 Alton Road, LLC

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

2 What is the nature of the claim? Personal Loan $ $1,500,000.00

843 Washington LLC

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

B104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 1

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Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 1 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Contact phone Unsecured claim $

3 What is the nature of the claim? Personal Loan $ $560,000.00

849 Washington LLC

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

4 What is the nature of the claim? Personal Loan $ $300,000.00

Anna Selechnik

Guatemala As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

5 What is the nature of the claim? Medical Practice $ $392,173.00

Bankers Healthcare Group

201 Solar Street

Syracuse, NY 13204

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $ $432,173.00

Value of security: - $ $40,000.00

Contact phone Unsecured claim $ $392,173.00

6 What is the nature of the claim? Credit Card $ $67,586.00

Citi Business Card

PO Box 9001037

Louisville, KY 40290-1037

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 2

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Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 2 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

7 What is the nature of the claim? Personal Loan $ $1,604,000.00

Edith Wigoda

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

8 What is the nature of the claim? Medical Practice,

Receivables, Property

$ $97,928.00

EIN Capital

160 Pearl St, 5th Floor

New York, NY 10005

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $ $137,928.00

Value of security: - $ $40,000.00

Contact phone Unsecured claim $ $97,928.00

9 What is the nature of the claim? Personal Loan $ $335,000.00

Gina Wigoda

18101 Collins Ave, #607

Sunny Isles Beach, FL 33160

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

10 What is the nature of the claim? Medical Practice,

Receivables, Property

$ $107,761.00

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 3

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 3 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Knight Capital

1 East Loockerman St, #202-543

Dover, DE 19901

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $ $147,761.00

Value of security: - $ $40,000.00

Contact phone Unsecured claim $ $107,761.00

11 What is the nature of the claim? Personal Loan $ $543,000.00

L & E United Inc.

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

12 What is the nature of the claim? 1404 E. Broward Blvd,

Fort Lauderdale, FL

33301

$ $400,000.00

Lift Forward

180 Maiden Lane, 10th Flr

New York, NY 10038

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $ $1,000,000.00

Value of security: - $ $600,000.00

Contact phone Unsecured claim $ $400,000.00

13 What is the nature of the claim? Personal Loan $ $105,000.00

Marie Ruiz Rodriguez

1321 NE 17th Ave

St Cloud, FL 33304

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 4

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 4 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

14 What is the nature of the claim? Personal Loan $ $98,000.00

Mark Levitats

15020 SW 76th Ct

Miami, FL 33158

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

15 What is the nature of the claim? Case # 6201260 $ $102,482.89

Mentor Group

33 Technology Drive

Irvine, CA 92618

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

16 What is the nature of the claim? Personal Loan $ $300,000.00

Michael Dezer

18001 Collins Ave, 31st Flr

Sunny Isles Beach, FL 33160

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

17 What is the nature of the claim? Medical Practice $ $4,692,217.00

Ocean Bank/PW Capital

Collections, LLC

c/o Peter A. Tappert, Esq.

Weissman & Dervishi, PA

1 SE Third Ave, Suite 1700

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 5

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 5 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Miami, FL 33131 As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $ $4,732,217.00

Value of security: - $ $40,000.00

Contact phone Unsecured claim $ $4,692,217.00

18 What is the nature of the claim? Personal Loan $ $75,000.00

Raquel Epelbaum

8035 Cecil St

Miami Beach, FL 33141

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

19 What is the nature of the claim? Breast Implants Accts

Payable

$ $156,790.00

Sientra Inc.

Dept CA 24673

Pasadena, CA 91185-4673

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

Value of security: - $

Contact phone Unsecured claim $

20 What is the nature of the claim? Personal Loan $ $100,000.00

SMDCBR, Real Estate Holding

LLC

9601 Collins Ave, #406

Bal Harbor, FL 33154

As of the date you file, the claim is: Check all that apply

 Contingent

 Unliquidated

 Disputed

 None of the above apply

Does the creditor have a lien on your property?

 No

Contact  Yes. Total claim (secured and unsecured) $

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 6

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 6 of 7
Debtor 1 Paul Wigoda Case number (if known) 19-22567

Value of security: - $

Contact phone Unsecured claim $

Part 2: Sign Below

Under penalty of perjury, I declare that the information provided in this form is true and correct.

X /s/ Paul Wigoda X

Paul Wigoda Signature of Debtor 2

Signature of Debtor 1

Date September 20, 2019 Date

B 104 (Official Form 104) For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Page 7

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-22567-AJC Doc 4 Filed 09/20/19 Page 7 of 7