Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

Official Form 206Sum

Summary of Assets and Liabilities for Non-Individuals 12/15

Part 1: Summary of Assets

1. Schedule A/B: Assets-Real and Personal Property (Official Form 206A/B)

1a. Real property:

 Copy line 88 from Schedule A/B............................................................................................................................. $ 0.00

1b. Total personal property:

 Copy line 91A from Schedule A/B......................................................................................................................... $ 387,000.00

1c. Total of all property:

 Copy line 92 from Schedule A/B........................................................................................................................... $ 387,000.00

Part 2: Summary of Liabilities

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

Copy the total dollar amount listed in Column A, Amount of claim, from line 3 of Schedule D.................................... $ 76,758,359.24

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

3a. Total claim amounts of priority unsecured claims:

 Copy the total claims from Part 1 from line 5a of Schedule E/F.......................................................................... $ 411,943.24

3b. Total amount of claims of nonpriority amount of unsecured claims:

 Copy the total of the amount of claims from Part 2 from line 5b of Schedule E/F................................................ +$ 0.00

4. Total liabilities .......................................................................................................................................................

Lines 2 + 3a + 3b $ 77,170,302.48

Official Form 206Sum Summary of Assets and Liabilities for Non-Individuals page 1

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 1 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

Official Form 206A/B

Schedule A/B: Assets - Real and Personal Property 12/15

Disclose all property, real and personal, which the debtor owns or in which the debtor has any other legal, equitable, or future interest.

Include all property in which the debtor holds rights and powers exercisable for the debtor's own benefit. Also include assets and properties

which have no book value, such as fully depreciated assets or assets that were not capitalized. In Schedule A/B, list any executory contracts

or unexpired leases. Also list them on Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G).

Be as complete and accurate as possible. If more space is needed, attach a separate sheet to this form. At the top of any pages added, write

the debtor’s name and case number (if known). Also identify the form and line number to which the additional information applies. If an

additional sheet is attached, include the amounts from the attachment in the total for the pertinent part.

For Part 1 through Part 11, list each asset under the appropriate category or attach separate supporting schedules, such as a fixed asset

schedule or depreciation schedule, that gives the details for each asset in a particular category. List each asset only once. In valuing the

debtor’s interest, do not deduct the value of secured claims. See the instructions to understand the terms used in this form.

Part 1: Cash and cash equivalents

1. Does the debtor have any cash or cash equivalents?

 No. Go to Part 2.

 Yes Fill in the information below.

All cash or cash equivalents owned or controlled by the debtor Current value of

debtor's interest

3. Checking, savings, money market, or financial brokerage accounts (Identify all)

Name of institution (bank or brokerage firm) Type of account Last 4 digits of account

number

3.1. Bank United Payroll Account 0718 $10,000.00

4. Other cash equivalents (Identify all)

5. Total of Part 1. $10,000.00

Add lines 2 through 4 (including amounts on any additional sheets). Copy the total to line 80.

Part 2: Deposits and Prepayments

6. Does the debtor have any deposits or prepayments?

 No. Go to Part 3.

 Yes Fill in the information below.

Part 3: Accounts receivable

10. Does the debtor have any accounts receivable?

 No. Go to Part 4.

 Yes Fill in the information below.

11. Accounts receivable

11a. 90 days old or less: 377,000.00 - 0.00 = .... $377,000.00

face amount doubtful or uncollectible accounts

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 1

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 2 of 90
Debtor Path Medical Center Holdings, Inc. Case number (If known) 21-18339-SMG

Name

12. Total of Part 3. $377,000.00

Current value on lines 11a + 11b = line 12. Copy the total to line 82.

Part 4: Investments

13. Does the debtor own any investments?

 No. Go to Part 5.

 Yes Fill in the information below.

Part 5: Inventory, excluding agriculture assets

18. Does the debtor own any inventory (excluding agriculture assets)?

 No. Go to Part 6.

 Yes Fill in the information below.

Part 6: Farming and fishing-related assets (other than titled motor vehicles and land)

27. Does the debtor own or lease any farming and fishing-related assets (other than titled motor vehicles and land)?

 No. Go to Part 7.

 Yes Fill in the information below.

Part 7: Office furniture, fixtures, and equipment; and collectibles

38. Does the debtor own or lease any office furniture, fixtures, equipment, or collectibles?

 No. Go to Part 8.

 Yes Fill in the information below.

Part 8: Machinery, equipment, and vehicles

46. Does the debtor own or lease any machinery, equipment, or vehicles?

 No. Go to Part 9.

 Yes Fill in the information below.

Part 9: Real property

54. Does the debtor own or lease any real property?

 No. Go to Part 10.

 Yes Fill in the information below.

Part 10: Intangibles and intellectual property

59. Does the debtor have any interests in intangibles or intellectual property?

 No. Go to Part 11.

 Yes Fill in the information below.

Part 11: All other assets

70. Does the debtor own any other assets that have not yet been reported on this form?

Include all interests in executory contracts and unexpired leases not previously reported on this form.

 No. Go to Part 12.

 Yes Fill in the information below.

Current value of

debtor's interest

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 2

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 3 of 90
Debtor Path Medical Center Holdings, Inc. Case number (If known) 21-18339-SMG

Name

71. Notes receivable

Description (include name of obligor)

Approximately $15,000,000 note

receivable due from Path Medical

ESOP Trust and Plan

15,000,000.00 - 15,000,000.00 =

$0.00

Total face amount doubtful or uncollectible amount

72. Tax refunds and unused net operating losses (NOLs)

Description (for example, federal, state, local)

73. Interests in insurance policies or annuities

74. Causes of action against third parties (whether or not a lawsuit

has been filed)

Potential claims and causes of action against State

Farm Insurance Co. and related entities sounding in

equity, tort and on statutory basis. Unknown

Nature of claim

Amount requested $0.00

75. Other contingent and unliquidated claims or causes of action of

every nature, including counterclaims of the debtor and rights to

set off claims

76. Trusts, equitable or future interests in property

77. Other property of any kind not already listed Examples: Season tickets,

country club membership

Path Medical, LLC - 100% Ownership Unknown

78. Total of Part 11. $0.00

Add lines 71 through 77. Copy the total to line 90.

79. Has any of the property listed in Part 11 been appraised by a professional within the last year?

 No

 Yes

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 3

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 4 of 90
Debtor Path Medical Center Holdings, Inc. Case number (If known) 21-18339-SMG

Name

Part 12: Summary

In Part 12 copy all of the totals from the earlier parts of the form

Type of property Current value of

personal property

Current value of real

property

80. Cash, cash equivalents, and financial assets.

Copy line 5, Part 1 $10,000.00

81. Deposits and prepayments. Copy line 9, Part 2. $0.00

82. Accounts receivable. Copy line 12, Part 3. $377,000.00

83. Investments. Copy line 17, Part 4. $0.00

84. Inventory. Copy line 23, Part 5. $0.00

85. Farming and fishing-related assets. Copy line 33, Part 6. $0.00

86. Office furniture, fixtures, and equipment; and collectibles.

Copy line 43, Part 7. $0.00

87. Machinery, equipment, and vehicles. Copy line 51, Part 8. $0.00

88. Real property. Copy line 56, Part 9.........................................................................................> $0.00

89. Intangibles and intellectual property. Copy line 66, Part 10. $0.00

90. All other assets. Copy line 78, Part 11. + $0.00

91. Total. Add lines 80 through 90 for each column $387,000.00 + 91b. $0.00

92. Total of all property on Schedule A/B. Add lines 91a+91b=92 $387,000.00

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 4

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 5 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

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

claim

2.1 Alpine Funding, LLC Describe debtor's property that is subject to a lien $134,944.82 $40,618.66

Creditor's Name

c/o Medley Capital, LLC

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.2 Comvest Capital III, L.P. Describe debtor's property that is subject to a lien $15,335,671.62 $4,622,088.15

Creditor's Name

c/o Comvest Partners

525 Okeechobee Blvd,

Suite 1050

West Palm Beach, FL 33401

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 5

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 6 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.3 Medley Capital Corporation Describe debtor's property that is subject to a lien $0.00 $0.00

Creditor's Name

c/ Medley Capital LLC

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.4 Medley Capital LLC, as

Agent Describe debtor's property that is subject to a lien $0.00 $0.00

Creditor's Name Comvest Capital III LP, Medley Credit

Strategies (KOC) LLC, Medley Opportunity

Fund III, LLP, Northport TRS LLC and

Phenixfin Corporation, Sierra Income

Corporation (the "Secured Lenders").

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Security agreements in favor of Agent and

Secured Lenders

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.5 Medley Credit Strategies

(KOC) LLC Describe debtor's property that is subject to a lien $3,071,134.35 $924,417.64

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 2 of 5

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 7 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

Creditor's Name

c/o Medley Capital LLC

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.6 Medley Oppurtunity Fund

III, LLP Describe debtor's property that is subject to a lien $7,736,494.50 $2,328,700.46

Creditor's Name

c/o Medley Capital LLC

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.7 Northport TRS, LLC Describe debtor's property that is subject to a lien $15,355,671.62 $4,622,088.15

Creditor's Name

c/o Medley Capital LLC

280 Park Avenue, 6th Floor

East

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 3 of 5

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 8 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.8 Phenixfin Corporation Describe debtor's property that is subject to a lien $15,112,744.95 $4,548,966.73

Creditor's Name

445 Park Avenue

9th Floor

New York, NY 10022

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. Specify each creditor,

including this creditor and its relative

priority.

2.9 Sierra Income Corporation Describe debtor's property that is subject to a lien $20,011,697.38 $6,023,561.30

Creditor's Name

c/o Medley Captial LLC

280 Park Avenue, 6th Floor

New York, NY 10017

Creditor's mailing address Describe the lien

Is the creditor an insider or related party?

 No

Creditor's email address, if known  Yes

Is anyone else liable on this claim?

Date debt was incurred  No

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

Last 4 digits of account number

Do multiple creditors have an

interest in the same property?

As of the petition filing date, the claim is:

Check all that apply

 No  Contingent

 Unliquidated

 Disputed

 Yes. 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 Page, if any.

$76,758,359.

24

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.

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 4 of 5

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 9 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

If no others need to 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

Davis Goldman, PLLC

1441 Brickell Ave

Sre 1400

Miami, FL 33131

Line 2.4 

Morgan, Lewis and Bockius, LLP

1717 Main Street, Suite 3200 Line 2.4 

Path Medical Center Holdings, Inc.

2304 W. Oakland Park Blvd

Fort Lauderdale, FL 33311

Line 2.4 

Proskauer Rose LLP

One International Place

Boston, MA 02110

Line 2.3 

Proskauer Rose LLP

One International Place

Boston, MA 02110

Line 2.6 

Proskauer Rose LLP

One International Place

Boston, MA 02110

Line 2.9 

Winston & Strawn LLP

333 South Grand Avenue, 38th Floor

Los Angeles, CA 90071

Line 2.2 

Winston & Strawn LLP

333 South Grand Avenue, 38th Floor

Los Angeles, CA 90071

Line 2.7 

Winston & Strawn LLP

333 South Grand Avenue, 38th Floor

Los Angeles, CA 90071

Line 2.5 

Winston & Strawn LLP

333 South Grand Avenue, 38th Floor

Los Angeles, CA 90071

Line 2.1 

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 5 of 5

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 10 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

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 with 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 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,923.07 $0.00

Abreu,Lisa

5035 Gardens Drive

Orlando, FL 32812

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.2 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,575.00 $0.00

Acosta, Leidy

871 Ibis Walk Place North

Apt 2209

Saint Petersburg, FL 33716

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 11 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.3 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,330.07 $0.00

Aghili, Shoukoh

3037 N. Oakland Forest Club

102

Oakland Park, FL 33309

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.4 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,091.81 $0.00

Alcazar, Leonor E

2417 Funston St

Hollywood, FL 33020

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.5 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,236.00 $0.00

Aldarondo, Shaida

408 NE 6th Street

Unit 303

Fort Lauderdale, FL 33304

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.6 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,502.20 $0.00

Almendares, Missel

4779 Poseidon Place

Lake Worth, FL 33463

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.7 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,105.22 $0.00

Alonso, Maria D

819 Southwest 27th Street

Fort Lauderdale, FL 33315

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.8 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,720.00 $0.00

Alvarez, Josue

1323 Dragon Head Drive

Valrico, FL 33594

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.9 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,271.08 $0.00

Arias, Elisa J

1377 W. 69th Street

Hialeah, FL 33014

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.10 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,468.80 $0.00

Armoza, Diana Catherine

Knollwood Street

Saint Cloud, FL 34773

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 13 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.11 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,846.15 $0.00

Atler, Denise L

2142 NW 85 Lane

Coral Springs, FL 33071

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.12 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Attorney General

U.S. Department of Justice

950 Pennsylvania Avenue, N.W.

Washington, DC 20530

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice Only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

2.13 Priority creditor's name and mailing address As of the petition filing date, the claim is: $562.51 $0.00

Aviles-Velazquez, Stephanie Marie

31236 Bridgegate Drive

Wesley Chapel, FL 33545

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.14 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,240.70 $0.00

Bailey, Lisa

404 N.W. 5th Terr.

Hallandale Beach, FL 33009

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.15 Priority creditor's name and mailing address As of the petition filing date, the claim is: $56.00 $0.00

Baille, Melila

2652 Carambola

Cir N unit 1

Coconut Creek, FL 33066

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.16 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,339.00 $0.00

Baldaras Saldierna, Irene

1007 King Street

Plant City, FL 33563

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.17 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,426.40 $0.00

Barreiro, Joshua A

201 Terrace Ridge Circle

Davenport, FL 33896

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.18 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,109.92 $0.00

Barzaga, Anny Lisney

13881 Northwest 238th Street

High Springs, FL 32643

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.19 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,133.92 $0.00

Bien Aime, Junie

1755 NE 164st

Apt 113

Miami, FL 33162

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.20 Priority creditor's name and mailing address As of the petition filing date, the claim is: $960.00 $0.00

Binet Rosario, Nelly

4910 NW 11th Court

Fort Lauderdale, FL 33313

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.21 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,184.00 $0.00

Blackwood, Delisha Torlse

2760 NW 164th Street

Miami Gardens, FL 33054

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.22 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,009.68 $0.00

Blake, Cadeen

6531 SW 10th St

North Lauderdale, FL 33068

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 16 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.23 Priority creditor's name and mailing address As of the petition filing date, the claim is: $949.96 $0.00

Bonet, Rosa

6161 Northwest 2nd Avenue

#223

Boca Raton, FL 33487

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.24 Priority creditor's name and mailing address As of the petition filing date, the claim is: $7,692.30 $0.00

Bonnardel, Neil S

18981 Sw 32 St

Miramar, FL 33029

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.25 Priority creditor's name and mailing address As of the petition filing date, the claim is: $901.80 $0.00

Brewton, Nichole

5880 Clydesdale Court

Davie, FL 33314

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.26 Priority creditor's name and mailing address As of the petition filing date, the claim is: $11,538.46 $0.00

Brooks, Robin D

146 Laurel Way

1B

Herndon, VA 20170

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 17 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.27 Priority creditor's name and mailing address As of the petition filing date, the claim is: $752.70 $0.00

Cabreja, Melanie

920 Woodside Circle

Apt A

Kissimmee, FL 34741

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.28 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,807.69 $0.00

Cadet, Marene

2781 Ocean Club Blvd.

Apt. 106

Hollywood, FL 33019

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.29 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,181.40 $0.00

Callen, Norma

3218 NW 23rd Ave

Miami, FL 33142

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.30 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,320.00 $0.00

Calvo, Maria A

3921 East 9th Lane

Hialeah, FL 33013

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.31 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,095.50 $0.00

Campbell, Christena

19500 NW 12th Ave

Miami, FL 33169

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.32 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,145.43 $0.00

Cantu, Eduardo

6901 Indian Creek Dr

Apt. 7

Miami Beach, FL 33141

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.33 Priority creditor's name and mailing address As of the petition filing date, the claim is: $912.80 $0.00

Capaz, Neysa

295 NW 72nd Ave

Apartment 407

Miami, FL 33126

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.34 Priority creditor's name and mailing address As of the petition filing date, the claim is: $4,593.55 $0.00

Capezza, Victoria

12230 Legacy Bright Street

Riverview, FL 33578

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 19 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.35 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,021.50 $0.00

Cardoso Lopes, Jarbas Felipe

5644 Blue Shadows Court

Orlando, FL 32811

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.36 Priority creditor's name and mailing address As of the petition filing date, the claim is: $870.00 $0.00

Carlin, Dalanie

791 N. Pine Island Road

#212

Fort Lauderdale, FL 33324

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.37 Priority creditor's name and mailing address As of the petition filing date, the claim is: $5,000.00 $0.00

Carlin, Patricia

1137 SE 6th Ave

Dania, FL 33004

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.38 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,523.12 $0.00

Castillo Padilla, Rosendo

451 nw 7 st

apt. 206

Miami, FL 33136

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.39 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,307.69 $0.00

Chavarria, Rommel

2890 W 71st St

Hialeah, FL 33018

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.40 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,172.73 $0.00

Cherian, Joseph

15444 Montesino Drive

Orlando, FL 32828

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.41 Priority creditor's name and mailing address As of the petition filing date, the claim is: $546.60 $0.00

Chukes, Jimeria

1128 Fennel Green Drive

Seffner, FL 33584

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.42 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,909.58 $0.00

Clarke, Leigh R

2501 Riverside Drive

APT 309

Coral Springs, FL 33065

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.43 Priority creditor's name and mailing address As of the petition filing date, the claim is: $412.83 $0.00

Claro Cisnero, Mirtha

7630 Cayuga Dr

New Port Richey, FL 34653

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.44 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,347.00 $0.00

Cockren, Lissette

330 S.W. 97th Ave.

Pembroke Pines, FL 33025

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.45 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,231.23 $0.00

Connor, Lyron G

1716 SW 10th st.

Fort Lauderdale, FL 33312

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.46 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,640.00 $0.00

Cordero, Crystal

725 Crest Pines Dr

Apt 417

Orlando, FL 32828

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.47 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,082.08 $0.00

Core Tossona , Danielle N

16724 Southwest 10th Street

Pembroke Pines, FL 33027

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.48 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,067.22 $0.00

Creighton, Shenequa

1219 S Dixie Hwy W

Apt 207

Pompano Beach, FL 33060

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.49 Priority creditor's name and mailing address As of the petition filing date, the claim is: $343.60 $0.00

Crespo, Aneika M

4831 Sw 193 Lane

Southwest Ranches, FL 33332

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.50 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,441.52 $0.00

Cruz Gonzalez, Victor

3702 Windham Dr

Holiday, FL 34691

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 23 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.51 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,461.53 $0.00

Curtis, Lance

11509 Southwest 15th Street

Hollywood, FL 33025

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.52 Priority creditor's name and mailing address As of the petition filing date, the claim is: $4,892.30 $0.00

D'Alesio, Ann Elizabeth

614 NE 2nd Place

Dania, FL 33004

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.53 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,611.20 $0.00

Da Silva Borges, Sergio

1019 South Hiawasee Road

Apt#3812

Orlando, FL 32835

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.54 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,131.68 $0.00

Dattus, Sheila

111 Sw 4th Ave #9

Pompano Beach, FL 33060

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 14 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 24 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.55 Priority creditor's name and mailing address As of the petition filing date, the claim is: $941.16 $0.00

Dawkins, Christina Venetta

610 Northwest 2nd Avenue

Hallandale Beach, FL 33009

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.56 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,197.85 $0.00

De La Paz, Iris

3305 W Aileen St

Tampa, FL 33607

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.57 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,323.44 $0.00

Delgado Cheong, Dania

3702 Windham Dr

Holiday, FL 34691

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.58 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Department of Treasury

Internal Revenue Service

Kansas City, MO 64999

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice Only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 15 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.59 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,500.00 $0.00

Diaz, Elisa

6261 SW 24th Place

Unit 306

Davie, FL 33314

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.60 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,111.77 $0.00

Djebelli, Jahan

3245 Virginia St

Apt 57

Miami, FL 33133

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.61 Priority creditor's name and mailing address As of the petition filing date, the claim is: $731.22 $0.00

Doctor, Antionesia

3700 Oakland Preserve Way

APT. 5304

Oakland Park, FL 33334

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.62 Priority creditor's name and mailing address As of the petition filing date, the claim is: $923.08 $0.00

Douglas, Ebony Lynn

1200 Via Lugano Circle

Apt. 211

Boynton Beach, FL 33436

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.63 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,271.92 $0.00

Dyges, Anthony

231 Northwest 47th Avenue

Plantation, FL 33317

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.64 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,098.58 $0.00

Eapen, Geogith

11226 Southwest 56th Circle

Fort Lauderdale, FL 33330

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.65 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,769.23 $0.00

Emmenecker, Andrew Charles

1108 Bartow Road

Apt j114

Lakeland, FL 33801

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.66 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,069.64 $0.00

Etienne, Felicia

1120 Northwest 147th Street

Miami, FL 33168

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.67 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,369.01 $0.00

Faez, Candida L

7602 W Henry Ave

Tampa, FL 33615

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.68 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,014.72 $0.00

Farrington, Taneisha

2403 South 25th Street

#111

Fort Pierce, FL 34981

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.69 Priority creditor's name and mailing address As of the petition filing date, the claim is: $694.40 $0.00

Fernandez, Akralys Veronica

6822 N. Clark

Tampa, FL 33614

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.70 Priority creditor's name and mailing address As of the petition filing date, the claim is: $930.02 $0.00

Fernandez, Andre

2160 Denny Court

Boca Raton, FL 33486

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 18 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.71 Priority creditor's name and mailing address As of the petition filing date, the claim is: $824.00 $0.00

Fernandez, Christian

9696 Hollyhill Drive

Orlando, FL 32824

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.72 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,087.50 $0.00

Fernandez, Judith

4050 Southwest 136th Avenue

Miramar, FL 33027

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.73 Priority creditor's name and mailing address As of the petition filing date, the claim is: $15,384.62 $0.00

Fernandez, Manuel A

2160 Denny Court

Boca Raton, FL 33486

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.74 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,024.98 $0.00

Ferreras, Gabriel

6011 Nw 42nd Ave

Coconut Creek, FL 33073

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 19 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.75 Priority creditor's name and mailing address As of the petition filing date, the claim is: $11,538.46 $0.00

Fiacco, Melissa L

11136 Meridian Dr N

Parkland, FL 33076

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.76 Priority creditor's name and mailing address As of the petition filing date, the claim is: $216.70 $0.00

Fiacco, Olivia L

11136 Meridian Drive North

Parkland, FL 33076

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.77 Priority creditor's name and mailing address As of the petition filing date, the claim is: $200.62 $0.00

Fiacco, Priscilla L

11136 Meridian Dr N

Parkland, FL 33076

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.78 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,657.58 $0.00

Firpi, Maria Emily

7001 NW 16th St

Apt A-406

Plantation, FL 33313

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 20 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.79 Priority creditor's name and mailing address As of the petition filing date, the claim is: $706.58 $0.00

Fleurent, Marie

4201 NW 34th Street

#415

Fort Lauderdale, FL 33319

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.80 Priority creditor's name and mailing address As of the petition filing date, the claim is: Unknown Unknown

Florida Department of Revenue

P.O. Box 6668

Tallahassee, FL 32314

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

For Information Purposes

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

2.81 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,073.93 $0.00

Forrest-Thomas, Brenda

404 Northwest 9th Avenue

Pompano Beach, FL 33060

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.82 Priority creditor's name and mailing address As of the petition filing date, the claim is: $295.05 $0.00

Franco Sterling, Alberto E.

6415 Camellia Garden Dr

Apt. 107

Orlando, FL 32822

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 21 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.83 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,171.68 $0.00

Francois Paul, Marie M

8261 V a Di Veneto

Boca Raton, FL 33496

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.84 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,923.08 $0.00

Frias, Lynette I

3596 Vega Creek Drive

St. Cloud, FL 34772

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.85 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,615.28 $0.00

Fuerte, Raul

209 Nw 109 Ave #407

Miami, FL 33172

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.86 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,461.54 $0.00

Fye, Kelly

2813 SW 2nd Ct

Fort Lauderdale, FL 33312

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 22 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.87 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,071.30 $0.00

Garcia Alvarez, Ahimed

6014 Lake Underhill Road

Orlando, FL 32807

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.88 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,552.80 $0.00

Garcia Bondani, Carlos Alejandro

10706 Savannah Wood Court

Orlando, FL 32832

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.89 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,093.12 $0.00

Gedeon, Iderlia

6337 NW 24 Court

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.90 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,153.27 $0.00

Gomez, Aracely

18440 Cayman St

Eustis, FL 32736

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 23 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.91 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,307.69 $0.00

Gomez, Fernando Martin

910 Coral Ridge Drive

#203

Coral Springs, FL 33071

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.92 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,984.22 $0.00

Gonzalez Garay, Dulce Maria

10550 West State Road 84

Lot 359

Davie, FL 33324

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.93 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,295.58 $0.00

Gonzalez, Arnaldo

10985 SW 107 Street

Apt 308

Miami, FL 33176

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.94 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,730.58 $0.00

Gonzalez, Ashley

4601 Northwest 42nd Street

Lauderdale Lakes, FL 33319

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 24 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 34 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.95 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,461.54 $0.00

Gonzalez, George

1301 W Branch St

Lantana, FL 33462

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.96 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,785.92 $0.00

Gonzalez, Gisette

1190 Muzano Street

Apt B-401

Kissimmee, FL 34741

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.97 Priority creditor's name and mailing address As of the petition filing date, the claim is: $463.06 $0.00

Gracia, Tamara

425 Sinbad Avenue

Port Saint Lucie, FL 34952

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.98 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,736.50 $0.00

Granda, Angel Enrique

1700 Azalea Ct

Apt. A

Oldsmar, FL 34677

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 25 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 35 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.99 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,690.01 $0.00

Guerra Mora, Sander

9125 Southwest 77th Avenue

Apto A206

Miami, FL 33156

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.100 Priority creditor's name and mailing address As of the petition filing date, the claim is: $983.94 $0.00

Guevara, Maria Milagros

818 Dundee Drive

Winter Springs, FL 32708

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.101 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,192.94 $0.00

Guillaume, Enide

4158 Inverrary Dr

Apt 408

Lauderhill, FL 33319

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.102 Priority creditor's name and mailing address As of the petition filing date, the claim is: $962.64 $0.00

Hankerson, Arlene

18932 NW 27th Avenue

Apt 309

Miami Gardens, FL 33056

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 26 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 36 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.103 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,191.40 $0.00

Hargrett, Latoya L

11684 Sanderling Drive

Wellington, FL 33414

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.104 Priority creditor's name and mailing address As of the petition filing date, the claim is: $868.66 $0.00

Harris, Elease

701 NW 2nd Terr

Deerfield Beach, FL 33441

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.105 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,000.00 $0.00

Henderson, Karla Michelle

2217 Chapin Street

Tampa, FL 33605

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.106 Priority creditor's name and mailing address As of the petition filing date, the claim is: $252.22 $0.00

Hernandez, Ana

14576 Laguna Beach

Orlando, FL 32824

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 27 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 37 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.107 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,111.32 $0.00

Hernandez, Liana

2674 Franklin Drive

Fort Lauderdale, FL 33311

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.108 Priority creditor's name and mailing address As of the petition filing date, the claim is: $916.44 $0.00

Hernandez, Mia Angela

2910 NE 53rd Terrace

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.109 Priority creditor's name and mailing address As of the petition filing date, the claim is: $753.60 $0.00

Hinkel, Reba R

301 NW 50th St

Pompano Beach, FL 33064

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.110 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Internal Revenue Service

Centralized Insolvency Operation

Post Office Box 7346

Philadelphia, PA 19101-7346

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice Only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 28 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 38 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.111 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Internal Revenue Service

Centralized Insolvency Operation

Post Office Box 7346

Philadelphia, PA 19101-7346

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice Only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

2.112 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Internal Revenue Service

P.o. Box 21126

Philadelphia, PA 19114

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice Only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (8)

Is the claim subject to offset?

 No

 Yes

2.113 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,093.82 $0.00

Ireland, Beverley A

3445 Pinewalk Drive North

Apt 208

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.114 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,502.82 $0.00

Irizarry, Jose Angel

5075 Ernst Court

Orlando, FL 32819

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 29 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.115 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,352.80 $0.00

Izquierdo, Madelaine

18678 NW 77th Place

Hialeah, FL 33015

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.116 Priority creditor's name and mailing address As of the petition filing date, the claim is: $970.80 $0.00

Jackson, Tamara

1470 Northwest 55th Avenue

Lauderhill, FL 33313

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.117 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,181.16 $0.00

Jamieson, Cory

3113 Cortez Rd W

Lot 74

Bradenton, FL 34207

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.118 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,659.10 $0.00

Janvier, Louis

1448 Herring Lane

Clermont, FL 34714

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 30 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.119 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,248.48 $0.00

Jenkins, Jarae

15741 Northwest 17th Court

Opa-locka, FL 33054

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.120 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,063.58 $0.00

Johnson, Shineta Twana

1510 Northwest 12th Avenue

Fort Lauderdale, FL 33311

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.121 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,632.85 $0.00

Jones, Valecia

1813 Meridel Ave

Tampa, FL 33612

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.122 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,663.85 $0.00

Jorge Hernandez, Violeta

6950 Sw 3rd Street

Pembroke Pines, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 31 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.123 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,080.96 $0.00

Jose, Emmanuel

4681 Sable Pine Cir

Unit D1

West Palm Beach, FL 33417

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.124 Priority creditor's name and mailing address As of the petition filing date, the claim is: $560.18 $0.00

Keller, Kristi

4225 Cypress Dr

Saint Cloud, FL 34772

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.125 Priority creditor's name and mailing address As of the petition filing date, the claim is: $371.25 $0.00

Kelley, Ashtyn

3410 Pinewalk Drive North

827

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.126 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,254.34 $0.00

Kerr, Stephane J

800 Sw 64 Terr North

Lauderdale, FL 33068

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 32 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.127 Priority creditor's name and mailing address As of the petition filing date, the claim is: $885.95 $0.00

Kurtic, Aldijana

4350 82nd Avenue North

Pinellas Park, FL 33781

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.128 Priority creditor's name and mailing address As of the petition filing date, the claim is: $760.00 $0.00

Letchworth, Tabitha

3615 Wayne Road

Lakeland, FL 33810

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.129 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,846.15 $0.00

Lewin, Karl

941 Framlingham Ct

APT 103

Lake Mary, FL 32746

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.130 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,136.15 $0.00

Ling, Kimberly J

1650 NW 27th Avenue

Fort Lauderdale, FL 33311

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 33 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.131 Priority creditor's name and mailing address As of the petition filing date, the claim is: $899.60 $0.00

Lopexdevictoria, Cynthia Altelia

5099 Elmnurst Road

West Palm Beach, FL 33417

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.132 Priority creditor's name and mailing address As of the petition filing date, the claim is: $791.05 $0.00

Lopez, Erin Albon

2598 South Conway Road

APT 1311

Orlando, FL 32812

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.133 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,354.07 $0.00

Lopez, Johanna M

1271 Nw 31st Street

Miami, FL 33142

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.134 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,398.40 $0.00

Lopez, Yennifer

121 Snapdragon court

Kissimmee, FL 34743

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 34 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 44 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.135 Priority creditor's name and mailing address As of the petition filing date, the claim is: $4,933.84 $0.00

Lossen, Samantha

5715 Harrison St

Hollywood, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.136 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,151.20 $0.00

Manfredonia, Michael Joseph

1005 NW 67th Avenue

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.137 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,380.40 $0.00

Manzanilla, Marisela O

6953 Pines Circle

Coconut Creek, FL 33073

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.138 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,913.46 $0.00

Markevich, Alexander

400 NE 12 ave

Apt. 704

Hallandale, FL 33009

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 35 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.139 Priority creditor's name and mailing address As of the petition filing date, the claim is: $5,384.62 $0.00

Martin, Bradford

920 Greenbriar Drive

Boynton Beach, FL 33435

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.140 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,461.54 $0.00

Martin, Christina E

5318 Anhinga Trail

New Port Richey, FL 34653

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.141 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,037.48 $0.00

Martinez, Elias

9291 E Bay Harbor Drive

Apartment 5A

Bal Harbor island, FL 33154

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.142 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,244.10 $0.00

Martinez, Jose Vladimir

2315 N. Congress Avenue

Apt. 27

Boynton Beach, FL 33426

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 36 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.143 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,013.93 $0.00

Martinez, Lee-Jeannette

5411 Mayo St

Hollywood, FL 33021

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.144 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,368.74 $0.00

Martinez, Victoria

2409 Tracy Lane

Deltona, FL 32738

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.145 Priority creditor's name and mailing address As of the petition filing date, the claim is: $464.00 $0.00

Martinez, Wendy E

828 NW 58th St

Miami, FL 33127

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.146 Priority creditor's name and mailing address As of the petition filing date, the claim is: $988.03 $0.00

McBride, Precious Nicole

720 N.W 15th Terrace

Fort Lauderdale, FL 33311

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 37 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 47 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.147 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,036.70 $0.00

Mccant, Alicia

5255 Cinderlane Parkway

Apt. 249

Orlando, FL 32808

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.148 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,296.85 $0.00

McEwen, Darleen K

3577 Cocoplum Circle

Coconut Creek, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.149 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,000.00 $0.00

McEwen, Monica A

3170 Coral Way

Apt. 1002

Miami, FL 33145

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.150 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,846.15 $0.00

McKnight, Alandra A

3504 Sprite Lane

St. Cloud, FL 34772

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 38 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 48 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.151 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,157.28 $0.00

Meneses Tohalino, Lizbeth J

3120 West Hallandale Beach Bou

# 614

Hallandale Beach, FL 33009

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.152 Priority creditor's name and mailing address As of the petition filing date, the claim is: $895.82 $0.00

Menjivar, Ana G

8208 Nw 74th Terr

Tamarac, FL 33321

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.153 Priority creditor's name and mailing address As of the petition filing date, the claim is: $5,000.00 $0.00

Mesa, Andres

13922 Magnolia Ridge Loop

Winter Garden, FL 34787

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.154 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,232.14 $0.00

Miranda-Rueda, Raquel

247 St Cloud Village Ct

#102

Kissimmee, FL 34744

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 39 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 49 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.155 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,361.58 $0.00

Mobley, Jerome

1402 Robin Ct.

Longwood, FL 32750

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.156 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,159.50 $0.00

Mojica, Jazmine

11433 Royal Palm Boulevard

Coral Springs, FL 33065

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.157 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,084.75 $0.00

Mojica, Jiamaryliz Delcarmen

350 24th Street NW #108C

Winter Haven, FL 33880

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.158 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,298.85 $0.00

Molina, Yuleidy

2900 Nw 100 St

Miami, FL 33147

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 40 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.159 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Monestime, Jeanine H

1175 Northwest 110th Street

Miami, FL 33168

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.160 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,209.88 $0.00

Montalvo, Amanda

4938 Elon Crescent

Lakeland, FL 33810

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.161 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,230.76 $0.00

Montalvo, Rosa

6460 Scott St

Hollywood, FL 33024

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.162 Priority creditor's name and mailing address As of the petition filing date, the claim is: $993.75 $0.00

Morales, Yeseny Y

2500 N 26th Terrace

Hollywood, FL 33020

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 41 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.163 Priority creditor's name and mailing address As of the petition filing date, the claim is: $935.55 $0.00

Munroe, Tamika Allison

4200 NW 3rd ct

unit 311

plantation, FL 33317

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.164 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,230.77 $0.00

Murphy, Cristin

4355 Corporate Ave

Apt 176

Lakeland, FL 33809

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.165 Priority creditor's name and mailing address As of the petition filing date, the claim is: $4,230.76 $0.00

Nahmany, Stacey

8302 Southwest 20th Street

North Lauderdale, FL 33068

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.166 Priority creditor's name and mailing address As of the petition filing date, the claim is: $4,961.53 $0.00

Nicoletti, Brian

7026 Chatum Light Run

Bradenton, FL 34212

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 42 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.167 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,435.18 $0.00

Nidetz, Andrew M

1301 NE Miami Gardens Dr #911

Miami, FL 33179

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.168 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,692.30 $0.00

Nixon, Janelle

7551 Viscaya Circle

Margate, FL 33063

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.169 Priority creditor's name and mailing address As of the petition filing date, the claim is: $0.00 $0.00

Norvelus, Naderge

711 Southwest 76th Avenue

North Lauderdale, FL 33068

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Notice only

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.170 Priority creditor's name and mailing address As of the petition filing date, the claim is: $500.00 $0.00

O'Shaughnessy, John W

13444 Fordwell Drive

Orlando, FL 32828

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 43 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.171 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,576.92 $0.00

Oliveros, Silvana P

3121 SW 64 Terrace

Miramar, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.172 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,403.35 $0.00

Orelus, Nancy

6424 Southwest 20th Court

Miramar, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.173 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,663.20 $0.00

Osias, Anne C

650 NE 149th St apt110A

North Miami, FL 33161

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.174 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,414.00 $0.00

Otero, Tasha Daniella

4689 King Cole Blvd

1200 W Holden Ave

Orlando, FL 32811

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 44 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.175 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,391.59 $0.00

Pagan Melanie Nicole

63 Las Brisas Way

Kissimmee, FL 34743

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.176 Priority creditor's name and mailing address As of the petition filing date, the claim is: $911.04 $0.00

Palma, Luisa

13839 Fairway Island Drive

Apt 1132

Orlando, FL 32837

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.177 Priority creditor's name and mailing address As of the petition filing date, the claim is: $779.76 $0.00

Palmer, Jayvin Jaquan Tyriq

6050 SW 27th Street

Apt. 205

Miramar, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.178 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,021.02 $0.00

Pellegrino, Lindsey M

8227 San Carlos Circle

Tamarac, FL 33321

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 45 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 55 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.179 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,692.30 $0.00

Pena, Nicholas

16116 Kilmarnock Drive

Miami Lakes, FL 33014

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.180 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,839.32 $0.00

Perera, Patricia

8844 NW 168ST

Miami, FL 33018

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.181 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,692.30 $0.00

Perez Gonzalez, Yamislaida

3004 Maple Shade Place

Seffner, FL 33584

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.182 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,385.09 $0.00

Perez, Gustavo A

704 Creekwater Terrace

#102

Lake Mary, FL 32746

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 46 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.183 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,005.31 $0.00

Perez, Lyzella Valentine

539B Albatross Drive

Kissimmee, FL 34759

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.184 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,165.50 $0.00

Perez, Teresa

421 Northeast 1st Street

Apt 101

Hallandale Beach, FL 33009

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.185 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,068.02 $0.00

Perez, Vidmarie Perez

341 Preserve Point Blvd

Davenport, FL 33837

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.186 Priority creditor's name and mailing address As of the petition filing date, the claim is: $701.17 $0.00

Perez, Zadys

663 Flagami Boulevard

Miami, FL 33144

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 47 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.187 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,807.69 $0.00

Perpetuo, Michelle

9104 NW 147th Terrace

Hialeah, FL 33018

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.188 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,306.20 $0.00

Philip, Avinash

268 nw 89th ave

Coral Springs, FL 33071

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.189 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,095.12 $0.00

Pierre Louis, Barbara

570 NW 47th Avenue

Plantation, FL 33317

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.190 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,955.25 $0.00

Pierre, Rochine Nerleta

611 SW Dalton Circle

Port Saint Lucie, FL 34953

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 48 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.191 Priority creditor's name and mailing address As of the petition filing date, the claim is: $458.92 $0.00

Pileta, Thalia

2813 West Patterson Street

Tampa, FL 33614

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.192 Priority creditor's name and mailing address As of the petition filing date, the claim is: $495.60 $0.00

Pina, Yusleny

3011 23rd Ave N

Saint Petersburg, FL 33713

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.193 Priority creditor's name and mailing address As of the petition filing date, the claim is: $708.05 $0.00

Planos, Marcos A

1113 54th Ave N

St Petersburg, FL 33703

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.194 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,755.81 $0.00

Porras, Luis

10400 NW 35th Pl

Miami, FL 33147

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 49 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.195 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,102.01 $0.00

Pozzi, Tammy Lyn

205 Derby Downs Pl

Apartment 204

Brandon, FL 33510

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.196 Priority creditor's name and mailing address As of the petition filing date, the claim is: $546.00 $0.00

Priester, Nikia

4324 N.W 9th Ave. apt 7-3 B

Deerfield Beach, FL 33064

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.197 Priority creditor's name and mailing address As of the petition filing date, the claim is: $440.50 $0.00

Qian, Jean

2516 Montclaire Circle

Weston, FL 33327

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.198 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,036.10 $0.00

Quintero Rodriguez, Aneudi

3001 Lilly Belle Drive

Kissimmee, FL 34744

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 50 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.199 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,404.54 $0.00

Quintero, Leticia

14533 Sw 285 Terr

Homestead, FL 33033

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.200 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,000.13 $0.00

Quintero, Misleibys

28004 Sw 136 Place

Homestead, FL 33033

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.201 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,959.61 $0.00

Quintero, Nelson

6824 Tanglewood Bay Drive

Orlando, FL 32821

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.202 Priority creditor's name and mailing address As of the petition filing date, the claim is: $937.37 $0.00

Ragoonanan, Shreya

2100 Northwest 61st Avenue

Sunrise, FL 33313

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 51 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.203 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,562.94 $0.00

Ram, Laishdeo

10205 Beneva Drive

Tampa, FL 33647

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.204 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,632.30 $0.00

Ramos, Kathleen

1837 SW Norman Lane

Port Saint Lucie, FL 34984

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.205 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,884.61 $0.00

Ramsuer, Felicia

15210 Amberly Dr. Apt #1924

Tampa, FL 33647

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.206 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,310.70 $0.00

Ravelo, Tonia

605 Koala Court

Kissimmee, FL 34759

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 52 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.207 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,290.45 $0.00

Reis, Angela

421 SO 61 Terrace

Hollywood, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.208 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,232.18 $0.00

Reyes, Emily katelin

18170 Northwest 59th Avenue

apt 103

Hialeah, FL 33015

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.209 Priority creditor's name and mailing address As of the petition filing date, the claim is: $846.58 $0.00

Rivera Torres, Yarelis

1110 Hackberry Drive

Orlando, FL 32825

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.210 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,213.50 $0.00

Rivera, Waymaliz Leean

2905 South Semoran Boulevard

Apt 162

Orlando, FL 32822

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 53 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.211 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,196.65 $0.00

Rivero, Felix

2909 Nw 92st

Miami, FL 33147

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.212 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,255.03 $0.00

Rodriguez, Barbara M

320 S Flamingo Rd

Apt 150

Pembroke Pines, FL 33027

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.213 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,164.48 $0.00

Rodriguez, Humberto

7012 NW 95th Ave.

Tamarac, FL 33321

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.214 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,538.47 $0.00

Rolon, Keyla M

6301 Sherman St

Hollywood, FL 33024

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 54 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.215 Priority creditor's name and mailing address As of the petition filing date, the claim is: $796.85 $0.00

Roman, Brenda Liz

14492 Ward Rd

Orlando, FL 32824

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.216 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,034.70 $0.00

Romero, Karla

6203 N. Hubert Avenue

Tampa, FL 33614

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.217 Priority creditor's name and mailing address As of the petition filing date, the claim is: $720.84 $0.00

Rosario Morales, Janais

1701 Shady Ridge Court

Orlando, FL 32807

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.218 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,869.84 $0.00

Salcedo, Jose

10936 SW 182nd Lane

Miami, FL 33157

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 55 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.219 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,432.12 $0.00

Sanchez, Saul

1700 Woodbury Road

Apt 3105

Orlando, FL 32828

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.220 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,114.95 $0.00

Sanchez, Yhester M

9182 Nw 112 Terr

Hialeah Gardens, FL 33018

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.221 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,153.84 $0.00

Santiago Fernandez, Jean

13124 Heather Moss Drive

Apt. 515

Orlando, FL 32837

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.222 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,637.44 $0.00

Santos, Marilee

111 Washington Palm Loop

Davenport, FL 33897

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 56 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 66 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.223 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,616.56 $0.00

Seraneau, Maureen

5704 Southwest 39th Street

West Park, FL 33023

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.224 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,776.92 $0.00

Silva, Dianelys

3402 Doctor Love Road

Orlando, FL 32810

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.225 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,160.76 $0.00

Simmer, Jacqueline

1009 N Ocean Blvd

#PH2

Pompano Beach, FL 33062

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.226 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,198.08 $0.00

Smith, Matthew

10434 Abelia Court

Port Richey, FL 34668

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 57 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 67 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.227 Priority creditor's name and mailing address As of the petition filing date, the claim is: $767.04 $0.00

Smith, Nicholas

4416 19th St Cir W

Apt A

Bradenton, FL 34207

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.228 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,286.51 $0.00

Smith, Vannetta

3733 N. Goldenrod Road

Apt. 204

Winter Park, FL 32792

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.229 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,706.50 $0.00

Solano, Rowland

713 Gazelle Way

Kissimmee, FL 34759

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.230 Priority creditor's name and mailing address As of the petition filing date, the claim is: $646.49 $0.00

Soto, Alma

7190 NW 21st Street

Sunrise, FL 33313

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 58 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 68 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.231 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,004.64 $0.00

Sotolongo, Roxanna

4515 E 8th Ln

Hialeah, FL 33013

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.232 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,518.00 $0.00

St Juste, Maryse

1312 26th St NW

Winter Haven, FL 33881

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.233 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,519.35 $0.00

Stephens, Calvin

4381 Southwest 10th Place

Apt 102

Deerfield Beach, FL 33442

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.234 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,274.59 $0.00

Suarez, Idenises

8164 NW 10St

Apt.2

Miami, FL 33126

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 59 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 69 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.235 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,646.40 $0.00

Talledo Jibaja, Deysi

2105 Island Walk Drive

Orlando, FL 32824

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.236 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,115.20 $0.00

Tanelus, Wideline

4714 NW 58th St

Tamarac, FL 33319

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.237 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,293.12 $0.00

Tejada, Giovanni

10600 Bloomfield Drive

apt. 418

Orlando, FL 32825

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.238 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,315.39 $0.00

Thaureaux Bueno, Yoanne

7310 W 3rd Ave

Hialeah, FL 33014

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 60 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 70 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.239 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,335.10 $0.00

Thomas, Pamela L

18920 Nw 56 Ct

Miami Gardens, FL 33055

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.240 Priority creditor's name and mailing address As of the petition filing date, the claim is: $6,494.77 $0.00

Tingo, Frank

6976 Swinscoe Lane

Windermere, FL 34786

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.241 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,252.83 $0.00

Torres, Anthony O

10176 Vickers Ridge Drive

Orlando, FL 32829

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.242 Priority creditor's name and mailing address As of the petition filing date, the claim is: $669.12 $0.00

Troutman, Tammy

4132 NW 181st Lane

Miami Gardens, FL 33055

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 61 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 71 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.243 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,500.00 $0.00

Urrutia, Jacqueline

6428 Vineland Road

Apt 302

Orlando, FL 32819

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.244 Priority creditor's name and mailing address As of the petition filing date, the claim is: $812.76 $0.00

Valcourt, Renette

1180 Northwest 155th Lane

Apt 211

Miami, FL 33169

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.245 Priority creditor's name and mailing address As of the petition filing date, the claim is: $767.90 $0.00

Valdiviezo, Elysia

7331 NW 37th St

Unit 4

Hollywood, FL 33024

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.246 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,923.07 $0.00

Vargas, Jahaira

670 Basingstoke Ct

Kissimmee, FL 34758

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 62 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 72 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.247 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,269.23 $0.00

Varona, Evert

9328 Longmeadow Circle

Boynton Beach, FL 33436

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.248 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,586.60 $0.00

Ventura, Teanny

13173 Oulton Cir

Orlando, FL 32832

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.249 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,197.45 $0.00

Volodarsky, Alexander

7441 Wayne Ave

apt # 14-0

Miami Beach, FL 33141

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.250 Priority creditor's name and mailing address As of the petition filing date, the claim is: $198.98 $0.00

Walker, Melvin J

8441 nw 26th Place

Sunrise, FL 33322

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 63 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 73 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.251 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,198.26 $0.00

Walker, Stefanie

4188 N Landar Drive

Lake Worth, FL 33463

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.252 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,197.29 $0.00

Ward, Fernando

4821 NW 58th St

TAMARAC, FL 33319

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.253 Priority creditor's name and mailing address As of the petition filing date, the claim is: $108.90 $0.00

Watkinson, Derek J.

7131 Bellaire terrace

New Port Richey, FL 34653

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.254 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,458.74 $0.00

Whitfield, Ray

6509 Sedgeford Drive

Lakeland, FL 33811

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 64 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 74 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.255 Priority creditor's name and mailing address As of the petition filing date, the claim is: $917.44 $0.00

Williams, Kyshawn M

1029 Putnam Drive

Sarasota, FL 34234

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.256 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,692.90 $0.00

Wilson, Ivonne

1926 Magical Ln

Kissimmee, FL 34744

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.257 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,870.00 $0.00

Woolsey, Timothy M

9213 Sw 16th Rd E

Boca Raton, FL 33428

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.258 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,656.90 $0.00

Wuertz, Michael A

1343 Gangplank Dr

Valrico, FL 33594

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 65 of 67

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

2.259 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,384.60 $0.00

Yero, Junior

9140 Chantilly Ln

Port Richey, FL 34668

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.260 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,354.40 $0.00

Zamora, Jose

17501 Northwest 48th Avenue

Miami Gardens, FL 33055

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

2.261 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,121.47 $0.00

Zupcau, Liliana

837 NW 82nd Pl

Boca Raton, FL 33487

Check all that apply.

 Contingent

 Unliquidated

 Disputed

Date or dates debt was incurred Basis for the claim:

Wages

Last 4 digits of account number

Specify Code subsection of PRIORITY

unsecured claim: 11 U.S.C. § 507(a) (4)

Is the claim subject to offset?

 No

 Yes

Part 2: List All Creditors with 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 unsecured claims, fill

out and attach the Additional Page of Part 2.

Amount of claim

3.1 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00

Broward County Tax Collector

115 S. Andrews Ave,Room #A100

Fort Lauderdale, FL 33301-1895

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.2 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00

State Farm Fire and Casualty Company

Chief Financial Officer

200 E. Gaines Street

Tallahassee, FL 32399

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 66 of 67

Software Copyright (c) 1996-2021 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 76 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name

3.3 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00

State Farm Mutual Automobile Ins. Co.

Chief Financial Officer

200 E. Gaines Street

Tallahassee, FL 32399

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

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 Part1 or Part 2 is the

related creditor (if any) listed?

Last 4 digits of

account number, if

any

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. $ 411,943.24

5b. Total claims from Part 2 5b. + $ 0.00

5c. Total of Parts 1 and 2

 Lines 5a + 5b = 5c. 5c. $ 411,943.24

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 67 of 67

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 77 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

Official Form 206G

Schedule G: Executory Contracts and Unexpired Leases 12/15

Be as complete and accurate as possible. If more space is needed, copy and attach the additional page, number the entries consecutively.

1. Does the debtor have any executory contracts or unexpired leases?

 No. Check this box and file this form with the debtor's other schedules. There is nothing else to report on this form.

 Yes. Fill in all of the information below even if the contacts of leases are listed on Schedule A/B: Assets - Real and Personal Property

(Official Form 206A/B).

2. List all contracts and unexpired leases State the name and mailing address for all other parties with

whom the debtor has an executory contract or unexpired

lease

2.1. State what the contract or

lease is for and the nature of

the debtor's interest

Administrative Services

Agreement dated

October 3, 2016 for the

provision of employees

and related services.

Path Medical - Aventura

18999 Biscayne

Suite 201

Miami, FL 33180

State the term remaining

List the contract number of any

government contract

Official Form 206G Schedule G: Executory Contracts and Unexpired Leases Page 1 of 1

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 78 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

Official Form 206H

Schedule H: Your Codebtors 12/15

Be as complete and accurate as possible. If more space is needed, copy the Additional Page, numbering the entries consecutively. Attach the

Additional Page to this page.

1. Do you have any codebtors?

 No. Check this box and submit this form to the court with the debtor's other schedules. Nothing else needs to be reported on this form.

 Yes

2. In Column 1, list as codebtors all of the people or entities who are also liable for any debts listed by the debtor in the schedules of

creditors, Schedules D-G. Include all guarantors and co-obligors. In Column 2, identify the creditor to whom the debt is owed and each schedule

on which the creditor is listed. If the codebtor is liable on a debt to more than one creditor, list each creditor separately in Column 2.

Column 1: Codebtor Column 2: Creditor

Name Mailing Address Name Check all schedules

that apply:

2.1 Path Medical,

LLC

2304 W. Oakland Park Blvd

Fort Lauderdale, FL 33311

Medley Capital LLC,

as Agent

 D 2.4 

 E/F 

 G 

Official Form 206H Schedule H: Your Codebtors Page 1 of 1

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 79 of 90
Fill in this information to identify the case:

Debtor name Path Medical Center Holdings, Inc.

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number (if known) 21-18339-SMG

 Check if this is an

amended filing

Official Form 207

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy 04/19

The debtor must answer every question. 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 case number (if known).

Part 1: Income

1. Gross revenue from business

 None.

Identify the beginning and ending dates of the debtor’s fiscal year,

which may be a calendar year

Sources of revenue

Check all that apply

Gross revenue

(before deductions and

exclusions)

From the beginning of the fiscal year to filing date:

From 1/01/2021 to Filing Date

 Operating a business $7,909,804.00

 Other

Employee leasing

and services

agreement

For prior year:

From 1/01/2020 to 12/31/2020

 Operating a business $15,600,516.00

 Other

Employee leasing

and services

agreement

2. Non-business revenue

Include revenue regardless of whether that revenue is taxable. Non-business income may include interest, dividends, money collected from lawsuits,

and royalties. List each source and the gross revenue for each separately. Do not include revenue listed in line 1.

 None.

Description of sources of revenue Gross revenue from

each source

(before deductions and

exclusions)

Part 2: List Certain Transfers Made Before Filing for Bankruptcy

3. Certain payments or transfers to creditors within 90 days before filing this case

List payments or transfers--including expense reimbursements--to any creditor, other than regular employee compensation, within 90 days before

filing this case unless the aggregate value of all property transferred to that creditor is less than $6,825. (This amount may be adjusted on 4/01/22

and every 3 years after that with respect to cases filed on or after the date of adjustment.)

 None.

Creditor's Name and Address Dates Total amount of value Reasons for payment or transfer

Check all that apply

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 1

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 80 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Creditor's Name and Address Dates Total amount of value Reasons for payment or transfer

Check all that apply

3.1. See attached $0.00  Secured debt

 Unsecured loan repayments

 Suppliers or vendors

 Services

 Other 

4. Payments or other transfers of property made within 1 year before filing this case that benefited any insider

List payments or transfers, including expense reimbursements, made within 1 year before filing this case on debts owed to an insider or guaranteed

or cosigned by an insider unless the aggregate value of all property transferred to or for the benefit of the insider is less than $6,825. (This amount

may be adjusted on 4/01/22 and every 3 years after that with respect to cases filed on or after the date of adjustment.) Do not include any payments

listed in line 3. Insiders include officers, directors, and anyone in control of a corporate debtor and their relatives; general partners of a partnership

debtor and their relatives; affiliates of the debtor and insiders of such affiliates; and any managing agent of the debtor. 11 U.S.C. § 101(31).

 None.

Insider's name and address

Relationship to debtor

Dates Total amount of value Reasons for payment or transfer

5. Repossessions, foreclosures, and returns

List all property of the debtor that was obtained by a creditor within 1 year before filing this case, including property repossessed by a creditor, sold at

a foreclosure sale, transferred by a deed in lieu of foreclosure, or returned to the seller. Do not include property listed in line 6.

 None

Creditor's name and address Describe of the Property Date Value of property

6. Setoffs

List any creditor, including a bank or financial institution, that within 90 days before filing this case set off or otherwise took anything from an account

of the debtor without permission or refused to make a payment at the debtor’s direction from an account of the debtor because the debtor owed a

debt.

 None

Creditor's name and address Description of the action creditor took Date action was

taken

Amount

Part 3: Legal Actions or Assignments

7. Legal actions, administrative proceedings, court actions, executions, attachments, or governmental audits

List the legal actions, proceedings, investigations, arbitrations, mediations, and audits by federal or state agencies in which the debtor was involved

in any capacity—within 1 year before filing this case.

 None.

Case title

Case number

Nature of case Court or agency's name and

address

Status of case

7.1. State Farm Mutual

Automobile v. Path Medical,

LLC et al

8:20-cv-02428-VMC-TGW

 Dismissed as to

Path Medical

Center Holdings,

Inc.

Middle District of Floirda

Tampa Divisio

 Pending

 On appeal

 Concluded

8. Assignments and receivership

List any property in the hands of an assignee for the benefit of creditors during the 120 days before filing this case and any property in the hands of a

receiver, custodian, or other court-appointed officer within 1 year before filing this case.

 None

Part 4: Certain Gifts and Charitable Contributions

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 2

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 81 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

9. List all gifts or charitable contributions the debtor gave to a recipient within 2 years before filing this case unless the aggregate value of

the gifts to that recipient is less than $1,000

 None

Recipient's name and address Description of the gifts or contributions Dates given Value

Part 5: Certain Losses

10. All losses from fire, theft, or other casualty within 1 year before filing this case.

 None

Description of the property lost and

how the loss occurred

Amount of payments received for the loss

If you have received payments to cover the loss, for

example, from insurance, government compensation, or

tort liability, list the total received.

List unpaid claims on Official Form 106A/B (Schedule

A/B: Assets – Real and Personal Property).

Dates of loss Value of property

lost

Part 6: Certain Payments or Transfers

11. Payments related to bankruptcy

List any payments of money or other transfers of property made by the debtor or person acting on behalf of the debtor within 1 year before the filing

of this case to another person or entity, including attorneys, that the debtor consulted about debt consolidation or restructuring, seeking bankruptcy

relief, or filing a bankruptcy case.

 None.

Who was paid or who received

the transfer?

Address

If not money, describe any property transferred Dates Total amount or

value

11.1.

Edelboim Lieberman Revah

PLLC

20200 W. Dixie Highway

Suite 905

Miami, FL 33180

Path Medical LLC transferred funds to

ELR’s trust account in connection with its

restructuring efforts on the following

dates: August 21, 2021 ($50,000), October

19, 2020 ($200,000), February 26 ,2021

($50,536.90), and August 16, 2021

($60,104.50).

ELR drew down funds from its trust

account to apply to monthly invoices in

the total amount of $204,771.50. On the

Petition Date, ELR held $155,869.9 in trust. $204,771.50

Email or website address

Who made the payment, if not debtor?

Path Medical, LLC

11.2.

Kapila Mukamal

On August 26, 2021, Path Medical LLC

funded a $7,500 retainer to KM. Prior to

the petition date, KM drew down

$2,793.00. $2,793.00

Email or website address

Who made the payment, if not debtor?

Path Medical, LLC

12. Self-settled trusts of which the debtor is a beneficiary

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 3

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 82 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

List any payments or transfers of property made by the debtor or a person acting on behalf of the debtor within 10 years before the filing of this case

to a self-settled trust or similar device.

Do not include transfers already listed on this statement.

 None.

Name of trust or device Describe any property transferred Dates transfers

were made

Total amount or

value

13. Transfers not already listed on this statement

List any transfers of money or other property by sale, trade, or any other means made by the debtor or a person acting on behalf of the debtor within

2 years before the filing of this case to another person, other than property transferred in the ordinary course of business or financial affairs. Include

both outright transfers and transfers made as security. Do not include gifts or transfers previously listed on this statement.

 None.

Who received transfer?

Address

Description of property transferred or

payments received or debts paid in exchange

Date transfer

was made

Total amount or

value

Part 7: Previous Locations

14. Previous addresses

List all previous addresses used by the debtor within 3 years before filing this case and the dates the addresses were used.

 Does not apply

Address Dates of occupancy

From-To

Part 8: Health Care Bankruptcies

15. Health Care bankruptcies

Is the debtor primarily engaged in offering services and facilities for:

- diagnosing or treating injury, deformity, or disease, or

- providing any surgical, psychiatric, drug treatment, or obstetric care?

 No. Go to Part 9.

 Yes. Fill in the information below.

Facility name and address Nature of the business operation, including type of services

the debtor provides

If debtor provides meals

and housing, number of

patients in debtor’s care

Part 9: Personally Identifiable Information

16. Does the debtor collect and retain personally identifiable information of customers?

 No.

 Yes. State the nature of the information collected and retained.

17. Within 6 years before filing this case, have any employees of the debtor been participants in any ERISA, 401(k), 403(b), or other pension or

profit-sharing plan made available by the debtor as an employee benefit?

 No. Go to Part 10.

 Yes. Does the debtor serve as plan administrator?

Part 10: Certain Financial Accounts, Safe Deposit Boxes, and Storage Units

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 4

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 83 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

18. Closed financial accounts

Within 1 year before filing this case, were any financial accounts or instruments held in the debtor’s name, or for the debtor’s benefit, closed, sold,

moved, or transferred?

Include checking, savings, money market, or other financial accounts; certificates of deposit; and shares in banks, credit unions, brokerage houses,

cooperatives, associations, and other financial institutions.

 None

Financial Institution name and

Address

Last 4 digits of

account number

Type of account or

instrument

Date account was

closed, sold,

moved, or

transferred

Last balance

before closing or

transfer

19. Safe deposit boxes

List any safe deposit box or other depository for securities, cash, or other valuables the debtor now has or did have within 1 year before filing this

case.

 None

Depository institution name and address Names of anyone with

access to it

Address

Description of the contents Do you still

have it?

20. Off-premises storage

List any property kept in storage units or warehouses within 1 year before filing this case. Do not include facilities that are in a part of a building in

which the debtor does business.

 None

Facility name and address Names of anyone with

access to it

Description of the contents Do you still

have it?

Part 11: Property the Debtor Holds or Controls That the Debtor Does Not Own

21. Property held for another

List any property that the debtor holds or controls that another entity owns. Include any property borrowed from, being stored for, or held in trust. Do

not list leased or rented property.

 None

Part 12: Details About Environment Information

For the purpose of Part 12, the following definitions apply:

Environmental law means any statute or governmental regulation that concerns pollution, contamination, or hazardous material, regardless of the

medium affected (air, land, water, or any other medium).

Site means any location, facility, or property, including disposal sites, that the debtor now owns, operates, or utilizes or that the debtor formerly

owned, operated, or utilized.

Hazardous material means anything that an environmental law defines as hazardous or toxic, or describes as a pollutant, contaminant, or a

similarly harmful substance.

Report all notices, releases, and proceedings known, regardless of when they occurred.

22. Has the debtor been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders.

 No.

 Yes. Provide details below.

Case title

Case number

Court or agency name and

address

Nature of the case Status of case

23. Has any governmental unit otherwise notified the debtor that the debtor may be liable or potentially liable under or in violation of an

environmental law?

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 5

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 84 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

 No.

 Yes. Provide details below.

Site name and address Governmental unit name and

address

Environmental law, if known Date of notice

24. Has the debtor notified any governmental unit of any release of hazardous material?

 No.

 Yes. Provide details below.

Site name and address Governmental unit name and

address

Environmental law, if known Date of notice

Part 13: Details About the Debtor's Business or Connections to Any Business

25. Other businesses in which the debtor has or has had an interest

List any business for which the debtor was an owner, partner, member, or otherwise a person in control within 6 years before filing this case.

Include this information even if already listed in the Schedules.

 None

Business name address Describe the nature of the business Employer Identification number

Do not include Social Security number or ITIN.

Dates business existed

25.1. Path Medical, LLC

2304 W. Oakland Blvd

Fort Lauderdale, FL 33311

Health Care EIN:

From-To

47-5580767

2016-present

26. Books, records, and financial statements

26a. List all accountants and bookkeepers who maintained the debtor’s books and records within 2 years before filing this case.

 None

Name and address Date of service

From-To

26a.1. Keefe McCullough

6550 N. Federal Highway

4th Floor

Fort Lauderdale, FL 33308

2016 - Present

26b. List all firms or individuals who have audited, compiled, or reviewed debtor’s books of account and records or prepared a financial statement

within 2 years before filing this case.

 None

Name and address Date of service

From-To

26b.1. Keefe McCullough

6550 N. Federal Highway

4th Floor

Fort Lauderdale, FL 33308

2016 - Present

26c. List all firms or individuals who were in possession of the debtor’s books of account and records when this case is filed.

 None

Name and address If any books of account and records are

unavailable, explain why

26c.1. Keefe McCullough

6550 N. Federal Highway

4th Floor

Fort Lauderdale, FL 33308

2016 - Present

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 6

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Case 21-18339-SMG Doc 15 Filed 09/28/21 Page 85 of 90
Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

26d. List all financial institutions, creditors, and other parties, including mercantile and trade agencies, to whom the debtor issued a financial

statement within 2 years before filing this case.

 None

Name and address

26d.1. Bank United

7765 NW 148th Street

Hialeah, FL 33016

26d.2. Medley Capital LLC, as Agent

280 Park Ave, 6th Floor East

New York, NY 10017

27. Inventories

Have any inventories of the debtor’s property been taken within 2 years before filing this case?

 No

 Yes. Give the details about the two most recent inventories.

Name of the person who supervised the taking of the

inventory

Date of inventory The dollar amount and basis (cost, market,

or other basis) of each inventory

28. List the debtor’s officers, directors, managing members, general partners, members in control, controlling shareholders, or other people

in control of the debtor at the time of the filing of this case.

Name Address Position and nature of any

interest

% of interest, if

any

Manuel A. Fernandez 2160 Denny Court

Boca Raton, FL 33486

Chairman of the Board of

Directors/CEO

0%

Name Address Position and nature of any

interest

% of interest, if

any

Marta Prado 949 South Southlake Drive

Hollywood, FL 33019

Director 0%

Name Address Position and nature of any

interest

% of interest, if

any

David Campbell Getzler Henrich & Associates, Inc.

150 S. Wacker Dr.

Chicago, IL 60606

Director 0%

29. Within 1 year before the filing of this case, did the debtor have officers, directors, managing members, general partners, members in

control of the debtor, or shareholders in control of the debtor who no longer hold these positions?

 No

 Yes. Identify below.

Name Address Position and nature of any

interest

Period during which

position or interest

was held

Alan Kessman 5603 Whirlaway Road

Palm Beach Gardens, FL 33418

Director December 2018

-November 10,

2020

30. Payments, distributions, or withdrawals credited or given to insiders

Within 1 year before filing this case, did the debtor provide an insider with value in any form, including salary, other compensation, draws, bonuses,

loans, credits on loans, stock redemptions, and options exercised?

 No

 Yes. Identify below.

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 7

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Debtor Path Medical Center Holdings, Inc. Case number (if known) 21-18339-SMG

Name and address of recipient Amount of money or description and value of

property

Dates Reason for

providing the value

30.1

.

David Campbell

Getzler Henrich & Associates,

Inc.

150 S. Wacker Drive 24th

Floor

Chicago, IL 60606 50,000.00

Equal

bi-weekly

payments of

director

salary from

March 2021

through

August 2021

Mr. Campbell

serves as a

director on the

board of Path

Medical Center

Holdings, Inc.,

and his salary is

funded by the

Debtor's 100%

subsidiary, Path

Medical, LLC.

Relationship to debtor

Director

30.2

.

Alan Kessman

5603 Whirlaway Road

Palm Beach Gardens, FL

33418 41,666.65

Equal

monthly

installments

of director

salary from

August 2020

through

December

2020.

Mr. Kessman

formerly served

as a director on

the board of Path

Medical Center

Holdings, Inc.,

and his salary

was funded by the

Debtor's 100%

subsidiary, Path

Medical, LLC.

Relationship to debtor

Former Board Member

30.3

.

Marta Prado

949 South Southlake Drive

Hollywood, FL 33019 100,000.00

Equal

monthly

installments

of director

salary from

September

2020 through

August 2021.

Ms. Prado serves

as a director on

the board of Path

Medical Center

Holdings, Inc.,

and her salary is

funded by the

Debtor's 100%

subsidiary, Path

Medical, LLC.

Relationship to debtor

Board Member

31. Within 6 years before filing this case, has the debtor been a member of any consolidated group for tax purposes?

 No

 Yes. Identify below.

Name of the parent corporation Employer Identification number of the parent

corporation

EIN:

EIN:

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 8

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