Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1 

Official Form 201

Voluntary Petition for Non-Individuals Filing for Bankruptcy 04/20

If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and the case 

number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.

1. Debtor’s name ______________________________________________________________________________________________________

2. All other names debtor used

in the last 8 years

Include any assumed names,

trade names, and doing business

as names

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

3. Debtor’s federal Employer

Identification Number (EIN) ______________________________________

4. Debtor’s address Principal place of business

______________________________________________

Number Street

______________________________________________

______________________________________________ 

City State ZIP Code 

______________________________________________

County 

Mailing address, if different from principal place 

of business

_______________________________________________

Number Street

_______________________________________________

P.O. Box

_______________________________________________ 

City State ZIP Code

Location of principal assets, if different from 

principal place of business

_______________________________________________

Number Street

_______________________________________________

_______________________________________________ 

City State ZIP Code

5. Debtor’s website (URL) ____________________________________________________________________________________________________

6. Type of debtor  Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))

 Partnership (excluding LLP)

 Other. Specify: __________________________________________________________________

 Check if this is an

amended filing

United States Bankruptcy Court for the:

____________________ District of _________________

(State) 

Case number (If known): _________________________ Chapter you are filing under:

 Chapter 7 

 Chapter 11

 Chapter 12

 Chapter 13

 Fill in this information to identify your case:

Fort Lauderdale FL

✔

33309

www.destinationhope.com

20-4845884

Southern District of Florida

✔

Broward County

Destination Hope, Inc.

6460 NW 5th Way

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 1 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2

7. Describe debtor’s business

A. Check one:

 Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Railroad (as defined in 11 U.S.C. § 101(44))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

 Commodity Broker (as defined in 11 U.S.C. § 101(6))

 Clearing Bank (as defined in 11 U.S.C. § 781(3))

 None of the above

B. Check all that apply:

 Tax-exempt entity (as described in 26 U.S.C. § 501)

 Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C.

§ 80a-3)

 Investment advisor (as defined in 15 U.S.C. § 80b-2(a)(11))

C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor.

See http://www.naics.com/search/ .

_________

8. Under which chapter of the

Bankruptcy Code is the

debtor filing?

Check one:

9. Were prior bankruptcy cases

filed by or against the debtor

within the last 8 years?

If more than 2 cases, attach a

separate list.

 No

 Yes. District _______________________ When _______________ Case number _________________________

MM / DD / YYYY

District _______________________ When _______________ Case number _________________________

MM / DD / YYYY

10. Are any bankruptcy cases

pending or being filed by a

business partner or an

affiliate of the debtor?

List all cases. If more than 1,

attach a separate list.

 No

 Yes. Debtor _____________________________________________ Relationship _________________________

District _____________________________________________ When __________________ 

MM / DD / YYYY 

Case number, if known ________________________________

A debtor who is a “small business 

debtor” must check the first subbox. A debtor as defined in 

§ 1182(1) who elects to proceed

under subchapter V of chapter 11

(whether or not the debtor is a

“small business debtor”) must

check the second sub-box.

 Chapter 7

 Chapter 9

 Chapter 11. Check all that apply:

 The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D), and its

aggregate noncontingent liquidated debts (excluding debts owed to insiders or

affiliates) are less than $2,725,625. If this sub-box is selected, attach the most

recent balance sheet, statement of operations, cash-flow statement, and federal

income tax return or if any of these documents do not exist, follow the procedure in

11 U.S.C. § 1116(1)(B).

 The debtor is a debtor as defined in 11 U.S.C. § 1182(1), its aggregate

noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are

less than $7,500,000, and it chooses to proceed under Subchapter V of

Chapter 11. If this sub-box is selected, attach the most recent balance sheet,

statement of operations, cash-flow statement, and federal income tax return, or if

any of these documents do not exist, follow the procedure in 11 U.S.C.

§ 1116(1)(B).

 A plan is being filed with this petition.

 Acceptances of the plan were solicited prepetition from one or more classes of

creditors, in accordance with 11 U.S.C. § 1126(b).

 The debtor is required to file periodic reports (for example, 10K and 10Q) with the

Securities and Exchange Commission according to § 13 or 15(d) of the Securities

Exchange Act of 1934. File the Attachment to Voluntary Petition for Non-Individuals Filing

for Bankruptcy under Chapter 11 (Official Form 201A) with this form.

 The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule

12b-2.

 Chapter 12

6232

✔

✔

Destination Hope, Inc.

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 2 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3

11. Why is the case filed in this

district?

Check all that apply:

 Debtor has had its domicile, principal place of business, or principal assets in this district for 180 days

immediately preceding the date of this petition or for a longer part of such 180 days than in any other

district.

 A bankruptcy case concerning debtor’s affiliate, general partner, or partnership is pending in this district.

12. Does the debtor own or have

possession of any real

property or personal property

that needs immediate

attention?

 No

 Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed.

Why does the property need immediate attention? (Check all that apply.)

 It poses or is alleged to pose a threat of imminent and identifiable hazard to public health or safety.

What is the hazard? _____________________________________________________________________

 It needs to be physically secured or protected from the weather.

 It includes perishable goods or assets that could quickly deteriorate or lose value without

attention (for example, livestock, seasonal goods, meat, dairy, produce, or securities-related

assets or other options).

 Other _______________________________________________________________________________

Where is the property?_____________________________________________________________________

Number Street

____________________________________________________________________

_______________________________________ _______ ________________

City State ZIP Code 

Is the property insured?

 No

 Yes. Insurance agency ____________________________________________________________________

Contact name ____________________________________________________________________

Phone ________________________________ 

Statistical and administrative information

13. Debtor’s estimation of

available funds

Check one:

 Funds will be available for distribution to unsecured creditors.

 After any administrative expenses are paid, no funds will be available for distribution to unsecured creditors.

14. Estimated number of

creditors

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5,001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than 100,000

15. Estimated assets

 $0-$50,000

 $50,001-$100,000

 $100,001-$500,000

 $500,001-$1 million

 $1,000,001-$10 million

 $10,000,001-$50 million

 $50,000,001-$100 million

 $100,000,001-$500 million

 $500,000,001-$1 billion

 $1,000,000,001-$10 billion

 $10,000,000,001-$50 billion

 More than $50 billion

✔

✔

✔

✔

✔

Destination Hope, Inc.

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 3 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 4

16. Estimated liabilities

 $0-$50,000

 $50,001-$100,000

 $100,001-$500,000

 $500,001-$1 million

 $1,000,001-$10 million

 $10,000,001-$50 million

 $50,000,001-$100 million

 $100,000,001-$500 million

 $500,000,001-$1 billion

 $1,000,000,001-$10 billion

 $10,000,000,001-$50 billion

 More than $50 billion

Request for Relief, Declaration, and Signatures

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement in connection with a bankruptcy case can result in fines up to 

$500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

17. Declaration and signature of

authorized representative of

debtor

The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this

petition.

I have been authorized to file this petition on behalf of the debtor.

I have examined the information in this petition and have a reasonable belief that the information is true and

correct.

I declare under penalty of perjury that the foregoing is true and correct. 

Executed on _________________

MM / DD / YYYY

_____________________________________________ _______________________________________________

Signature of authorized representative of debtor Printed name

Title _________________________________________ 

18. Signature of attorney _____________________________________________ Date _________________

Signature of attorney for debtor MM / DD / YYYY

_________________________________________________________________________________________________

Printed name

_________________________________________________________________________________________________

Firm name

_________________________________________________________________________________________________

Number Street

____________________________________________________ ____________ ______________________________

City State ZIP Code 

____________________________________ __________________________________________

Contact phone Email address

______________________________________________________ ____________

Bar number State

awernick@wernicklaw.com

FL

Benjamin Brafman

Boca Raton

Wernick Law, PLLC

14059

FL 33431

561-961-0922

✔

/s/ Aaron Wernick

08/28/2020

08/28/2020

Aaron Wernick

2255 Glades Road Suite 324A

/s/ Benjamin Brafman

President

Destination Hope, Inc.

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 4 of 28
Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims page 1 

Official Form 204 

Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest 

Unsecured Claims and Are Not Insiders 12/15

A list of creditors holding the 20 largest unsecured claims must be filed in a Chapter 11 or Chapter 9 case. Include claims which the debtor 

disputes. Do not include claims by any person or entity who is an insider, as defined in 11 U.S.C. § 101(31). 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. 

Name of creditor and complete 

mailing address, including zip code

Name, telephone number, 

and email address of 

creditor contact 

Nature of the claim 

(for example, trade

debts, bank loans, 

professional 

services, and 

government 

contracts)

Indicate if 

claim is 

contingent, 

unliquidated, 

or disputed 

Amount of unsecured claim

If the claim is fully unsecured, fill in only unsecured 

claim amount. If claim is partially secured, fill in 

total claim amount and deduction for value of 

collateral or setoff to calculate unsecured claim. 

Total claim, if 

partially 

secured

Deduction for 

value of 

collateral or 

setoff

Unsecured 

claim

1

2

3

4

5

6

7

8

 Check if this is an

amended filing

Debtor name __________________________________________________________________ 

United States Bankruptcy Court for the:_______________________________ 

Case number (If known): _________________________ 

 Fill in this information to identify the case:

Destination Hope, Inc.

Medical billing

PPP loan

Breach of lease

Loan to company

Medical billing

Billing solutions

Unpaid rent

Loan to business

Disputed

Disputed

1,500,000.00

1,230,000.00

Disputed

800,000.00

600,000.00

Disputed

570,276.74

400,000.00

240,000.00

227,000.00

Southern District of Florida

David Gussack

1851 Blount Road

Pompano Beach, FL, 33069

3831 Crystal Lake Drive, LLC

2707-2709 NE 33rd Ave

Fort Lauderdale, FL, 33308

Professional Revenue Recovery

Solutions, Inc.

13630 NW 8th St.

Suite 220

Sunrise, FL, 33325

Cigna

900 Cottage Grove Road

Hartford, CT, 6152

Halpern Family Trust

1711 N. Fort Lauderdale Beach Blvd

Fort Lauderdale, FL, 33305

EastGroup Properties Inc.

3495 Piedmont Road NE

Building 11, Ste #350

Atlanta, GA, 30305

City National Bank

100 SE 2nd St.

Miami, FL, 33131

TRICARE

PO Box 8923

Madison, WI, 53707-8923

Marty Halpern

David Gussack

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 5 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims page 2 

Name of creditor and complete 

mailing address, including zip code

Name, telephone number, 

and email address of 

creditor contact 

Nature of the claim 

(for example, trade

debts, bank loans, 

professional 

services, and 

government 

contracts)

Indicate if 

claim is 

contingent, 

unliquidated, 

or disputed 

Amount of unsecured claim

If the claim is fully unsecured, fill in only unsecured 

claim amount. If claim is partially secured, fill in 

total claim amount and deduction for value of 

collateral or setoff to calculate unsecured claim. 

Total claim, if 

partially 

secured

Deduction for 

value of 

collateral or 

setoff

Unsecured 

claim

9

10

11

12

13

14

15

16

17

18

19

20

CapFlow

2232 Brigham Street

#5K

Brooklyn, NY, 11229

Marlin Capital Solutions

300 Fellowship Road

Mount Laurel, NJ, 08054

Cindy Wisdom

821 NW 66th Avenue

Plantation, FL, 33317-1235

MCA

Nole Financial

701 Brickell Key Blvd.

#CU-02

Miami, FL, 33131

Rent arrearage and

property tax

SBA

51 SW 1st Ave #201, Miami, FL 33130

Miami, FL, 33130

Brokerage commission

MD Solutions Group

3330 Fairchild Gardens Ave

#32613

Palm Beach Gardens, FL, 33420

Medical billing

BMF Capital

1820 Avenue M

Brooklyn, NY, 11230

MCA

Billing solutions

Aetna

PO Box 14079

Lexington, KY, 40512

EIDL loan

Alantes Corp attn: Ken Dotson

510 5th Avenue

3rd Floor

New York, NY, 10036

Destination Hope, Inc.

65,332.91

Loan brokerage

Pontus SW Portfolio LLC

875 Prospect Street

Suite 303

La Jolla, CA, 92037

Loan to business

AJ Equity Group, LLC

1648 61st Street

Brooklyn, NY, 11204

Equipment lease - stolen

equipment

79,593.20

80,000.00

Loan to business

MCA

100,000.00

160,000.00

163,443.30

197,846.32

200,000.00

200,000.00

200,000.00

201,698.54

204,710.26

Disputed

Unliquidated

Disputed

Disputed

Disputed

Unliquidated

Disputed

Disputed

Disputed

Unliquidated

858-345-4544

Kenneth R. Dotson

646-820-6085 or 310-462-4506

Gabe Isaacov

561-223-1504

305-323-9254

Cindy Wisdom

954-591-0492

Bankers Healthcare Group, LLC

201 Solar Street

Syracuse, NY, 13204

347-962-7976

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 6 of 28
Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property page 1 of ___

Official Form 206D 

Schedule D: Creditors Who Have Claims Secured by Property 12/15

Be as complete and accurate as possible.

1. Do any creditors have claims secured by debtor’s property?

 No. Check this box and submit page 1 of this form to the court with debtor’s other schedules. Debtor has nothing else to report on this form.

 Yes. Fill in all of the information below.

Part 1: List Creditors Who Have Secured Claims 

2. List in alphabetical order all creditors who have secured claims. If a creditor has more than one

secured claim, list the creditor separately for each claim.

Column A

Amount of claim 

Do not deduct the value 

of collateral.

Column B

Value of collateral 

that supports this 

2.1 Creditor’s name Describe debtor’s property that is subject to a lien claim

__________________________________________ $__________________ $_________________ 

Creditor’s mailing address

________________________________________________________

________________________________________________________

Creditor’s email address, if known

_________________________________________

 No

 Yes

Date debt was incurred __________________

Last 4 digits of account 

number _________________ Is anyone else liable on this claim?

 No

 Yes. Fill out Schedule H: Codebtors (Official Form 206H).

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Specify each creditor, including this creditor, As of the petition filing date, the claim is: 

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

2.2 Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________

Creditor’s mailing address

________________________________________________________ 

________________________________________________________

Creditor’s email address, if known 

_________________________________________ 

Date debt was incurred __________________

Last 4 digits of account 

number _________________

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Have you already specified the relative 

priority?

 No. Specify each creditor, including this

creditor, and its relative priority. 

3. Total of the dollar amounts from Part 1, Column A, including the amounts from the Additional $________________ 

Debtor name __________________________________________________________________ 

United States Bankruptcy Court for the: _______________________________________

Case number (If known): _________________________ 

 Fill in this information to identify the case:

 Check if this is an

amended filing

Describe the lien

_________________________________________________ 

Is the creditor an insider or related party? 

Page, if any.

 Yes. The relative priority of creditors is

specified on lines _____

$__________________ $_________________ 









No

Yes

Is anyone else liable on this claim?

No

Yes. Fill out Schedule H: Codebtors (Official Form 206H).

As of the petition filing date, the claim is: 

Check all that apply. 







Contingent

Unliquidated

Disputed

Describe the lien

_________________________________________________ 

Is the creditor an insider or related party? 

Undetermined

Undetermined

✔

✔

Agreement you made

PO Box 650575

Agreement you made

PO Box 650575

✔

✔

Dallas, TX 75265-0575

Dallas, TX 75265-0575

4,754,369.45

12-person passenger van

12-person passenger van

5,702.33

5,680.54

Destination Hope, Inc.

Southern District of Florida

Ford Credit

Ford Credit

✔

4

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 7 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________

Name

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___

Part 1: Additional Page 

Column A

Amount of claim 

Do not deduct the value 

of collateral.

Column B

Value of collateral 

that supports this 

claim

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page.

2.__ Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________ $__________________ $_________________

Creditor’s mailing address

________________________________________________________

________________________________________________________

Creditor’s email address, if known

_________________________________________

Date debt was incurred __________________

Last 4 digits of account 

number _________________

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Have you already specified the relative 

priority?

 No. Specify each creditor, including this

creditor, and its relative priority. 

 Yes. The relative priority of creditors is

specified on lines _____

2.__ Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________ $__________________ $_________________

Creditor’s mailing address

________________________________________________________

________________________________________________________

Describe the lien

__________________________________________________

Creditor’s email address, if known

_________________________________________

Is the creditor an insider or related party? 

 No

 Yes

Date debt was incurred __________________

Last 4 digits of account 

number _________________

Is anyone else liable on this claim?

 No

 Yes. Fill out Schedule H: Codebtors (Official Form 206H).

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Have you already specified the relative 

priority?

As of the petition filing date, the claim is: 

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

 No. Specify each creditor, including this

creditor, and its relative priority. 

 Yes. The relative priority of creditors is

specified on lines _____

Describe the lien

__________________________________________________

Is the creditor an insider or related party? 





No

Yes

Is anyone else liable on this claim? 





No

Yes. Fill out Schedule H: Codebtors (Official Form 206H).

As of the petition filing date, the claim is: 

Check all that apply. 







Contingent

Unliquidated

Disputed

✔

✔

✔

✔

1981 Marcus Avenue

PO Box 650575

Agreement you made

Blanket lien

✔

✔

Dallas, TX 75265-0575

Suite 130, Lake Success, NY 11042

1344

4

3

12-person passenger van

1,498,188.00

33,158.56

2

Destination Hope, Inc.

Newtek Small Business Finance, LLC

Ford Credit

4

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 8 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________

Name

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___

Part 1: Additional Page 

Column A

Amount of claim 

Do not deduct the value 

of collateral.

Column B

Value of collateral 

that supports this 

claim

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page.

2.__ Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________ $__________________ $_________________

Creditor’s mailing address

________________________________________________________

________________________________________________________

Creditor’s email address, if known

_________________________________________

Date debt was incurred __________________

Last 4 digits of account 

number _________________

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Have you already specified the relative 

priority?

 No. Specify each creditor, including this

creditor, and its relative priority. 

 Yes. The relative priority of creditors is

specified on lines _____

2.__ Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________ $__________________ $_________________

Creditor’s mailing address

________________________________________________________

________________________________________________________

Describe the lien

__________________________________________________

Creditor’s email address, if known

_________________________________________

Is the creditor an insider or related party? 

 No

 Yes

Date debt was incurred __________________

Last 4 digits of account 

number _________________

Is anyone else liable on this claim?

 No

 Yes. Fill out Schedule H: Codebtors (Official Form 206H).

Do multiple creditors have an interest in the 

same property?

 No

 Yes. Have you already specified the relative 

priority?

As of the petition filing date, the claim is: 

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

 No. Specify each creditor, including this

creditor, and its relative priority. 

 Yes. The relative priority of creditors is

specified on lines _____

Describe the lien

__________________________________________________

Is the creditor an insider or related party? 





No

Yes

Is anyone else liable on this claim? 





No

Yes. Fill out Schedule H: Codebtors (Official Form 206H).

As of the petition filing date, the claim is: 

Check all that apply. 







Contingent

Unliquidated

Disputed

✔

✔

✔

✔

23 Corporate Plaza

1981 Marcus Avenue

Blanket lien

Blanket lien

✔

✔

Suite 130, Lake Success, NY 11042

Suite #100, Newport Beach, CA 92660

✔

5174

6

5

1,784,166.68

1,427,473.34

3

Destination Hope, Inc.

SG Credit Partners

Newtek Small Business Finance, LLC

4

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 9 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________

Name

Form 206D Official Part 2 of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___

Part 2: List Others to Be Notified for a Debt Already Listed in Part 1 

List in alphabetical order any others who must be notified for a debt already listed in Part 1. Examples of entities that may be listed are collection 

agencies, assignees of claims listed above, and attorneys for secured creditors. 

If no others need to be notified for the debts listed in Part 1, do not fill out or submit this page. If additional pages are needed, copy this page. 

Name and address On which line in Part 1 

did you enter the 

related creditor? 

Last 4 digits of 

account number 

for this entity

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Line 2. __ _________________

Destination Hope, Inc.

4 4

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 10 of 28
Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of ___

Official Form 206E/F

Schedule E/F: Creditors Who Have Unsecured Claims 12/15

Be as complete and accurate as possible. Use Part 1 for creditors with PRIORITY unsecured claims and Part 2 for creditors with NONPRIORITY 

unsecured claims. List the other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts 

on Schedule A/B: Assets - Real and Personal Property (Official Form 206A/B) and on Schedule G: Executory Contracts and Unexpired Leases

(Official Form 206G). Number the entries in Parts 1 and 2 in the boxes on the left. If more space is needed for Part 1 or Part 2, fill out and attach 

the Additional Page of that Part included in this form. 

Part 1: List All Creditors w ith PRIORITY Unsecured Claims

1. Do any creditors have priority unsecured claims? (See 11 U.S.C. § 507).

 No. Go to Part 2.

 Yes. Go to line 2.

2. List in alphabetical order all creditors who have unsecured claims that are entitled to priority in whole or in part. If the debtor has more than

3 creditors with priority unsecured claims, fill out and attach the Additional Page of Part 1.

Total claim Priority amount

2.1 As of the petition filing date, the claim is:

Check all that apply. 

$______________________ $_________________ 

 Contingent

 Unliquidated

 Disputed

Basis for the claim:

Priority creditor’s name and mailing address

Date or dates debt was incurred 

_________________________________ 

Last 4 digits of account 

number _______________________

Specify Code subsection of PRIORITY unsecured 

claim: 11 U.S.C. § 507(a) (_____)

2.2 As of the petition filing date, the claim is:

Check all that apply. 

$______________________ $_________________ 

 Contingent

 Unliquidated

 Disputed

Basis for the claim:

2.3 As of the petition filing date, the claim is:

Check all that apply. 

$______________________ $_________________ 

 Contingent

 Unliquidated

 Disputed

Basis for the claim:

Debtor __________________________________________________________________ 

United States Bankruptcy Court for the: ________________________________ 

Case number ___________________________________________

(If known)

Fill in this information to identify the case:

 Check if this is an

amended filing

Is the claim subject to offset? 





No

Yes

Is the claim subject to offset? 





No

Yes

Is the claim subject to offset? 





No

Yes

Priority creditor’s name and mailing address

Date or dates debt was incurred 

_________________________________ 

Last 4 digits of account 

number _______________________

Specify Code subsection of PRIORITY unsecured 

claim: 11 U.S.C. § 507(a) (_____)

Priority creditor’s name and mailing address

Date or dates debt was incurred 

_________________________________ 

Last 4 digits of account 

number _______________________

Specify Code subsection of PRIORITY unsecured 

claim: 11 U.S.C. § 507(a) (_____)

Destination Hope, Inc.

0.00

0.00

800,000.00

2019 2020

Taxes & Other Government Units

Taxes & Other Government Units

Taxes & Other Government Units

11

✔

✔

✔

Broward County Tax Collector

115 S. Andrews Ave

Room # A100

Fort Lauderdale, FL, 33301

Florida Dept of Revenue

5050 W Tennessee Street

Bldg L

Tallahassee, FL, 32399-0180

Internal Revenue Service

111 Constitution Avenue NW

Washington , DC

✔

Southern District of Florida

8

8

8

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 11 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: List All Creditors w ith NONPRIORITY Unsecured Claims

3. List in alphabetical order all of the creditors with nonpriority unsecured claims. If the debtor has more than 6 creditors with nonpriority

Amount of claim

3.1

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

unsecured claims, fill out and attach the Additional Page of Part 2.

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

3.2 As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Is the claim subject to offset? 

3.3 As of the petition filing date, the claim is:

Check all that apply. $________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

3.4 As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Is the claim subject to offset? 





No

Yes

3.5 As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________ 

__________________

Is the claim subject to offset? 

3.6 As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________ 

___________________

Is the claim subject to offset? 





No

Yes

Basis for the claim:

Is the claim subject to offset? 

Is the claim subject to offset? 

Basis for the claim:

Basis for the claim:

 Contingent

 Unliquidated

 Disputed

 No

 Yes

Basis for the claim:

Basis for the claim:





No

Yes

Basis for the claim:





No

Yes





No

Yes

Alantes Corp attn: Ken Dotson

510 5th Avenue

3rd Floor

New York, NY, 10036 ✔

11

✔

AJ Equity Group, LLC

1648 61st Street

Brooklyn, NY, 11204 ✔

Aetna

PO Box 14079

Lexington, KY, 40512

✔

3831 Crystal Lake Drive, LLC

2707-2709 NE 33rd Ave

Fort Lauderdale, FL, 33308

121 Capital

178 Manhattan Street

Staten Island, NY, 10307

✔

0.00

240,000.00

200,000.00

201,698.54

200,000.00

40,000.00

Brokerage commission

Unpaid rent

Medical billing

MCA

Brokerage commission

Loan to business

2

✔

✔

✔

✔

✔

✔

Destination Hope, Inc.

Andrew Merker

1535 Mt Vernon Rd

Dunwoody, GA, 30338 ✔

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 12 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

✔

30,000.00

204,710.26

197,846.32

✔

✔

✔

✔

Legal services

Loan to business

MCA

10

3

11

CapFlow

2232 Brigham Street

#5K

Brooklyn, NY, 11229

Cigna

900 Cottage Grove Road

Hartford, CT, 6152

MCA

Medical billing

65,332.91

570,276.74

✔

✔

✔

9

8

7

Destination Hope, Inc.

✔

BMF Capital

1820 Avenue M

Brooklyn, NY, 11230 ✔

Bankers Healthcare Group, LLC

201 Solar Street

Syracuse, NY, 13204

Anthony S. Hearn P.A

One Biscayne Tower

2 Biscayne Blvd, Ste 3400

Miami, FL, 33131

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 13 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

7970

80,000.00

1,230,000.00

1,990.29

✔

✔

✔

Loan to business

PPP loan

Waste/trash

15

4

16

3259

0-10

Daszkal Bolton LLP

2401 NW Boca Raton Boulevard

Boca Raton, FL, 33431-6632

David Gussack

1851 Blount Road

Pompano Beach, FL, 33069

Accoutning services

Loan to business

28,000.00

227,000.00

✔

✔

✔

14

13

12

Destination Hope, Inc.

City of Deerfield Beach

401 SW 4th Street

Deerfield Beach, FL, 33441-4666

City National Bank

100 SE 2nd St.

Miami, FL, 33131

Cindy Wisdom

821 NW 66th Avenue

Plantation, FL, 33317-1235

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 14 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

800,000.00

10,000.00

600,000.00

✔

✔

✔

Breach of lease

Unpaid rent

Loan to company

20

5

21

Healthpac Computer

1010 East Victory Drive

Suite B

Savannah, GA, 31405

HealthSmart Benefit

PO Box 3244

Charleston, WV, 25332-3244

Billing software

Billing software

1,700.00

3,225.00

✔

✔

✔

19

18

17

Destination Hope, Inc.

Halpern Family Trust

1711 N. Fort Lauderdale Beach Blvd

Fort Lauderdale, FL, 33305

Group 716, LLC

245 Country Club Drive

Suite 300D

Stockbridge, GA, 30281

EastGroup Properties Inc.

3495 Piedmont Road NE

Building 11, Ste #350

Atlanta, GA, 30305

✔

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 15 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

40,000.00

13,000.00

79,593.20

✔

✔

✔

✔

MCA

Client refund

Equipment lease - stolen equipment

25

6

26

MD Solutions Group

3330 Fairchild Gardens Ave

#32613

Palm Beach Gardens, FL, 33420

Michael Anthony Volpe

178 Manhattan Street

Staten Island, NY, 10307

Billing solutions

Broker commission

163,443.30

0.00

✔

✔

✔

24

23

22

Destination Hope, Inc.

Marlin Capital Solutions

300 Fellowship Road

Mount Laurel, NJ, 08054

Linda Hess

1620 NW 121 Way

Gainesville, FL, 32606

Hewlett Packard Financial Services Co.

200 Connell Drive

Suite 5000

Berkeley Heights, NJ, 07922

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 16 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

✔

21,000.00

48,382.00

100,000.00

✔

✔

Copier lease

MCA

Loan brokerage

30

7

31

Pawnee Leasing Corp.

3801 Automation Way

Suite 207

Fort Collins, CO, 80525

Pontus SW Portfolio LLC

875 Prospect Street

Suite 303

La Jolla, CA, 92037

Medical eqipment

Rent arrearage and property tax

19,433.02

200,000.00

✔

✔

✔

29

28

27

Destination Hope, Inc.

Nole Financial

701 Brickell Key Blvd.

#CU-02

Miami, FL, 33131 ✔

Mr. Advance LLC

35-12 19th Ave

Astoria, NY, 11105 ✔

Milner, Inc.

PO Box 923197

Norcross, GA, 30010-3197

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 17 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

400,000.00

160,000.00

4,428.31

✔

✔

✔

Billing solutions

EIDL loan

A/C repair

35

8

36

ThyssenKrupp Elevator Corporation

PO Box 3796

Carol Stream, IL, 60132-3796

TRICARE

PO Box 8923

Madison, WI, 53707-8923

Elevator repair

Medical billing

3,340.60

1,500,000.00

✔

✔

✔

34

33

32

Destination Hope, Inc.

Shaboon Air & Refrigeration

3530 NW 32nd Court

Lauderdale Lakes, FL, 33309 ✔

SBA

51 SW 1st Ave #201, Miami, FL 33130

Miami, FL, 33130

Professional Revenue Recovery Solutions, Inc.

13630 NW 8th St.

Suite 220

Sunrise, FL, 33325

✔

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 18 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the 

previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

Amount of claim

3.___ As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

Is the claim subject to offset? 

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

__________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

___________________

___________________

Basis for the claim:

 No

 Yes

3.___

As of the petition filing date, the claim is:

Check all that apply. 

 Contingent

 Unliquidated

 Disputed

$________________________________

Nonpriority creditor’s name and mailing address

Date or dates debt was incurred

Last 4 digits of account number

____________________

___________________

Basis for the claim:

 No

 Yes

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

Is the claim subject to offset? 

11

17,000.00

53,000.00

2,843.15

✔

Drinking water supplies

Retirement plan

Billing solutions

40

9

69076

1000

Weiss Serota Helfman Cole & Bierman, P.L.

1200 N. Federal Highway

Suite 312

Boca Raton, FL, 33432

Legal services

24,164.10

✔

✔

✔

39

38

37

Destination Hope, Inc.

Waystar Revenue Cycle Technology

1311 Solutions Center

Chicago, IL, 60677-1311

Vanguard c/o Ascensus

415 8th Avenue NE

Brainerd, MN, 56401

Ultimate Water, LLC

PO Box 677784

Dallas, TX, 75267-7784

✔

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 19 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 3: List Others to Be Notified About Unsecured Claims

4. List in alphabetical order any others who must be notified for claims listed in Parts 1 and 2. Examples of entities that may be listed are collection agencies, 

assignees of claims listed above, and attorneys for unsecured creditors.

If no others need to be notified for the debts listed in Parts 1 and 2, do not fill out or submit this page. If additional pages are needed, copy the next page.

Name and mailing address On which line in Part 1 or Part 2 is the 

related creditor (if any) listed?

Last 4 digits of 

account number, if 

any

4.1. Line _____

 Not listed. Explain:

________________

4.2. Line _____

 Not listed. Explain ________________

4.3. Line _____

 Not listed. Explain ________________

4.4. Line _____

 Not listed. Explain ________________

41. Line _____

 Not listed. Explain ________________

4.5. Line _____

 Not listed. Explain ________________

4.6. Line _____

 Not listed. Explain ________________

4.7. Line _____

 Not listed. Explain ________________

4.8. Line _____

 Not listed. Explain ________________

4.9. Line _____

 Not listed. Explain ________________

4.10. Line _____

 Not listed. Explain ________________

4.11. 

Line _____

 Not listed. Explain ________________

11

3.36

3.35

3.22

3.22

3.27

3.27

3.8

3.13

TRICARE

PO Box 7981

Madison, WI

ThyssenKrupp Elevator Corporation

3100 Interstate North Cir SE

Ste 500

Atlanta, GA, 30339-2227

Hewlett Packard FS

1501 Page Mill Road

Palo Alto, CA, 94304

Hewlett Packard Financial Services Company

PO Box 402582

Atlanta, GA, 30384-2582

DLL Financial Solutions Partner

1111 Old Eagle School Road

Wayne, PA, 19087

De Lage Landen Financial Services, Inc.

PO Box 41602

Philadelphia, PA, 19101-1602

CJC Law Office

201 Solar Street

Syracuse, NY, 13204

City National Bank

1450 Brickell Ave

Suite 2910

Miami, FL, 33131

10

Destination Hope, Inc. Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 20 of 28
Debtor _______________________________________________________ Case number (if known)_____________________________________ 

Name

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Part 4: Total Amounts of the Priority and Nonpriority Unsecured Claims

5. Add the amounts of priority and nonpriority unsecured claims.

Total of claim amounts

5a. Total claims from Part 1 5a. $_____________________________

5b. Total claims from Part 2 5b. + $_____________________________

5c. Total of Parts 1 and 2

Lines 5a + 5b = 5c.

5c. $_____________________________

11

8,581,407.74

7,781,407.74

800,000.00

Destination Hope, Inc.

11

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 21 of 28
Official Form 202 Declaration Under Penalty of Perjury for Non-Individual Debtors

Official Form 202 

Declaration Under Penalty of Perjury for Non-Individual Debtors 12/15

An individual who is authorized to act on behalf of a non-individual debtor, such as a corporation or partnership, must sign and submit 

this form for the schedules of assets and liabilities, any other document that requires a declaration that is not included in the document, 

and any amendments of those documents. This form must state the individual’s position or relationship to the debtor, the identity of the 

document, and the date. Bankruptcy Rules 1008 and 9011. 

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement, concealing property, or obtaining money or property by fraud in 

connection with a bankruptcy case can result in fines up to $500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 

1519, and 3571.

Declaration and signature

I am the president, another officer, or an authorized agent of the corporation; a member or an authorized agent of the partnership; or 

another individual serving as a representative of the debtor in this case.

I have examined the information in the documents checked below and I have a reasonable belief that the information is true and correct:

 Schedule A/B: Assets–Real and Personal Property (Official Form 206A/B)

 Schedule D: Creditors Who Have Claims Secured by Property (Official Form 206D)

 Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 206E/F)

 Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G)

 Schedule H: Codebtors (Official Form 206H)

 Summary of Assets and Liabilities for Non-Individuals (Official Form 206Sum)

 Amended Schedule ____

 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders (Official Form 204)

 Other document that requires a declaration__________________________________________________________________________________ 

I declare under penalty of perjury that the foregoing is true and correct. 

Executed on ______________ _________________________________________________________________________

MM / DD / YYYY Signature of individual signing on behalf of debtor

________________________________________________________________________

Printed name

______________________________________

Position or relationship to debtor

Debtor Name __________________________________________________________________ 

United States Bankruptcy Court for the: ________________________________ 

Case number (If known): _________________________ 

 Fill in this information to identify the case and this filing:

✔

✔

Southern District of Florida

Benjamin Brafman

08/28/2020

✔

/s/ Benjamin Brafman

President

Destination Hope, Inc.

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 22 of 28
United States Bankruptcy Court

In re: Case No.

Chapter

Debtor(s)

Verification of Creditor Matrix

The above-named Debtor(s) hereby verify that the attached list of creditors is

true and correct to the best of their knowledge.

Date:

Signature of Individual signing on behalf of debtor

Position or relationship to debtor

11

President

Southern District of Florida

08/28/2020 /s/ Benjamin Brafman

Destination Hope, Inc.

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 23 of 28
121 Capital

178 Manhattan Street

Staten Island, NY 10307

3831 Crystal Lake Drive, LLC

2707-2709 NE 33rd Ave

Fort Lauderdale, FL 33308

Aetna

PO Box 14079

Lexington, KY 40512

AJ Equity Group, LLC

1648 61st Street

Brooklyn, NY 11204

Alantes Corp attn: Ken Dotson

510 5th Avenue

3rd Floor

New York, NY 10036

Andrew Merker

1535 Mt Vernon Rd

Dunwoody, GA 30338

Anthony S. Hearn P.A

One Biscayne Tower

2 Biscayne Blvd, Ste 3400

Miami, FL 33131

Bankers Healthcare Group, LLC

201 Solar Street

Syracuse, NY 13204

BMF Capital

1820 Avenue M

Brooklyn, NY 11230

Broward County Tax Collector

115 S. Andrews Ave

Room # A100

Fort Lauderdale, FL 33301

CapFlow

2232 Brigham Street

Brooklyn, NY 11229

Cigna

900 Cottage Grove Road

Hartford, CT 6152

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 24 of 28
Cindy Wisdom

821 NW 66th Avenue

Plantation, FL 33317-1235

City National Bank

100 SE 2nd St.

Miami, FL 33131

City National Bank

1450 Brickell Ave

Suite 2910

Miami, FL 33131

City of Deerfield Beach

401 SW 4th Street

Deerfield Beach, FL 33441-4666

CJC Law Office

201 Solar Street

Syracuse, NY 13204

Daszkal Bolton LLP

2401 NW Boca Raton Boulevard

Boca Raton, FL 33431-6632

David Gussack

1851 Blount Road

Pompano Beach, FL 33069

De Lage Landen Financial Services, Inc.

PO Box 41602

Philadelphia, PA 19101-1602

DLL Financial Solutions Partner

1111 Old Eagle School Road

Wayne, PA 19087

EastGroup Properties Inc.

3495 Piedmont Road NE

Building 11, Ste #350

Atlanta, GA 30305

Florida Dept of Revenue

5050 W Tennessee Street

Bldg L

Tallahassee, FL 32399-0180

Ford Credit

PO Box 650575

Dallas, TX 75265-0575

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 25 of 28
Group 716, LLC

245 Country Club Drive

Suite 300D

Stockbridge, GA 30281

Halpern Family Trust

1711 N. Fort Lauderdale Beach Blvd

Fort Lauderdale, FL 33305

Healthpac Computer

1010 East Victory Drive

Suite B

Savannah, GA 31405

HealthSmart Benefit

PO Box 3244

Charleston, WV 25332-3244

Hewlett Packard Financial Services Co.

200 Connell Drive

Suite 5000

Berkeley Heights, NJ 07922

Hewlett Packard Financial Services Company

PO Box 402582

Atlanta, GA 30384-2582

Hewlett Packard FS

1501 Page Mill Road

Palo Alto, CA 94304

Internal Revenue Service

111 Constitution Avenue NW

Washington , DC

Linda Hess

1620 NW 121 Way

Gainesville, FL 32606

Marlin Capital Solutions

300 Fellowship Road

Mount Laurel, NJ 08054

MD Solutions Group

3330 Fairchild Gardens Ave

Palm Beach Gardens, FL 33420

Michael Anthony Volpe

178 Manhattan Street

Staten Island, NY 10307

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 26 of 28
Milner, Inc.

PO Box 923197

Norcross, GA 30010-3197

Mr. Advance LLC

35-12 19th Ave

Astoria, NY 11105

Newtek Small Business Finance, LLC

1981 Marcus Avenue

Suite 130

Lake Success, NY 11042

Nole Financial

701 Brickell Key Blvd.

Miami, FL 33131

Pawnee Leasing Corp.

3801 Automation Way

Suite 207

Fort Collins, CO 80525

Pontus SW Portfolio LLC

875 Prospect Street

Suite 303

La Jolla, CA 92037

Professional Revenue Recovery Solutions, Inc.

13630 NW 8th St.

Suite 220

Sunrise, FL 33325

SBA

51 SW 1st Ave #201, Miami, FL 33130

Miami, FL 33130

SG Credit Partners

23 Corporate Plaza

Suite #100

Newport Beach, CA 92660

Shaboon Air & Refrigeration

3530 NW 32nd Court

Lauderdale Lakes, FL 33309

ThyssenKrupp Elevator Corporation

PO Box 3796

Carol Stream, IL 60132-3796

ThyssenKrupp Elevator Corporation

3100 Interstate North Cir SE

Ste 500

Atlanta, GA 30339-2227

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 27 of 28
TRICARE

PO Box 8923

Madison, WI 53707-8923

TRICARE

PO Box 7981

Madison, WI

Ultimate Water, LLC

PO Box 677784

Dallas, TX 75267-7784

Vanguard c/o Ascensus

415 8th Avenue NE

Brainerd, MN 56401

Waystar Revenue Cycle Technology

1311 Solutions Center

Chicago, IL 60677-1311

Weiss Serota Helfman Cole & Bierman, P.L.

1200 N. Federal Highway

Suite 312

Boca Raton, FL 33432

Case 20-19402-PDR Doc 1 Filed 08/28/20 Page 28 of 28