Fill in this information to identify the case: 

Debtor name Warren Douglas, LP 

United States Bankruptcy Court for the: NORTHERN DISTRICT OF TEXAS 

Case number (if known) 

El Check if this is an 

amended filing 

Official Form 207 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy 04/22 

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 

0 None. 

Identify the beginning and ending dates of the debtor's fiscal year, Sources of revenue 

which may be a calendar year Check all that apply 

Gross revenue 

(before deductions and 

exclusions) 

For prior year: 

From 1/01/2023 to 12/31/2023 

• Operating a business 

O Other 

$6,181,026.06 

For year before that: 

From 1101/2022 to 12131/2022 

• Operating a business 

0 Other 

$6,394,201.56 

For the fiscal year: 

From 1101/2021 to 12131/2021 

• Operating a business 

O Other 

$8,163,511.99 

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 $7,575. (This amount may be adjusted on 4/01/25 

and every 3 years after that with respect to cases filed on or after the date of adjustment.) 

0 None. 

Creditor's Name and Address Dates Total amount of value Reasons for payment or transfer 

Check all that apply 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 1 Official Form 207 

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Document Page 1 of 10
Debtor 

3.1. 

Warren Douglas, LP Case number (if known) 

Creditor's Name and Address 

American Benefit Systems, Inc. 

Dates 

12/11/2023 - 

Total amount of value 

$17,395.68 

Reasons for payment or transfer 

Check all that apply 

0 Secured debt 

20770 Highway 281 North $3,233.76 0 Unsecured loan repayments 

Suite 108, Box 450 12/13/2023 - 0 Suppliers or vendors 

San Antonio, TX 78258-7500 $3,233.76 0 Services 

12/13/2023 - 

$3,278.76 • Other Payments to 401K 

Plan 1/3/2024 - 

$3,27876 

2/28/2024 - 

$4,370.64 

3.2. Backd 12/5/2023 - $43,269.26 0 Secured debt 

2101 S. IH-35 Frontage Rd. $6,009.62 0 Unsecured loan repayments 

Suite 400 12/12/2023 - 0 Suppliers or vendors 

Austin, TX 78741 $6,009.62 0 Services 

12/19/2023 - 

$6,009.62 • Other 

12/26/2023 - 

$6,009.62 

1/3/2024 - 

$6009.62 

2/6/2023 - 

$6009.62 

2/6/2023 - 

$3,605.77 

2/20/2024 - 

$3,605.77 

3.3. Truist Bank Daily $359,802.84 0 Secured debt 

214 N. Tryon Street 0 Unsecured loan repayments 

Charlotte, NC 28202 0 Suppliers or vendors 

0 Services 

• Other Sweep Transactions on 

Line of Credit 

3.4. Moore Acquisition Partners LLC 12/1/2023 - $44,663.27 0 Secured debt 

1204 West 7th Street $22,842.74 0 Unsecured loan repayments 

Suite #200 1/1112024 - 0 Suppliers or vendors 

Fort Worth, TX 76102 $21,820.53 0 Services 

• Other Rent 

3.5. United Healthcare 12/5/2023 - $61,288.42 0 Secured debt 

PO Box 9597820 $20,131.75 0 Unsecured loan repayments 

Saint Louis, MO 63195-9782 12128/2023 - 0 Suppliers or vendors 

$20,131.75 El Services 

1/31/2024 - 

$21,024.92 • Other Employee Health 

Benefits 

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 2 

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Document Page 2 of 10
Debtor 

3.6. 

Warren Douglas, LP Case number Of known) 

Creditor's Name and Address 

United States Treasury 

Dates 

12/18/2023 - 

Total amount of value 

$89,937.66 

Reasons for payment or transfer 

Check all that apply 

0 Secured debt 

PO Box 7028 $18,746.10 0 Unsecured loan repayments 

San Francisco, CA 94120-7028 12/20/2023 - 0 Suppliers or vendors 

$30,014.76 0 Services 12/28/2023 - 

$18,673.72 • Other Payroll Taxes, Federal 

Unemployment 1/10/2024 - 

$45.80 

2/10/2024 - 

$17,755.92 

2/28/2024 - 

$4,701.36 

3.7. Texas Comptroller 2.29.2024 $3,000.00 0 Secured debt 

PO Box 149348 0 Unsecured loan repayments 

Austin, TX 78714-9348 0 Suppliers or vendors 

0 Services 

• Other Sales Tax 

3.8. Wendy Burgess 2.29.2024 $690.00 0 Secured debt 

Tax Assessor-Collector 0 Unsecured loan repayments 

6551 Granbury Rd. 0 Suppliers or vendors 

Fort Worth, TX 76133 0 Services 

• Other Property Taxes 

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 $7,575. (This amount 

may be adjusted on 4/01/25 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). 

0 None. 

Insider's name and address Dates Total amount of value Reasons for payment or transfer 

Relationship to debtor 

4.1 Doug Briley Pay down $54,000.00 Repayment of Loan 

3788 Arroyo Road owner's 

Fort Worth, TX 76109 $275k loan to 

Self co. kids 

college 

tuitition: 

$25,000 - 

4.10.2023; 

$4,500 - 

6.6.2023: 

$5,000 - 

8.7.2023; 

$4,000 - 

9.5.2023 

$5,000 - 

9.5.2023 

$10,500 - 

11.8.2023 

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. 

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 3 

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Document Page 3 of 10
Debtor Warren Douglas, LP Case number (if known) 

• 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 Amount 

taken 

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 Nature of case Court or agency's name and Status of case 

Case number address 

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 

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 

Value of property 

how the loss occurred lost 

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 

NB: Assets— Real and Personal Property). 

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. 

0 None. 

Description of the property lost and Amount of payments received for the loss Dates of loss 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 4 Official Form 207 

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Document Page 4 of 10
Debtor Warren Douglas, LP Case number (if known) 

Who was paid or who received If not money, describe any property transferred Dates Total amount or 

the transfer? value 

Address 

Cantey Hanger LLP 

600 W. 6th Street 

Suite 300 

Fort Worth, TX 76102 12/12/2023 $4,857.00 

Email or website address 

Canteyhanger.com 

Who made the payment, if not debtor? 

11.2. Whitaker Chalk Swindle & 

Schwartz PLLC 12/28/2023 

301 Commerce Street, Suite 2/4/2024 

3500 2/21/2024 

Fort Worth, TX 76102 2/29/2024 $21,000.00 

Email or website address 

whitakerchalk.com 

Who made the payment, if not debtor? 

12. Self-settled trusts of which the debtor is a beneficiary 

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 Total amount or 

were made 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 Date transfer Total amount or 

payments received or debts paid in exchange was made 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? 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 5 Official Form 207 

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Document Page 5 of 10
Debtor Warren Douglas, LP Case number (if known) 

• No. Go to Part 9. 

O 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. 

O 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? 

O No. Go to Part 10. 

• Yes. Does the debtor serve as plan administrator? 

0 No Go to Part 10. 

• Yes. Fill in below: 

Name of plan 

Warren Douglas 401(K) 

Has the plan been terminated? 

• No 

0 Yes 

Employer identification number of the plan 

EIN: 20-0943799 

Part 10: Certain Financial Accounts, Safe Deposit Boxes, and Storage Units 

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. 

0 None 

Financial Institution name and Last 4 digits of Type of account or Date account was Last balance 

Address account number instrument closed, sold, before closing or 

moved, or transfer 

transferred 

18.1. Bank of Texas (Operations XXXX-1371 • Checking 3/3/2022 $8,293.66 

Checking) 0 Savings 

PO Box 29775 0 Money Market 

Dallas, TX 75229-0775 0 Brokerage 

0 Other 

18.2. Bank of Texas (Media 

Checking) 

PO Box 29775 

Dallas, TX 75229-0775 

YJCXX-1382 • Checking 

0 Savings 

0 Money Market 

0 Brokerage 

0 Other 

5/1/202 $0.00 

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. 

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 6 

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Document Page 6 of 10
Debtor Warren Douglas, LP Case number Of known) 

• None 

Depository institution name and address Names of anyone with Description of the contents Does debtor 

access to it still have it? 

Address 

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. 

0 None 

Facility name and address 

Public Storage 

1015 Henderson St. 

Fort Worth, TX 76102-4520 

Names of anyone with 

access to it 

Doug Briley 

3788 Arroyo Road 

Fort Worth, TX 76109 

Description of the contents 

Files and Old Furniture 

Does debtor 

still have it? 

O No 

• Yes 

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. 

0 Yes. Provide details below. 

Case title Court or agency name and Nature of the case Status of case 

Case number address 

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? 

• No. 

0 Yes. Provide details below. 

Site name and address Governmental unit name and Environmental law, if known Date of notice 

address 

24. Has the debtor notified any governmental unit of any release of hazardous material? 

• No. 

• Yes. Provide details below. 

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 7 

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Document Page 7 of 10
Describe the nature of the business Employer Identification number 

Do not include Social Security number or ITIN. 

Debtor Warren Douglas, LP Case number (if known) 

Site name and address Governmental unit name and Environmental law, if known Date of notice 

address 

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 

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. 

0 None 

Name and address Date of service 

From-To 

26a.1. Elizabeth Tilleman 8/16/2011 to 

PO Box 73 12/31/2023 

Chinook, MT 59523 

26a.2. Douglas Briley 2/2/1998 to present 

3788 Arroyo Road 

Fort Worth, TX 76109 

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. 

0 None 

Name and address Date of service 

From-To 

26b.1. Douglas Briley - self-prepared 1998 to 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. 

0 None 

Name and address If any books of account and records are 

unavailable, explain why 

26c.1. Whitley Penn 

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. 

0 None 

Name and address 

26d.1. Truist Bank 

214 N. Tryon Street No. 3 

Charlotte, NC 28202 

26d.2. Austin Business Finance dba Backd 

2101 S. IH-35 Frontage Rd., Suite 400 

Austin, TX 78741 

27. Inventories 

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 8 

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Debtor Warren Douglas, LP Case number (if known) 

Have any inventories of the debtor's property been taken within 2 years before filing this case? 

• No 

O Yes. Give the details about the two most recent inventories. 

Name of the person who supervised the taking of the Date of inventory The dollar amount and basis (cost, market, 

inventory 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 % of interest, if 

interest any 

Doug Briley 3788 Arroyo Road President & CEO 100% 

Fort Worth, TX 76109 

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 

O Yes. Identify below. 

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. 

30.1 

Name and address of recipient 

Douglas Briley 

3788 Arroyo Road 

Fort Worth, TX 76109 

Relationship to debtor 

President 

Amount of money or description and value of Dates Reason for 

property providing the value 

$245,500 (Mar 15-Dec 15 2023) $13k draw 

twice per month 

$205.70 (Mar 31-Dec 31 2023) $20.57/mo 

locker dues City Cl 

$22.39 (8/31/23) wife used co cc at 

Whataburger (mistake) 

31. Within 6 years before filing this case, has the debtor been a member of any consolidated group for tax purposes? 

• No 

O Yes. Identify below. 

Name of the parent corporation Employer Identification number of the parent 

corporation 

32. Within 6 years before filing this case, has the debtor as an employer been responsible for contributing to a pension fund? 

O No 

• Yes. Identify below. 

Name of the pension fund 

Warren Douglas 401(K) 

Employer Identification number of the pension 

fund 

EIN: 20-0943799 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 9 Official Form 207 

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Document Page 9 of 10
Douglas W. Briley 

Signature of ividual signing on be 

Position or r ationship to debtor President! CEO 

Debtor Warren Douglas, LP Case number (if known) 

Part 14: Signature and Declaration 

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. 

I have examined the information in this Statement of Financial Affairs and any attachments and have a reasonable belief that the information is true 

and correct. 

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

Are additional pages to Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy (Official Form 207) attached? 

• No 

Yes 

Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 10 Official Form 207 

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