Official Form 204

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

Claims and Are Not Insiders 12/15 

 Check if this is an

amended filing

Nature of the claim Amount of unsecured claim

Fill in this information to identify the case:

Debtor name

United States Bankruptcy Court for the:

Case number

(if known)

Lion Star Nacogdoches Hospital, LLC

NORTHERN DISTRICT OF TEXAS

23-

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

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

not include claims by secured creditors, unless the unsecured claims resulting from inadequate collateral value places the 

creditor among the holders of the 20 largest unsecured claims.

Name of creditor and 

complete mailing 

address, including zip 

code

Name, telephone 

number, and email 

address of 

creditor 

contact

(for example, trade 

debts, bank loans, 

professional 

services, and 

government 

contracts)

If the claim is fully unsecured, fill in only 

unsecured claim amount. If claim is partially 

secured, fill in total claim amount and 

deduction for value of collateral or setoff to 

calculate unsecured claim.

Indicate if 

claim is 

contingent, 

unliquidated, 

or disputed

Total 

claim, if 

partially 

secured

Deduction 

for value 

of 

collateral 

or setoff

Unsecured 

claim

1 TRS Managed Services, $2,831,127.74 

LLC

5001 Founders Way, 

Suite L10

Rogers, AR 72758

Caleb English, CFO

479-303-4233

cenglish@trshealthca

re.com

Clinical Staffing

2 Cerner Health Services, $1,077,018.89 

Inc.

PO Box 959156

St. Louis, MO 63195

Robert Gonzales

816-201-6674

robert.gonzales@ora

cle.com

Electronic Health 

Record-Patients

3 Medygate, Inc. $581,896.00 

447 S. Robertson Blvd., 

#204

Beverly Hills, CA 90211

Dariush Yaghoubi

310-385-7300

dariush@medygate.c

om

Bio-Medical 

Services

4 EDF, Inc. $431,854.24 

PO Box 74007029

Chicago, IL 60674

Laendra Davis

281-366-0104

retailcustreceivable@

bp.com

Electricity Provider

5 SCC Soft Computer $357,110.54 

5400 Tech Data Dr.

Clearwater, FL 33760

Tarrah Veilleux

727-789-0100 x4

tarrahv@softcompute

r.com

Lab Software, 

Hardware Mtn. 

Interface

Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims page 1 

Case 23-43535-mxm11 Doc 4 Filed 11/17/23 Entered 11/17/23 12:25:24 Desc Main

Document Page 1 of 4
Debtor Case number (if known)

Name

Nature of the claim Amount of unsecured claim

Lion Star Nacogdoches Hospital, LLC 23-

Name of creditor and 

complete mailing 

address, including zip 

code

Name, telephone 

number, and email 

address of 

creditor 

contact

(for example, trade 

debts, bank loans, 

professional 

services, and 

government 

contracts)

If the claim is fully unsecured, fill in only 

unsecured claim amount. If claim is partially 

secured, fill in total claim amount and 

deduction for value of collateral or setoff to 

calculate unsecured claim.

Indicate if 

claim is 

contingent, 

unliquidated, 

or disputed

Total 

claim, if 

partially 

secured

Deduction 

for value 

of 

collateral 

or setoff

Unsecured 

claim

6 AT&T $260,343.45 

PO Box 105414

Atlanta, GA 30348

Abdi Abdulahi

877-970-8676

aa120s@att.com

Telephone Provider

7 Medline Industries, Inc. $250,112.21 

Dept. 1080

PO Box 121080

Dallas, TX 75312

Tina Ridley

847-643-4019

tridley@medline.com

Medical Supplies

8 Gjerset & Lorez, LLP $215,110.00 

2801 Via Fortuna

Austin, TX 78746

Tammy Sullivan

512-692-8799

sullivan@gl-law.com

Attorney Fees

9 Wipfli, LLP $196,129.24 

PO Box 3160

Milwaukee, WI 53201

David M. Hersch

816-769-7014

david.hersch@wipfli.

com

Former Proj. Mgr. 

for Electronic Health 

Record

10 Biomerieux, Inc. - St. $189,031.58 

Louis

PO Box 500308

St. Louis, MO 63150

Kate Kohlschein

385-770-3110

kate.kohlschein@bio

merieux.com

Lab Supplies

11 SCI Solutions $164,922.04 

PO Box 735381

Dallas, TX 75373

Bernie Gay

866-472-4338 x1

bgay@r1rcm.com

Patient Scheduling 

Software

12 Young's Professional $162,945.48 

Svc

200 Greenleaves Blvd., 

Suite 5

Mandeville, LA 70448

Brian Young

985-951-2202

byoung@essentialam

g.com

Anesthesia 

Services

13 Gordon Food $125,843.90 

PO Box 88029

Chicago, IL 60680

Chris Pitcher

616-717-4814

chris.pitcher@gfs.co

m

Dietary-Food 

Supplies (Cafeteria)

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

Case 23-43535-mxm11 Doc 4 Filed 11/17/23 Entered 11/17/23 12:25:24 Desc Main

Document Page 2 of 4
Debtor Case number (if known)

Name

Nature of the claim Amount of unsecured claim

Lion Star Nacogdoches Hospital, LLC 23-

Name of creditor and 

complete mailing 

address, including zip 

code

Name, telephone 

number, and email 

address of 

creditor 

contact

(for example, trade 

debts, bank loans, 

professional 

services, and 

government 

contracts)

If the claim is fully unsecured, fill in only 

unsecured claim amount. If claim is partially 

secured, fill in total claim amount and 

deduction for value of collateral or setoff to 

calculate unsecured claim.

Indicate if 

claim is 

contingent, 

unliquidated, 

or disputed

Total 

claim, if 

partially 

secured

Deduction 

for value 

of 

collateral 

or setoff

Unsecured 

claim

14 Medtronic Xomed $123,494.94 

PO Box 848086

Dallas, TX 75284

Mike Maday

800-511-0934 x5

mike.n.maday@medtr

onic.com

Cath Lab Medical 

Supplies

15 Matheson Tri-Gas $123,428.72 

Dept. 3028

PO Box 123028

Dallas, TX 75312

Rayanne Hayes

888-815-1000 x2

rahayes@mathesong

as.com

Patient Cases

16 Biotronik, Inc. $122,332.63 

PO Box 205421

Dallas, TX 75320

Angela Stanfield

971-335-4506

angela.stanfield@biot

ronik.com

Cath Lab Medical 

Supplies

17 Stericycle, Inc. $120,379.80 

PO Box 6575

Carol Stream, IL 60197

Rodney Dickens

847-943-6231

rodney.dickens@steri

cycle.com

Medical Waste

18 Beckman Coulter, Inc. $111,340.65 

Dept. CH 10164

Palatine, IL 60055

Kevin Thomas

903-805-8001

rodney.dickens@steri

cycle.com

Supplies/Service 

Equip. Contract

19 Garlic Media $108,000.00 

Management LLC

1195 S Lipan St, Unit A

Denver, CO 80223

Will Feldman

720-545-7635

will@garlicmediagrou

p.com

Marketing

20 Banner State Emergency $107,758.00 

Phy PA

5000 Ambassador 

Caffery Pkwy

Bldg. 15, Suite A

Lafayette, LA 70508

Mark McGrew

850-293-8879

mark.mcgrew@ecp.n

et

ER Physician Group

Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims page 3 

Case 23-43535-mxm11 Doc 4 Filed 11/17/23 Entered 11/17/23 12:25:24 Desc Main

Document Page 3 of 4
Official Form 202

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

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

Debtor Name

United States Bankruptcy Court for the:

Case number

(if known)

Lion Star Nacogdoches Hospital, LLC

NORTHERN DISTRICT OF TEXAS

23-

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

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

in the document, and any amendments of those documents. This form must state the individual's position or relationship to 

the debtor, the identity of the document, and the date. Bankruptcy Rules 1008 and 9011.

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

property by fraud in connection with a bankruptcy case can result in fines up to $500,000 or imprisonment for up to 20 years, or 

both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

Declaration and signature

X

Signature of individual signing on behalf of debtor

Executed on

MM / DD / YYYY



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



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

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





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

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





Schedule H: Codebtors (Official Form 206H)

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





Amended Schedule

Other document that requires a declaration

Printed name

Position or relationship to debtor

 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders

(Official Form 204)

Sean Fowler

Chief Executive Officer

11/16/2023

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

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

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

correct:

Official Form 202 Declaration Under Penalty of Perjury for Non-Individual Debtors

Case 23-43535-mxm11 Doc 4 Filed 11/17/23 Entered 11/17/23 12:25:24 Desc Main

Document Page 4 of 4