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5/17/18 4:51PM

Fill in this information to identify your case:

United States Bankruptcy Court for the:

WESTERN DISTRICT OF WASHINGTON

Case number (if known) Chapter 7


Check if this an
amended filing

Official Form 201


Voluntary Petition for Non-Individuals Filing for Bankruptcy 4/16
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).
For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.

1. Debtor's name Qliance Management Inc.

2. All other names debtor


used in the last 8 years
Include any assumed Qliance
names, trade names and
doing business as names

3. Debtor's federal
Employer Identification 81-1559010
Number (EIN)

4. Debtor's address Principal place of business Mailing address, if different from principal place of
business

1915 2nd Ave. #1002


Seattle, WA 98101
Number, Street, City, State & ZIP Code P.O. Box, Number, Street, City, State & ZIP Code

King Location of principal assets, if different from principal


County place of business

Number, Street, City, State & ZIP Code

5. Debtor's website (URL)

6. Type of debtor Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))
Partnership (excluding LLP)
Other. Specify:

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1
Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 1 of 70
5/17/18 4:51PM

Debtor Qliance Management Inc. Case number (if known)


Name

7. Describe debtor's business A. Check one:


Health Care Business (as defined in 11 U.S.C. § 101(27A))
Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))
Railroad (as defined in 11 U.S.C. § 101(44))
Stockbroker (as defined in 11 U.S.C. § 101(53A))
Commodity Broker (as defined in 11 U.S.C. § 101(6))
Clearing Bank (as defined in 11 U.S.C. § 781(3))
None of the above

B. Check all that apply


Tax-exempt entity (as described in 26 U.S.C. §501)
Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C. §80a-3)
Investment advisor (as defined in 15 U.S.C. §80b-2(a)(11))

C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor.
See http://www.uscourts.gov/four-digit-national-association-naics-codes.
6211

8. Under which chapter of the Check one:


Bankruptcy Code is the
debtor filing? Chapter 7
Chapter 9
Chapter 11. Check all that apply:
Debtor's aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates)
are less than $2,566,050 (amount subject to adjustment on 4/01/19 and every 3 years after that).
The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D). If the debtor is a small
business debtor, attach the most recent balance sheet, statement of operations, cash-flow
statement, and federal income tax return or if all of these documents do not exist, follow the
procedure in 11 U.S.C. § 1116(1)(B).
A plan is being filed with this petition.
Acceptances of the plan were solicited prepetition from one or more classes of creditors, in
accordance with 11 U.S.C. § 1126(b).
The debtor is required to file periodic reports (for example, 10K and 10Q) with the Securities and
Exchange Commission according to § 13 or 15(d) of the Securities Exchange Act of 1934. File the
attachment to Voluntary Petition for Non-Individuals Filing for Bankruptcy under Chapter 11
(Official Form 201A) with this form.
The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule 12b-2.
Chapter 12

9. Were prior bankruptcy No.


cases filed by or against
the debtor within the last 8 Yes.
years?
If more than 2 cases, attach a
separate list. District When Case number
District When Case number

10. Are any bankruptcy cases No


pending or being filed by a
business partner or an Yes.
affiliate of the debtor?
List all cases. If more than 1,
attach a separate list Debtor Qliance Medical Group of WA PC Relationship

Western District WA -
District Seattle When 5/17/18 Case number, if known 18-11998

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2
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Debtor Qliance Management Inc. Case number (if known)


Name

11. Why is the case filed in Check all that apply:


this district?
Debtor has had its domicile, principal place of business, or principal assets in this district for 180 days immediately
preceding the date of this petition or for a longer part of such 180 days than in any other district.
A bankruptcy case concerning debtor's affiliate, general partner, or partnership is pending in this district.

12. Does the debtor own or No


have possession of any
real property or personal Answer below for each property that needs immediate attention. Attach additional sheets if needed.
Yes.
property that needs
immediate attention? Why does the property need immediate attention? (Check all that apply.)
It poses or is alleged to pose a threat of imminent and identifiable hazard to public health or safety.
What is the hazard?
It needs to be physically secured or protected from the weather.
It includes perishable goods or assets that could quickly deteriorate or lose value without attention (for example,
livestock, seasonal goods, meat, dairy, produce, or securities-related assets or other options).
Other
Where is the property?
Number, Street, City, State & ZIP Code
Is the property insured?
No
Yes. Insurance agency
Contact name
Phone

Statistical and administrative information

13. Debtor's estimation of . Check one:


available funds
Funds will be available for distribution to unsecured creditors.

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

14. Estimated number of 1-49 1,000-5,000 25,001-50,000


creditors 50-99 5001-10,000 50,001-100,000
100-199 10,001-25,000 More than100,000
200-999

15. Estimated Assets $0 - $50,000 $1,000,001 - $10 million $500,000,001 - $1 billion


$50,001 - $100,000 $10,000,001 - $50 million $1,000,000,001 - $10 billion
$100,001 - $500,000 $50,000,001 - $100 million $10,000,000,001 - $50 billion
$500,001 - $1 million $100,000,001 - $500 million More than $50 billion

16. Estimated liabilities $0 - $50,000 $1,000,001 - $10 million $500,000,001 - $1 billion


$50,001 - $100,000 $10,000,001 - $50 million $1,000,000,001 - $10 billion
$100,001 - $500,000 $50,000,001 - $100 million $10,000,000,001 - $50 billion
$500,001 - $1 million $100,000,001 - $500 million More than $50 billion

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3
Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 3 of 70
5/17/18 4:51PM

Debtor Qliance Management Inc. Case number (if known)


Name

Request for Relief, Declaration, and Signatures

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement in connection with a bankruptcy case can result in fines up to $500,000 or
imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

17. Declaration and signature


of authorized The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this petition.
representative of debtor
I have been authorized to file this petition on behalf of the debtor.

I have examined the information in this petition and have a reasonable belief that the information is trued and correct.

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

Executed on May 17, 2018


MM / DD / YYYY

X /s/ Erika Bliss Erika Bliss


Signature of authorized representative of debtor Printed name

Title CEO

18. Signature of attorney X /s/ Catherine J. Reny Date May 17, 2018
Signature of attorney for debtor MM / DD / YYYY

Catherine J. Reny 43058


Printed name

Wenokur Riordan PLLC


Firm name

600 Stewart St
Suite 1300
Seattle, WA 98101
Number, Street, City, State & ZIP Code

Contact phone 206-492-7084 Email address cat@wrlawgroup.com

43058 WA
Bar number and State

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 4
Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 4 of 70
5/17/18 4:51PM

Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


Check if this is an
amended filing

Official Form 202


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

An individual who is authorized to act on behalf of a non-individual debtor, such as a corporation or partnership, must sign and submit this
form for the schedules of assets and liabilities, any other document that requires a declaration that is not included in the document, and any
amendments of those documents. This form must state the individual’s position or relationship to the debtor, the identity of the document,
and the date. Bankruptcy Rules 1008 and 9011.

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement, concealing property, or obtaining money or property by fraud in
connection with a bankruptcy case can result in fines up to $500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341,
1519, and 3571.

Declaration and signature

I am the president, another officer, or an authorized agent of the corporation; a member or an authorized agent of the partnership; or another
individual serving as a representative of the debtor in this case.

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

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


Schedule D: Creditors Who Have Claims Secured by Property (Official Form 206D)
Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 206E/F)
Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G)
Schedule H: Codebtors (Official Form 206H)
Summary of Assets and Liabilities for Non-Individuals (Official Form 206Sum)
Amended Schedule
Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders (Official Form 204)
Other document that requires a declaration

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

Executed on May 17, 2018 X /s/ Erika Bliss


Signature of individual signing on behalf of debtor

Erika Bliss
Printed name

CEO
Position or relationship to debtor

Official Form 202 Declaration Under Penalty of Perjury for Non-Individual Debtors
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Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 5 of 70


5/17/18 4:51PM

Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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......................................................................................................................... $ 8,100.00

1c. Total of all property:


Copy line 92 from Schedule A/B........................................................................................................................... $ 8,100.00

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.................................... $ 113,586.00

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.......................................................................... $ 216,115.49

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................................................ +$ 1,349,812.86

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


Lines 2 + 3a + 3b $ 1,679,514.35

Official Form 206Sum Summary of Assets and Liabilities for Non-Individuals page 1
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5/17/18 4:51PM

Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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

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

11b. Over 90 days old: 0.00 - 0.00 =.... Unknown


face amount doubtful or uncollectible accounts

12. Total of Part 3. $0.00


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)?

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 1
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Debtor Qliance Management Inc. Case number (If known)


Name

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.

General description Net book value of Valuation method used Current value of
debtor's interest for current value debtor's interest
(Where available)

39. Office furniture

40. Office fixtures

41. Office equipment, including all computer equipment and


communication systems equipment and software
2 Monitors
2 Servers
15 Switches
Back up server power vault
Microsoft Windows Server 2012
Dell Server Cabinet $21,337.66 Liquidation $8,100.00

42. Collectibles Examples: Antiques and figurines; paintings, prints, or other artwork;
books, pictures, or other art objects; china and crystal; stamp, coin, or baseball card
collections; other collections, memorabilia, or collectibles

43. Total of Part 7. $8,100.00


Add lines 39 through 42. Copy the total to line 86.

44. Is a depreciation schedule available for any of the property listed in Part 7?
No
Yes

45. Has any of the property listed in Part 7 been appraised by a professional within the last year?
No
Yes

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.
Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 2
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Debtor Qliance Management Inc. Case number (If known)


Name

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

71. Notes receivable


Description (include name of obligor)

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)
Gregory Steadman, et al for 2017 New Horizon/NH
Acquisition debt settlement scam,
theft/embezzlement/fraud of Medicaid and other account
funds Unknown
Nature of claim theft/embezzlement/fraud
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

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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Debtor Qliance Management Inc. Case number (If known)


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 Current value of real
personal property property

80. Cash, cash equivalents, and financial assets.


Copy line 5, Part 1 $0.00

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

82. Accounts receivable. Copy line 12, Part 3. $0.00

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. $8,100.00

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 $8,100.00 + 91b. $0.00

92. Total of all property on Schedule A/B. Add lines 91a+91b=92 $8,100.00

Official Form 206A/B Schedule A/B Assets - Real and Personal Property page 4
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Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 10 of 70


5/17/18 4:51PM

Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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
Column A Column B
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. Amount of claim Value of collateral
that supports this
Do not deduct the value claim
of collateral.
2.1 Acme Company Describe debtor's property that is subject to a lien $0.00 Unknown
Creditor's Name UCC #2017-070-2880-3: All accounts
64 Beaver St.
Suite 344
New York, NY 10004
Creditor's mailing address Describe the lien
UCC-1
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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply
No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

Corporation Service
2.2 Describe debtor's property that is subject to a lien Unknown Unknown
Company
Creditor's Name UCC #2017-068-2381-2: All assets
PO Box 2576
Springfield, IL 62708
Creditor's mailing address Describe the lien
UCC-1
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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply

Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 3
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Debtor Qliance Management Inc. Case number (if know)


Name

No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

Crestmark Equipment
2.3 $58,000.00 Unknown
Finance Describe debtor's property that is subject to a lien
Creditor's Name UCC-1 #2017-066-1631-5
40950 Woodward Ave.
Suite 201
Bloomfield Hills, MI
48304-5127
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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply
No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

2.4 New Era Lending, LLC Describe debtor's property that is subject to a lien $45,212.00 Unknown
Creditor's Name UCC #2017-083-6501-3: future receivables;
1201 North Orange St. siezed $1795.00 personal acct ckd
Suite 762
Wilmington, DE 19801
Creditor's mailing address Describe the lien
UCC-1
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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply
No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

2.5 Saturn Funding LLC Describe debtor's property that is subject to a lien $10,374.00 Unknown
Creditor's Name UCC #2017-069-2592-9: All assets
c/o MCA Servicing
Attn: Steven Berkovitch
40 Exchange Pl. Ste 1306
New York, NY 10005
Creditor's mailing address Describe the lien
UCC-1

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 2 of 3
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5/17/18 4:51PM

Debtor Qliance Management Inc. Case number (if know)


Name

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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply
No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

Technology Finance
2.6 $0.00 Unknown
Corporation Describe debtor's property that is subject to a lien
Creditor's Name UCC #2017-122-6370-1: All equipment and
7077 E. Marilyn Rd other personal property
Bldg 3 Ste 125
Scottsdale, AZ 85254
Creditor's mailing address Describe the lien
UCC-1
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 As of the petition filing date, the claim is:
interest in the same property? Check all that apply
No Contingent
Yes. Specify each creditor, Unliquidated
including this creditor and its relative Disputed
priority.

3. Total of the dollar amounts from Part 1, Column A, including the amounts from the Additional Page, if any. $113,586.00

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


List in alphabetical order any others who must be notified for a debt already listed in Part 1. Examples of entities that may be listed are collection agencies,
assignees of claims listed above, and attorneys for secured creditors.

If no others need to 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 Last 4 digits of
you enter the related creditor? account number for
this entity
ABF Servicing
Attn: Steven Berkovitch Line 2.4
40 Exchange Place
Suite 1306
New York, NY 10005

Saturn Funding, LLC


333 7th Avenue, Floor 3 Line 2.5
New York, NY 10001

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 3 of 3
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5/17/18 4:51PM

Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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: $2,484.69 $2,484.69
Brenda Borja Check all that apply.
4032 Evanston Avenue N Contingent
Seattle, WA 98103 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.2 Priority creditor's name and mailing address As of the petition filing date, the claim is: $29,218.36 $29,218.36
Cheryl Kilodavis Check all that apply.
9512 4th Ave. NW Contingent
Seattle, WA 98117 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

2.3 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,347.61 $1,347.61
Christopher Baumann Check all that apply.
10130 Idaho Avenue Contingent
Everett, WA 98204 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.4 Priority creditor's name and mailing address As of the petition filing date, the claim is: $982.94 $982.94
Dionee Hilaire Check all that apply.
406 N. L Street Contingent
Tacoma, WA 98403 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.5 Priority creditor's name and mailing address As of the petition filing date, the claim is: $483.87 Unknown
Employment Security Department Check all that apply.
PO Box 34468 Contingent
SEATTLE, WA 98124-1468 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (8)
Yes

2.6 Priority creditor's name and mailing address As of the petition filing date, the claim is: $171,590.38 Unknown
Internal Revenue Service Check all that apply.
PO Box 7346 Contingent
Philadelphia, PA 19101-7346 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (8)
Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

2.7 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,238.25 $1,238.25
Kathryn DeHan Check all that apply.
9212 227th Ave. East Contingent
Buckley, WA 98321 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.8 Priority creditor's name and mailing address As of the petition filing date, the claim is: $859.00 $859.00
LaFawn Smith Check all that apply.
607 Williams Avenue South, #21 Contingent
Renton, WA 98047 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.9 Priority creditor's name and mailing address As of the petition filing date, the claim is: $1,514.01 $1,514.01
Meagan Batcheldor Check all that apply.
18909 11 th Avenue Court E Contingent
Spanaway, WA 98387 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.10 Priority creditor's name and mailing address As of the petition filing date, the claim is: $3,382.22 Unknown
Pierce County Budget & Finance Check all that apply.
950 Fawcett Ave, STE 100 Contingent
Tacoma, WA 98402 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (8)
Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

2.11 Priority creditor's name and mailing address As of the petition filing date, the claim is: $2,133.66 $2,133.66
Stephanie Bracamonte Check all that apply.
4905 Narrow Way NE Contingent
Saint Michael, MN 55376 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.12 Priority creditor's name and mailing address As of the petition filing date, the claim is: $880.50 $880.50
Tanya Knight Check all that apply.
27224 23rd Avenue S Contingent
Federal Way, WA 98003 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number Is the claim subject to offset?


Specify Code subsection of PRIORITY No
unsecured claim: 11 U.S.C. § 507(a) (4)
Yes

2.13 Priority creditor's name and mailing address As of the petition filing date, the claim is: Unknown Unknown
WA Dept of L&I Check all that apply.
PO Box 44171 Contingent
Olympia, WA 98504-4171 Unliquidated
Disputed

Date or dates debt was incurred Basis for the claim:

Last 4 digits of account number 6949 Is the claim subject to offset?

Specify Code subsection of PRIORITY No


unsecured claim: 11 U.S.C. § 507(a) (8)
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
2420 Union Avenue Co-Tenancy Contingent
c/o Crawford & Katica Unliquidated
2915 North McCarver Disputed
Tacoma, WA 98403
Basis for the claim: lease: 2420 South Union Ave., Suite 100, Tacoma
Date(s) debt was incurred
Last 4 digits of account number 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
Adam's Interpreting Services Contingent
PO Box 6122 Unliquidated
Bellevue, WA 98008 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 20
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Debtor Qliance Management Inc. Case number (if known)


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
Aidarex Pharmaceuticals LLC Contingent
595 North Smith Street Unliquidated
Corona, CA 92880 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.4 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Airgas Inc. Contingent
West Division 2349495 Unliquidated
4401 Airport Way S Disputed
Seattle, WA 98108
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.5 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Alice Franck Contingent
6335 Wilson Avenue S Unliquidated
Seattle, WA 98118 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.6 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $17,256.84
All Phase Comm LLC Contingent
4209 21st Ave W #200 Unliquidated
Seattle, WA 98199 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.7 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $949.00
Alston & Bird LLP Contingent
1201 West Peachtree St Unliquidated
Suite 4900 Disputed
Atlanta, GA 30309
Basis for the claim: Legal services
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.8 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $10,585.00
Ann Thurley Contingent
1915 2nd Ave. #1002 Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
garnished bank account SS funds ($5250);
Basis for the claim:
Last 4 digits of account number atty fees + filing fee
Is the claim subject to offset? No Yes

3.9 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Bankers Healthcare Group, LLC Contingent
201 Solar Street Unliquidated
Syracuse, NY 13204 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.10 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $6,269.18
BeavEx, Inc. Contingent
6901 S 194th St Unliquidated
Kent, WA 98032 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.11 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Benjamin McLaughlin Contingent
7501 Greenwood Avenue N #306 Unliquidated
Seattle, WA 98103 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.12 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Carena, Inc Contingent
PO Box 673 Unliquidated
Seattle, WA 98111 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.13 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Carol Radio Contingent
3805 206th Place NE Unliquidated
Sammamish, WA 98074 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.14 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Center for Diagnostic Imaging Contingent
PO Box 94624 Unliquidated
Seattle, WA 98124-6924 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.15 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $3,000.00
Cheryl Kilodavis Contingent
9512 4th Ave. NW Unliquidated
Seattle, WA 98117 Disputed
Date(s) debt was incurred
Basis for the claim: Payments made to Kent Station
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.16 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Christopher Gaynor Contingent
6250 1st Avenue S Unliquidated
Seattle, WA 98118 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.17 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,938.00
CICS Employment Services, Inc. Contingent
1220 SW Morrision St. #505 Unliquidated
Portland, OR 97205 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.18 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,359.91
CIGNA Life Insurance Co. of NA Contingent
Two Liberty Place Unliquidated
1601 Chestnut Street Disputed
Philadelphia, PA 19192
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.19 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $34,435.44
CIGNA Medical Insurance Contingent
Two Liberty Place Unliquidated
1601 Chestnut Street Disputed
Philadelphia, PA 19192
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.20 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $847.00
City of Lynnwood Contingent
PO Box 5008 Unliquidated
Lynnwood, WA 98046-5008 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.21 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $15,754.35
Colo (Zayo Group) Contingent
4772 Walnut St. Suite 100 Unliquidated
Boulder, CO 80301 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.22 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $973.60
Colonial Life Contingent
245 4th St #206 Unliquidated
Bremerton, WA 98337 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.23 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $40,037.87
Comcast Business Contingent
PO Box 34744 Unliquidated
Seattle, WA 98124-1744 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number 6663
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.24 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,301.56
Concur Contingent
62157 Collections Center Drive Unliquidated
Chicago, Il 60693 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.25 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $640.00
Davis Wright Tremaine LLP Contingent
1201 3rd Ave Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
Basis for the claim: Legal services
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.26 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $394.56
Duo TEC Contingent
2960 4th Ave S #112 Unliquidated
Seattle, WA 98134 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.27 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Edward Gregory Steadman Contingent
9900 W. Sample Rd. Ste. 300 Unliquidated
Pompano Beach, FL 33065 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.28 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $20,662.00
EIN Cap, Inc. Contingent
160 Pearl St. 5th Floor Unliquidated
New York, NY 10005 Disputed
Date(s) debt was incurred
Basis for the claim: QMG
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.29 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $18,325.22
Electric Lightwave Contingent
300 Elliott Ave W STE 580 Unliquidated
Seattle, WA 98119 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.30 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Emma Swingle Contingent
8212 Corliss Avenue N Unliquidated
Seattle, WA 98103 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.31 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Epax Systems, Inc Contingent
7767 Lemona Ave Unliquidated
Van Nuys,, CA 91402 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.32 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $43,584.91
Equinox Primary Care Contingent
Attn: Erika Bliss Unliquidated
2200 6th Ave. #102 Disputed
Seattle, WA 98121
Basis for the claim: Monthly IT and medical recordkeeping expenses
Date(s) debt was incurred
(2017-ongoing)
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.33 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $4,500.00
Erika Bliss Contingent
1915 2nd Ave. #1002 Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
Basis for the claim: Payments made to Kent Station
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.34 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Evergreen Radia LLC Contingent
1521 NE 128th St #200 Unliquidated
Kirkland, WA 98034 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.35 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Expedia/Tower 333 LLC? Contingent
333 108th Ave NE Unliquidated
Bellevue, WA 98004 Disputed
Date(s) debt was incurred
Basis for the claim: lease: 333 108th Ave. NE, Bellevue
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.36 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $969.00
First Choice Health Network Contingent
600 University St #1400 Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.37 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
First Premier Funding, LLC
c/o Schweet Linde & Coulson Contingent
Attn: Laurin S. Schweet Unliquidated
575 S. Michigan St. Disputed
Seattle, WA 98108
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.38 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Gemini Diversified Services Contingent
18350 Mt Langley St #101 Unliquidated
Fountain Valley, CA 92708 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.39 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $133,081.74
GRE 509 Olive LLC Contingent
509 Olive Way, Suite 1019 Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
Basis for the claim: commercial lease: 509 Olive Way, Suite 1607, Seattle
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.40 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $606.00
Guardian Security Contingent
1743 1st Ave S Unliquidated
Seattle, WA 98134 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.41 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $27,763.67
Integra/Electric Lightwave Contingent
18110 SE 34th St Unliquidated
Bldg One Ste 100 Disputed
Vancouver, WA 98683-9497
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.42 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $72,245.27
IT Source Contingent
1010 S 336th St, Suite 108 Unliquidated
Federal Way, WA 98003 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.43 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $44,303.26
Kabbage LOC Contingent
925B Peachtree St. NE #1688 Unliquidated
Atlanta, GA 30309 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.44 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Kelsey Hobbs Contingent
521 Stadium Pl. S Unliquidated
Seattle, WA 98104 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.45 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $14,500.00
Kent Station Retail, LLC Contingent
c/o Green & Norwood PLLC Unliquidated
2722 Eastlake Avenue East Disputed
Suite 350
Seattle, WA 98102 Basis for the claim: judgment entered 5/11/2017 against QMI; stlmt agmt
11/2017
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.46 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $137,543.00
Knight Capital, LLC Contingent
9 East Lockerman St. Unliquidated
Suite 3A-543 Disputed
Dover, DE 19901
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.47 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Kurt Velguth Contingent
5716 15th Avenue NE, Apt. B Unliquidated
Seattle, WA 98105 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.48 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $4,590.00
Lasher, Holzapfel, Sperry & Ebberson Contingent
601 Union St. Suite 2600 Unliquidated
Seattle, WA 98101 Disputed
Date(s) debt was incurred
Basis for the claim: Legal services
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.49 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Laura Breyman Contingent
5122 162nd Place SE Unliquidated
Bellevue, WA 98006 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.50 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Lester Pitle Contingent
4825 45th Avenue S Unliquidated
Seattle, WA 98118 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.51 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. Unknown
Lumeon Contingent
10 Leake St Unliquidated
Lambeth Disputed
London SE1 7NN, UK
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.52 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,539.00
Mantis Contingent
187 Wolf Road Unliquidated
Suite 101 Disputed
Albany, NY 12205
Basis for the claim: judgment?
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.53 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Marcie Hamrick Contingent
1238 NW Blakely Court Unliquidated
Seattle, WA 98177 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.54 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
McKesson Medical Supplies Contingent
9954 Mayland Drive Unliquidated
Richmond, VA 23233 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.55 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Merchant Cash & Capital LLC
dba BizFi Funding Contingent
460 Park Avenue South Unliquidated
10th Floor Disputed
New York, NY 10016
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.56 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $184,051.39
Merchant Funding Svcs Contingent
30 Broad St. 14th Fl. Unliquidated
New York, NY 10004 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.57 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Merck Sharp & Dohme Corp Contingent
1 Merck Dr, Whitehouse Station Unliquidated
Whitehouse Station, NJ 08889 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.58 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $4,172.40
Miss Sudsy Contingent
2310 Mildred St. SW Suite 126 Unliquidated
University Place, WA 98466 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.59 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $54,936.00
Norima Consulting US Contingent
11590 W. Bernardo Court Unliquidated
Suite 200 Disputed
San Diego, CA 92127-1662
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.60 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $60,497.86
Northup Place, LLC Contingent
c/o Azose Commercial Prop Unliquidated
8451 SE 68th Street, Ste 200 Disputed
Mercer Island, WA 98040
Basis for the claim: commercial lease: 15419 NE 2oth St. Suite 102 & 103,
Date(s) debt was incurred
Bellevue
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.61 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $3,226.56
Nu-Century Maintenance Systems Contingent
16541 Redmond Hwy, PMB#355-C Unliquidated
Redmond, WA 98052 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.62 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $5,600.00
Nuon Nop Cleaning Contingent
1112 S Dawson St Unliquidated
Seattle, WA 98108 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.63 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Pacific Interpreters Contingent
707 SW Washington, Suite 200 Unliquidated
Portland, OR 97205 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.64 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,234.40
Pacific Northwest Shredding Contingent
3215 Lafayette Ave S Unliquidated
Seattle, WA 98144 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.65 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $152.34
Pacific Office Automation Inc Contingent
14747 NW Greenbrier Parkway Unliquidated
Beaverton, OR 97006 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.66 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
PerfectServe, Inc. Contingent
10024 Investment Drive Unliquidated
Suite 200 Disputed
Knoxville, TN 37932
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.67 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Physicians Insurance Contingent
43406 Busines Park Drive Unliquidated
Temecula, CA 92590 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.68 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,682.05
Pitney Bowes Inc Contingent
800 Vinial St # B201 Unliquidated
Pittsburgh, PA 15212 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.69 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Power Up Lending Group, LTD Contingent
111 Grat Neck Roadd Unliquidated
Suite 216 Disputed
Great Neck, NY 11021
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.70 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $278.61
Propel Insurance Contingent
925 Fourth Avenue, Suite 3200 Unliquidated
Seattle, WA 98104-1159 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.71 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $3,194.18
Puget Sound Building Maintenance LLC Contingent
Unliquidated
Mercer Island, WA 98040 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.72 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,645.59
Puget Sound Energy Contingent
PO Box 91269 Unliquidated
Bellevue, WA 98009 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 14 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.73 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Quest Diagnostics Contingent
8403 Fallbrook Avenue Unliquidated
West Hills, CA 91304 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.74 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $76.35
Recology CleanScapes Inc. Contingent
7303 8th Ave S Unliquidated
Seattle, WA 98108 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.75 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $19,590.00
RH Lynnwood Corp Center Assoc LLC Contingent
PO Box 5003 Unliquidated
Bellevue, WA 98009-5003 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.76 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Roxanne Ho Contingent
6917 47th Street Court W Unliquidated
University Place, WA 98466 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.77 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Rubicon MD, Inc. Contingent
524 Broadway, 11th Floor Unliquidated
New York, NY 10012 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.78 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Sanofi Pasteur Inc Contingent
1 Discovery Dr Unliquidated
Swiftwater, PA 18370 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.79 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,650.32
Smart Data Solutions, Inc. Contingent
960 Blue Gentian Road Unliquidated
Eagan, MN 55121 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 15 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.80 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $21,469.91
Spoken Communication Contingent
2101 Fourth Avenue, Suite 620 Unliquidated
Seattle, WA 98121 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.81 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Stanford Dosimetry LLC Contingent
1204 Raymond St Unliquidated
Bellingham, WA 98229-2416 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.82 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
Stericycle Inc. Contingent
28161 N. Keith Drive Unliquidated
Lake Forest, IL 60045 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.83 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $705.72
Tacoma Public Utilities Contingent
PO Box 11010 Unliquidated
Tacoma, WA 98411-1010 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.84 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $316.25
TASC Contingent
2302 International Lane Unliquidated
Madison, WI 53704 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.85 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
TheraCom LLC Contingent
150 N Field Dr. Unliquidated
Two Conway Park Ste 200 Disputed
Lake Forest, IL 60045
Basis for the claim: Notice Only
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.86 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $0.00
TRA Medical Imaging Contingent
1304 Fawcett Ave., Suite 100 Unliquidated
Tacoma, WA 98402 Disputed
Date(s) debt was incurred
Basis for the claim: Notice Only
Last 4 digits of account number
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

3.87 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $21,279.34
Union Ave Investors LLC Contingent
Attn: Dana Carlisle Unliquidated
PO Box 394 Disputed
Tacoma, WA 98401
QMM Inc. lease: 2420 South Union Ave., Suite 100,
Basis for the claim:
Date(s) debt was incurred
Tacoma;
Last 4 digits of account number judgment 7/13/2017 Pierce Cty #17-2-08490-1
Is the claim subject to offset? No Yes

3.88 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $393.27
Universal Mechanical Service Contingent
8901 Willows Rd Unliquidated
Redmond, WA 98052 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.89 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $8,542.60
US Bank Equipment Finance Contingent
13010 SW 68th Pkwy #100 Unliquidated
Portland, OR 97223 Disputed
Date(s) debt was incurred
Basis for the claim: 2 Koncia C654e
Last 4 digits of account number 10 Canon IR500
Is the claim subject to offset? No Yes

3.90 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,235.00
Vanguard Cleaning Systems of WA Contingent
6912 220th Street SW, Ste. 306 Unliquidated
Mountlake Terrace, WA 98043 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.91 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $245.11
Wave Business Contingent
401 Parkplace Center # 500 Unliquidated
Kirkland, WA 98033 Disputed
Date(s) debt was incurred
Basis for the claim:
Last 4 digits of account number
Is the claim subject to offset? No Yes

3.92 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $58,000.00
Wells Fargo Financial Leasing Contingent
800 Walnut Street Unliquidated
MAC N0005-044 Disputed
Des Moines, IA 50309
Basis for the claim:
Date(s) debt was incurred
Last 4 digits of account number Is the claim subject to offset? No Yes

3.93 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $230,682.23
Yellowstone Capital LLC Contingent
30 Broad St. 14th Floor Unliquidated
New York, NY 10004 Disputed
Date(s) debt was incurred
Basis for the claim: judgment in Erie County, NY #803808/2017 on
Last 4 digits of account number 3/21/2017
Is the claim subject to offset? No Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

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 Last 4 digits of
related creditor (if any) listed? account number, if
any
4.1 Barbara Roussin
9900 West Sample Road Line 3.27
Coral Springs, FL 33065
Not listed. Explain

4.2 CJC Law Office


Attn: Christopher Cali Line 3.9
201 Solar St.
Not listed. Explain
Syracuse, NY 13204

4.3 EIN Cap, Inc.


2899 Ocean Ave. 2nd Fl. Line 3.28
Brooklyn, NY 11235
Not listed. Explain

4.4 Foster Pepper PLLC


Attn: Miriam Chung Line 3.39
1111 Third Ave. Suite 3000
Not listed. Explain
Seattle, WA 98101

4.5 Green & Norwood PLLC


Attn: Matthew Green Line 3.45
2722 Eastlake Avenue East
Not listed. Explain
Suite 350
Seattle, WA 98102

4.6 Internal Revenue Service


Special Procedures Line 2.6
915 2nd Ave., M/S W244
Not listed. Explain
Seattle, WA 98174

4.7 Jameson Babbitt Stites Lombard


Attn: Alan Bornstein Line 3.60
801 Second Ave.
Not listed. Explain
Suite 1000
Seattle, WA 98104

4.8 Johanna Rivadeneira


6530 Hayes Street Line 3.27
Hollywood, FL 33024
Not listed. Explain

4.9 Jude Overo


222 West 122nd Street Line 3.27
Apt. 4-A
Not listed. Explain
New York, NY 10027

4.10 Livengood Alskog PLLC


Attn: Rebecca Lauren Penn Line 3.87
Attn: David Benjamin Johnston
Not listed. Explain
PO Box 908
Kirkland, WA 98083

4.11 Magnozzi & Kye, LLP


Attn: Mark Magnozzi Line 3.55
23 Green St. STE 302
Not listed. Explain
Huntington, NY 11743

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 18 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

Name and mailing address On which line in Part1 or Part 2 is the Last 4 digits of
related creditor (if any) listed? account number, if
any
4.12 Naidich Wurman LLP
111 Great Neck Road Line 3.69
Suite 214
Not listed. Explain
Great Neck, NY 11021

4.13 Nura Adam


14205 SE 36th St. #100 Line 3.2
Bellevue, WA 98006
Not listed. Explain

4.14 Patsy Britto


9900 West Sample Road Line 3.27
Coral Springs, FL 33065
Not listed. Explain

4.15 Puget Sound Energy


355 110th Ave NE Line 3.72
Bellevue, WA 98004
Not listed. Explain

4.16 Renata Bukhman, Esq.


17 State St. STE 4000 Line 3.93
New York, NY 10004
Not listed. Explain

4.17 Renata Bukhman, Esq.


17 State St. STE 4000 Line 3.56
New York, NY 10004
Not listed. Explain

4.18 RTR Recovery


Attn: Jacob Verstandig Line 3.37
122 East 42nd St.
Not listed. Explain
Suite 2112
New York, NY 10168

4.19 Sanjiv Matta


9900 West Sample Road Line 3.27
Coral Springs, FL 33065
Not listed. Explain

4.20 Tacoma Public Utilities


3628 South 35th Street Line 3.83
Tacoma, WA 98409
Not listed. Explain

4.21 Turnbull & Born PLLC


Attn: Brian Born Line 3.89
Commerce Building, Suite 1050
Not listed. Explain
950 Pacific Ave.
Tacoma, WA 98402

4.22 TVT Capital LLC


8 Hunters Lane Line 3.37
Roslyn, NY 11576
Not listed. Explain

4.23 US Bank Equipment Finance


1310 Madrid Street Line 3.89
Marshall, MN 56258
Not listed. Explain

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 19 of 20
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Debtor Qliance Management Inc. Case number (if known)


Name

Name and mailing address On which line in Part1 or Part 2 is the Last 4 digits of
related creditor (if any) listed? account number, if
any
4.24 WA Attorney General's Office
Labor & Industries Div. Line 2.13
Attn: Diana Cartwright
Not listed. Explain
800 Fifth Ave. Ste 2000
Seattle, WA 98104

4.25 WA Dept of L&I


Attn: David Johnson Line 2.13
PO Box 44510
Not listed. Explain
Olympia, WA 98504

4.26 WA Dept of L&I


Attn: David Johnson Line 2.13
7273 Linderson Way SW
Not listed. Explain
Olympia, WA 98501

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. $ 216,115.49
5b. Total claims from Part 2 5b. + $ 1,349,812.86

5c. Total of Parts 1 and 2


Lines 5a + 5b = 5c. 5c. $ 1,565,928.35

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 20 of 20
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Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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 Settlement agreement


lease is for and the nature of re: judgment entered
the debtor's interest 5/11/2017 against QMI
Kent Station Retail, LLC
State the term remaining c/o Green & Norwood PLLC
2722 Eastlake Avenue East
List the contract number of any Suite 350
government contract Seattle, WA 98102

Official Form 206G Schedule G: Executory Contracts and Unexpired Leases Page 1 of 1
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Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


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 Cheryl Kilodavis 9512 4th Ave. NW Yellowstone Capital D


Seattle, WA 98117 LLC E/F 3.93
G

2.2 Cheryl Kilodavis 9512 4th Ave. NW Kent Station Retail, D


Seattle, WA 98117 LLC E/F 3.45
G

2.3 Cheryl Kilodavis 9512 4th Ave. NW New Era Lending, D 2.4
Seattle, WA 98117 LLC E/F
G

2.4 Cheryl Kilodavis 9512 4th Ave. NW WA Dept of L&I D


Seattle, WA 98117 E/F 2.13
G

2.5 Cheryl Kilodavis 9512 4th Ave. NW Employment Security D


Seattle, WA 98117 Department E/F 2.5
G

Official Form 206H Schedule H: Your Codebtors Page 1 of 6


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Debtor Qliance Management Inc. Case number (if known)

Additional Page to List More Codebtors


Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.
Column 1: Codebtor Column 2: Creditor

2.6 Cheryl Kilodavis 9512 4th Ave. NW Internal Revenue D


Seattle, WA 98117 Service E/F 2.6
G

2.7 Cheryl Kilodavis 9512 4th Ave. NW EIN Cap, Inc. D


Seattle, WA 98117 E/F 3.28
G

2.8 Cheryl Kilodavis 9512 4th Ave. NW Knight Capital, LLC D


Seattle, WA 98117 E/F 3.46
G

2.9 Cheryl Kilodavis 9512 4th Ave. NW Mantis D


Seattle, WA 98117 E/F 3.52
G

2.10 Cheryl Kilodavis 9512 4th Ave. NW Saturn Funding LLC D 2.5
Seattle, WA 98117 E/F
G

2.11 Cheryl Kilodavis 9512 4th Ave. NW Brenda Borja D


Seattle, WA 98117 E/F 2.1
G

2.12 Cheryl Kilodavis 9512 4th Ave. NW Cheryl Kilodavis D


Seattle, WA 98117 E/F 2.2
G

2.13 Cheryl Kilodavis 9512 4th Ave. NW Christopher D


Seattle, WA 98117 Baumann E/F 2.3
G

Official Form 206H Schedule H: Your Codebtors Page 2 of 6


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Debtor Qliance Management Inc. Case number (if known)

Additional Page to List More Codebtors


Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.
Column 1: Codebtor Column 2: Creditor

2.14 Cheryl Kilodavis 9512 4th Ave. NW Dionee Hilaire D


Seattle, WA 98117 E/F 2.4
G

2.15 Cheryl Kilodavis 9512 4th Ave. NW LaFawn Smith D


Seattle, WA 98117 E/F 2.8
G

2.16 Cheryl Kilodavis 9512 4th Ave. NW Meagan Batcheldor D


Seattle, WA 98117 E/F 2.9
G

2.17 Cheryl Kilodavis 9512 4th Ave. NW Tanya Knight D


Seattle, WA 98117 E/F 2.12
G

2.18 Cheryl Kilodavis 9512 4th Ave. NW Acme Company D 2.1


Seattle, WA 98117 E/F
G

2.19 Cheryl Kilodavis 9512 4th Ave. NW Kathryn DeHan D


Seattle, WA 98117 E/F 2.7
G

2.20 Cheryl Kilodavis 9512 4th Ave. NW Stephanie D


Seattle, WA 98117 Bracamonte E/F 2.11
G

2.21 Erika Bliss 1915 2nd Ave. #1002 GRE 509 Olive LLC D
Seattle, WA 98101 E/F 3.39
G

Official Form 206H Schedule H: Your Codebtors Page 3 of 6


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Debtor Qliance Management Inc. Case number (if known)

Additional Page to List More Codebtors


Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.
Column 1: Codebtor Column 2: Creditor

2.22 Erika Bliss 1915 2nd Ave. #1002 Northup Place, LLC D
Seattle, WA 98101 E/F 3.60
G

2.23 Erika Bliss 1915 2nd Ave. #1002 Yellowstone Capital D


Seattle, WA 98101 LLC E/F 3.93
G

2.24 Erika Bliss 1915 2nd Ave. #1002 Kent Station Retail, D
Seattle, WA 98101 LLC E/F 3.45
G

2.25 Erika Bliss 1915 2nd Ave. #1002 Saturn Funding LLC D 2.5
Seattle, WA 98101 E/F
G

2.26 Erika Bliss 1915 2nd Ave. #1002 New Era Lending, D 2.4
Seattle, WA 98101 LLC E/F
G

2.27 Erika Bliss 1915 2nd Ave. #1002 WA Dept of L&I D


Seattle, WA 98101 E/F 2.13
G

2.28 Erika Bliss 1915 2nd Ave. #1002 Employment Security D


Seattle, WA 98101 Department E/F 2.5
G

2.29 Erika Bliss 1915 2nd Ave. #1002 Internal Revenue D


Seattle, WA 98101 Service E/F 2.6
G

Official Form 206H Schedule H: Your Codebtors Page 4 of 6


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Debtor Qliance Management Inc. Case number (if known)

Additional Page to List More Codebtors


Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.
Column 1: Codebtor Column 2: Creditor

2.30 Erika Bliss 1915 2nd Ave. #1002 Kabbage LOC D


Seattle, WA 98101 E/F 3.43
G

2.31 Erika Bliss 1915 2nd Ave. #1002 Knight Capital, LLC D
Seattle, WA 98101 E/F 3.46
G

2.32 Erika Bliss 1915 2nd Ave. #1002 Mantis D


Seattle, WA 98101 E/F 3.52
G

2.33 Erika Bliss 1915 2nd Ave. #1002 Brenda Borja D


Seattle, WA 98101 E/F 2.1
G

2.34 Erika Bliss 1915 2nd Ave. #1002 Cheryl Kilodavis D


Seattle, WA 98101 E/F 2.2
G

2.35 Erika Bliss 1915 2nd Ave. #1002 Christopher D


Seattle, WA 98101 Baumann E/F 2.3
G

2.36 Erika Bliss 1915 2nd Ave. #1002 Dionee Hilaire D


Seattle, WA 98101 E/F 2.4
G

2.37 Erika Bliss 1915 2nd Ave. #1002 LaFawn Smith D


Seattle, WA 98101 E/F 2.8
G

Official Form 206H Schedule H: Your Codebtors Page 5 of 6


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Debtor Qliance Management Inc. Case number (if known)

Additional Page to List More Codebtors


Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.
Column 1: Codebtor Column 2: Creditor

2.38 Erika Bliss 1915 2nd Ave. #1002 Meagan Batcheldor D


Seattle, WA 98101 E/F 2.9
G

2.39 Erika Bliss 1915 2nd Ave. #1002 Tanya Knight D


Seattle, WA 98101 E/F 2.12
G

2.40 Erika Bliss 1915 2nd Ave. #1002 Kathryn DeHan D


Seattle, WA 98101 E/F 2.7
G

2.41 Erika Bliss 1915 2nd Ave. #1002 Stephanie D


Seattle, WA 98101 Bracamonte E/F 2.11
G

2.42 Qliance Medical 1915 2nd Ave. #1002 EIN Cap, Inc. D
Group of WA PC Seattle, WA 98101 E/F 3.28
G

Official Form 206H Schedule H: Your Codebtors Page 6 of 6


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Fill in this information to identify the case:

Debtor name Qliance Management Inc.

United States Bankruptcy Court for the: WESTERN DISTRICT OF WASHINGTON

Case number (if known)


Check if this is an
amended filing

Official Form 207


Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy 04/16
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, Sources of revenue Gross revenue
which may be a calendar year Check all that apply (before deductions and
exclusions)

For prior year: Operating a business $995,752.00


From 1/01/2017 to 12/31/2017
Other

For year before that: Operating a business $2,987,258.00


From 1/01/2016 to 12/31/2016
Other

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 $6,425. (This amount may be adjusted on 4/01/19
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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Debtor Qliance Management Inc. Case number (if known)

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 $6,425. (This amount
may be adjusted on 4/01/19 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 Dates Total amount of value Reasons for payment or transfer
Relationship to debtor
4.1. Erika Bliss June 2017 $1,775.00 Office quipment transferred as
1915 2nd Ave. #1002 reimbursement for costs
Seattle, WA 98101 incurred to vacate/close down
member Qliance clinics.

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 Amount
taken
EIN Cap, Inc. Set off from account of Ann Thurley 2/15/2018 $5,750.00
160 Pearl St. 5th Floor (principal Erika Bliss's mother) due to ($8000 siezed;
New York, NY 10005 cosigner status on account of Erika Bliss-- $2250
QMG debt. All funds in the account returned to
belonged to Ann Thurley and was Ms. Ann Thurley
Thurley's social security income. on 4/17/18)
Last 4 digits of account number: 6676

Pacific Western Bank $0.00


Last 4 digits of account number:

Coordinated Care Corporation Coordinated Care Corp. interpleader 3/23/2018 $75,000.00


c/o Stoel Rives LLP against Qliance re disbursement of funds
Attn: Maren Norton owed to Qliance: judgment awarded
600 University St. Ste 3600 $25,019.31 to Stoel Rives LLP (Coordinated
Seattle, WA 98101 Care's attorney); $46,584.52 to creditor
First Premier Funding; balance (approx.
$3396.17) to DOR.
Last 4 digits of account number:

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

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 2
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Debtor Qliance Management Inc. Case number (if known)

Case title Nature of case Court or agency's name and Status of case
Case number address
7.1. Merchant Cash & Capital LLC Breach of Suffolk County, NY Pending
v. Debtor, et al Contract NY On appeal
604570/2017
Concluded

7.2. Merchant Funding Svcs judgment entered Erie County, NY Pending


v. Debtor, et al 3/21/2017 On appeal
803812/2017
Concluded

7.3. Yellowstone Capital LLC judgment entered Erie County, NY Pending


v. 3/21/2017 On appeal
Debtor, et al
Concluded
803808/2017

7.4. Northup Place, LLC Commercial King County Superior Pending


v. Debtor, et al Lease; On appeal
17-2-30134-5 SEA default judgment
Concluded
entered 1/30/2018:
#18-9-02990-8

7.5. GRE Medical Dental Building Commercial lease King County Superior Pending
LLC On appeal
v. Debtor, et al
Concluded
18-2-05649-7 SEA

7.6. Kent Station Retail LLC Commercial lease; King County Superior Pending
v. judgment entered On appeal
Erika Bliss, et al 5/11/2017 against
Concluded
17-9-11120-7 QMI

7.7. US Bank Equipment Finance replevin and King County Superior Pending
v. Debtor, et al monies owed On appeal
18-2-07259-0 SEA
Concluded

7.8. Union Ave Investors judgment entered Pierce County Superior Pending
v. Debtor et al 7/13/2017 On appeal
17-2-08490-1
Concluded

7.9. Coordinated Care interpleader US District, Western District Pending


Corporation of WA On appeal
v. Debtor, et al
Concluded
17-CV-01180

7.10 Bankers Healthcare Group, Breach of Onondoga County, NY Pending


. LLC Contract On appeal
v. Erika Bliss, Cheryl
Concluded
Kilodavis
002720/2018

7.11 WA Employment Security Tax Warrant for King County Superior Pending
. Department - overpaid benefits: On appeal
Tax Warrant for overpaid #18-9-02305-5;
Concluded
benefits dated 1/17/2018
18-2-01404-2

7.12 WA State Dept. of Revenue - Tax Warrant: King County Superior Pending
. Tax Warrant #17-9-15723-1; On appeal
17-2-19326-7 dated 7/20/2017
Concluded

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 3
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Debtor Qliance Management Inc. Case number (if known)

Case title Nature of case Court or agency's name and Status of case
Case number address
7.13 WA State Dept. of Revenue - Tax Warrant: King County Superior Pending
. Tax Warrant #17-9-15323-6; On appeal
17-2-19396-8 dated 7/20/2017
Concluded

7.14 QMI and QMG appeal of WA Pending


. Dept of L&I Citation and On appeal
Assessment of wage payment
Concluded
violations #122862 and
#123162

7.15 Power Up Lending Group, Judgment by Nassau County, NY Pending


. LTD Confession On appeal
v. Qliance et al entered 3/20/17
Concluded
001569/17

7.16 Edward Steadman v. Debtor Dismissed on Palm Beach County, FL Pending


. QMI and Dr. Erika Bliss 9/6/2017 On appeal
50-2017-CA-005371
Concluded

7.17 Debtor vs. Jude Overo et al Embezzlement/the Broward County, Forida Pending
. CACE-17-014898 ft/fraud re New On appeal
Horizon Funding
Concluded
LLC debt
settlement scam

7.18 U.S. Department of Justice Debtor notified by Pending


. Federal Bureau of FBI on Feb. 4, On appeal
Investigation 2018, of being
Concluded
FBI - Miami possible victim of
318A-MM-2173571 a crime re New
Horizon Funding
LLC debt
settlement scam
and theft of
Medicare/Medicai
d funds from
Debtor's bank
account

7.19 Merchant Cash & Capital LLC breach of contract Suffolk County, NY Pending
. v. Qliance, et al On appeal
604570/2017
Concluded

7.20 Nura Adam, Adam's small claims KCDC- West Div. Seattle Pending
. Interpreting Services LLC judgment entered On appeal
v. Qliance 7/28/2017
Concluded
175-02025

7.21 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.

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 4
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Debtor Qliance Management Inc. Case number (if known)

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

9.1. Goodwill Office equipment and supplies


Oct. 2017 $5,000.00

Recipients relationship to debtor


none

9.2. Rainier Valley Schools Computer equipment and office supplies


Nov. 2017 $7,000.00

Recipients relationship to debtor


none

9.3. Vietnam Dental Outreach Computers


Program
Nov. 2017 $5,500.00

Recipients relationship to debtor


none

9.4. Ghanaian and Malian Schools Computers


Dec. 2017 $6,000.00

Recipients relationship to debtor


none

9.5. DAWN (Domestic Abuse Computer equipment, furniture, office


Women's Network supplies, office equipment
2/15/18 $9,700.00

Recipients relationship to debtor

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 Amount of payments received for the loss Dates of loss 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


A/B: Assets – Real and Personal Property).

Part 6: Certain Payments or Transfers

11. Payments related to bankruptcy

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 5
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Debtor Qliance Management Inc. Case number (if known)

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 If not money, describe any property transferred Dates Total amount or
the transfer? value
Address
11.1. Wenokur Riordan PLLC
600 Stewart St
Suite 1300 Attorney Fees: $5000
Seattle, WA 98101 Filing fee: $335 3/20/2018 $5,335.00

Email or website address


nate@wrlawgroup.com

Who made the payment, if not debtor?


Ann Thurley

11.2.
Gloria Nagler August 12,
2017 $300.00

Email or website address

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? Description of property transferred or Date transfer Total amount or
Address payments received or debts paid in exchange was made value
13.1 Kent Station Retail, LLC
. c/o Green & Norwood PLLC
2722 Eastlake Avenue East Office equipment and supplies pursuant
Suite 350 to Settlement Agreement/Bill of Sale
Seattle, WA 98102 dated Nov. 2017 Nov. 2017 $12,600.00

Relationship to debtor
former lessor and judgment
creditor

Part 7: Previous Locations

14. Previous addresses

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 6
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Debtor Qliance Management Inc. Case number (if known)

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
14.1. 2101 4th Ave., Suite 600 March 2016-May 2017 (admin.
Seattle, WA 98121 office)

14.2. 509 Olive Way, Suite 1607 March 2016-June 2017 (clinic)
Seattle, WA 98101

14.3. 521 2nd Place North, Suite 103 March 2016-May 2017 (clinic)
Kent, WA 98032

14.4. 2420 S. Union Ave., Suite 100 March 2016-June 2017 (clinic)
Tacoma, WA 98405

14.5. 15419 NE 20th Street March 2016-June 2017 (clinic)


Bellevue, WA 98007

14.6. 19401 40th Ave. West March 2016-May 2017 (clinic)


Lynnwood, WA 98036

14.7. 333 108th Ave. NE, Suite M150 March 2016 – September 2016
Bellevue, WA 98004 (clinic)

14.8. 2318 4th Ave. March 2016-June 2017 (clinic)


Seattle, WA 98121

14.9. 1915 2nd Ave., #2405 May 2017-Feb 2018


Seattle, WA 98101 (mail,server,storage)

14.10 1915 2nd Ave., #1002 Feb 2018-present


. Seattle, WA 98101 (mail,server,storage)

14.11 2200 6th Ave., Suite 520 Nov 2017-present (medical records
. Seattle, WA 98121 mgmt)

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 If debtor provides meals
the debtor provides and housing, number of
patients in debtor’s care
15.1. Qliance Primary Care Primary care services by Qliance Medical Group of WA
509 Olive Way, Suite 1607 PC;
Seattle, WA 98101 March 2016-June 2017

Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 7
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Debtor Qliance Management Inc. Case number (if known)

Facility name and address Nature of the business operation, including type of services If debtor provides meals
the debtor provides and housing, number of
patients in debtor’s care

Electronically
Paper

15.2. Qliance Primary Care Primary care services by Qliance Medical Group of WA
521 2nd Place North, Suite PC;
103 March 2016-May 2017
Kent, WA 98032
Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper

15.3. Qliance Primary Care Primary care services by Qliance Medical Group of WA
2420 S. Union Ave., Suite PC;
100 March 2016-June 2017
Tacoma, WA 98405
Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper

15.4. Qliance Primary Care Primary care services by Qliance Medical Group of WA
15419 NE 20th Street PC;
Bellevue, WA 98007 March 2016-June 2017

Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper

15.5. Qliance Primary Care Primary care services by Qliance Medical Group of WA
19401 40th Ave. West PC;
Lynnwood, WA 98036 March 2016-May 2017

Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper

15.6. Qliance Primary Care Primary care services by Qliance Medical Group of WA
333 108th Ave. NE, Suite PC;
M150 March 2016 - September 2016
Bellevue, WA 98004
Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 8
Software Copyright (c) 1996-2018 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor Qliance Management Inc. Case number (if known)

Facility name and address Nature of the business operation, including type of services If debtor provides meals
the debtor provides and housing, number of
patients in debtor’s care

Electronically
Paper

15.7. Qliance Primary Care Primary care services by Qliance Medical Group of WA
2318 4th Ave. PC;
Seattle, WA 98121 March 2016-June 2017

Location where patient records are maintained (if different from How are records kept?
facility address). If electronic, identify any service provider.
Equinox Primary Care Check all that apply:
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper

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.

Personal Identifiers and Personal Health Information


Does the debtor have a privacy policy about that information?
No
Yes

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?

No Go to Part 10.
Yes. Fill in below:
Name of plan Employer identification number of the plan
Charles Schwab 401(k) plan EIN: 81-1559010

Has the plan been terminated?


No
Yes

No Go to Part 10.
Yes. Fill in below:
Name of plan Employer identification number of the plan
Transamerica EIN: 81-1559010

Has the plan been terminated?


No
Yes

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 9
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Debtor Qliance Management Inc. Case number (if known)

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 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. Wells Fargo Bank XXXX-1914 Checking January 2017 $0.00
Savings
Money Market
Brokerage
Other

18.2. Bank of America XXXX-1822 Checking May 2017 $0.00


Savings
Money Market
Brokerage
Other

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 Description of the contents Do you still
access to it 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.

None

Facility name and address Names of anyone with Description of the contents Do you still
access to it have it?
Public Storage Erika Bliss Office and Medical equipment No
10020 Martin Luther King Jr. Way 1915 2nd Ave., #1002 and supplies Yes
Seattle, WA 98178 Seattle, WA 98101

Kirkland Way Storage Erika Bliss Office and Medical equipment No


11200 Kirkland Way 1915 2nd Ave. #1002 and supplies Yes
Kirkland, WA 98033 Seattle, WA 98101

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


Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 10
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Debtor Qliance Management Inc. Case number (if known)

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 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.
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.

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

Business name address Describe the nature of the business Employer Identification number
Do not include Social Security number or ITIN.

Dates business existed

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. Denise Williams (former employee) March 2016-June
2016

26a.2. Wesley Howe July 2016-present


7027 139th Place NE
Redmond, WA 98052

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.

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 11
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Debtor Qliance Management Inc. Case number (if known)

None

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. Erika Bliss/Equinox Primary Care
1915 2nd Ave. #1002
Seattle, WA 98101
26c.2. Cheryl Kilodavis
9512 4th Ave. NW
Seattle, WA 98117

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. ICG Enterprises

26d.2. Paramount Lending

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 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
Erika Bliss 1915 2nd Ave. #1002 member and CEO 51
Seattle, WA 98101

Name Address Position and nature of any % of interest, if


interest any
Cheryl Kilodavis 9512 4th Ave. NW member and 49
Seattle, WA 98117 President/Secretary

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.

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?
Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 12
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Debtor Qliance Management Inc. Case number (if known)

No
Yes. Identify below.

Name and address of recipient Amount of money or description and value of Dates Reason for
property providing the value
30.1 Cheryl Kilodavis
. 9512 4th Ave. NW
Seattle, WA 98117 $22,916 April 2017 salary

Relationship to debtor
member and President

30.2 Erika Bliss


. 1915 2nd Ave. #1002
Seattle, WA 98101 $14,583 April 2017 salary

Relationship to debtor
member, CEO

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

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

No
Yes. Identify below.

Name of the pension fund Employer Identification number of the parent


corporation

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.

Executed on May 17, 2018

/s/ Erika Bliss Erika Bliss


Signature of individual signing on behalf of the debtor Printed name

Position or relationship to debtor CEO

Are additional pages to Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy (Official Form 207) attached?
No
Yes

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 13
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B2030 (Form 2030) (12/15)


United States Bankruptcy Court
Western District of Washington
In re Qliance Management Inc. Case No.
Debtor(s) Chapter 7

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR(S)


1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the attorney for the above named debtor(s) and that
compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered or to
be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows:
For legal services, I have agreed to accept $ 5,000.00
Prior to the filing of this statement I have received $ 5,000.00
Balance Due $ 0.00

2. The source of the compensation paid to me was:

Debtor Other (specify): Ann Thurley


1915 2nd Ave. #1002
Seattle, WA 98101

3. The source of compensation to be paid to me is:

Debtor Other (specify):

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm.

I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A
copy of the agreement, together with a list of the names of the people sharing in the compensation is attached.

5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:

a. Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy;
b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;
c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;
d. [Other provisions as needed]
Negotiations with secured creditors to reduce to market value; exemption planning; preparation and filing of
reaffirmation agreements and applications as needed; preparation and filing of motions pursuant to 11 USC
522(f)(2)(A) for avoidance of liens on household goods.

6. By agreement with the debtor(s), the above-disclosed fee does not include the following service:
Representation of the debtors in any dischargeability actions, judicial lien avoidances, relief from stay actions or
any other adversary proceeding.
CERTIFICATION
I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s) in
this bankruptcy proceeding.

May 17, 2018 /s/ Catherine J. Reny


Date Catherine J. Reny 43058
Signature of Attorney
Wenokur Riordan PLLC
600 Stewart St
Suite 1300
Seattle, WA 98101
206-492-7084 Fax: 206-219-4141
cat@wrlawgroup.com
Name of law firm

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5/17/18 4:51PM

United States Bankruptcy Court


Western District of Washington
In re Qliance Management Inc. Case No.
Debtor(s) Chapter 7

VERIFICATION OF CREDITOR MATRIX

I, the CEO of the corporation named as the debtor in this case, hereby verify that the attached list of creditors is true and correct to the

best of my knowledge.

Date: May 17, 2018 /s/ Erika Bliss


Erika Bliss/CEO
Signer/Title

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2420 UNION AVENUE CO-TENANCY


C/O CRAWFORD & KATICA
2915 NORTH MCCARVER
TACOMA, WA 98403

ABF SERVICING
ATTN: STEVEN BERKOVITCH
40 EXCHANGE PLACE
SUITE 1306
NEW YORK, NY 10005

ACME COMPANY
64 BEAVER ST.
SUITE 344
NEW YORK, NY 10004

ADAM'S INTERPRETING SERVICES


PO BOX 6122
BELLEVUE, WA 98008

AIDAREX PHARMACEUTICALS LLC


595 NORTH SMITH STREET
CORONA, CA 92880

AIRGAS INC.
WEST DIVISION 2349495
4401 AIRPORT WAY S
SEATTLE, WA 98108

ALICE FRANCK
6335 WILSON AVENUE S
SEATTLE, WA 98118

ALL PHASE COMM LLC


4209 21ST AVE W #200
SEATTLE, WA 98199

ALSTON & BIRD LLP


1201 WEST PEACHTREE ST
SUITE 4900
ATLANTA, GA 30309

ANN THURLEY
1915 2ND AVE. #1002
SEATTLE, WA 98101

Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 56 of 70


BANKERS HEALTHCARE GROUP, LLC
201 SOLAR STREET
SYRACUSE, NY 13204

BARBARA ROUSSIN
9900 WEST SAMPLE ROAD
CORAL SPRINGS, FL 33065

BEAVEX, INC.
6901 S 194TH ST
KENT, WA 98032

BENJAMIN MCLAUGHLIN
7501 GREENWOOD AVENUE N #306
SEATTLE, WA 98103

BRENDA BORJA
4032 EVANSTON AVENUE N
SEATTLE, WA 98103

CARENA, INC
PO BOX 673
SEATTLE, WA 98111

CAROL RADIO
3805 206TH PLACE NE
SAMMAMISH, WA 98074

CENTER FOR DIAGNOSTIC IMAGING


PO BOX 94624
SEATTLE, WA 98124-6924

CHERYL KILODAVIS
9512 4TH AVE. NW
SEATTLE, WA 98117

CHRISTOPHER BAUMANN
10130 IDAHO AVENUE
EVERETT, WA 98204

CHRISTOPHER GAYNOR
6250 1ST AVENUE S
SEATTLE, WA 98118

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CICS EMPLOYMENT SERVICES, INC.
1220 SW MORRISION ST. #505
PORTLAND, OR 97205

CIGNA LIFE INSURANCE CO. OF NA


TWO LIBERTY PLACE
1601 CHESTNUT STREET
PHILADELPHIA, PA 19192

CIGNA MEDICAL INSURANCE


TWO LIBERTY PLACE
1601 CHESTNUT STREET
PHILADELPHIA, PA 19192

CITY OF LYNNWOOD
PO BOX 5008
LYNNWOOD, WA 98046-5008

CJC LAW OFFICE


ATTN: CHRISTOPHER CALI
201 SOLAR ST.
SYRACUSE, NY 13204

COLO (ZAYO GROUP)


4772 WALNUT ST. SUITE 100
BOULDER, CO 80301

COLONIAL LIFE
245 4TH ST #206
BREMERTON, WA 98337

COMCAST BUSINESS
PO BOX 34744
SEATTLE, WA 98124-1744

CONCUR
62157 COLLECTIONS CENTER DRIVE
CHICAGO, IL 60693

CORPORATION SERVICE COMPANY


PO BOX 2576
SPRINGFIELD, IL 62708

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CRESTMARK EQUIPMENT FINANCE
40950 WOODWARD AVE. SUITE 201
BLOOMFIELD HILLS, MI 48304-5127

DAVIS WRIGHT TREMAINE LLP


1201 3RD AVE
SEATTLE, WA 98101

DIONEE HILAIRE
406 N. L STREET
TACOMA, WA 98403

DUO TEC
2960 4TH AVE S #112
SEATTLE, WA 98134

EDWARD GREGORY STEADMAN


9900 W. SAMPLE RD. STE. 300
POMPANO BEACH, FL 33065

EIN CAP, INC.


160 PEARL ST. 5TH FLOOR
NEW YORK, NY 10005

EIN CAP, INC.


2899 OCEAN AVE. 2ND FL.
BROOKLYN, NY 11235

ELECTRIC LIGHTWAVE
300 ELLIOTT AVE W STE 580
SEATTLE, WA 98119

EMMA SWINGLE
8212 CORLISS AVENUE N
SEATTLE, WA 98103

EMPLOYMENT SECURITY DEPARTMENT


PO BOX 34468
SEATTLE, WA 98124-1468

EPAX SYSTEMS, INC


7767 LEMONA AVE
VAN NUYS,, CA 91402

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EQUINOX PRIMARY CARE
ATTN: ERIKA BLISS
2200 6TH AVE. #102
SEATTLE, WA 98121

ERIKA BLISS
1915 2ND AVE. #1002
SEATTLE, WA 98101

EVERGREEN RADIA LLC


1521 NE 128TH ST #200
KIRKLAND, WA 98034

EXPEDIA/TOWER 333 LLC?


333 108TH AVE NE
BELLEVUE, WA 98004

FIRST CHOICE HEALTH NETWORK


600 UNIVERSITY ST #1400
SEATTLE, WA 98101

FIRST PREMIER FUNDING, LLC


C/O SCHWEET LINDE & COULSON
ATTN: LAURIN S. SCHWEET
575 S. MICHIGAN ST.
SEATTLE, WA 98108

FOSTER PEPPER PLLC


ATTN: MIRIAM CHUNG
1111 THIRD AVE. SUITE 3000
SEATTLE, WA 98101

GEMINI DIVERSIFIED SERVICES


18350 MT LANGLEY ST #101
FOUNTAIN VALLEY, CA 92708

GRE 509 OLIVE LLC


509 OLIVE WAY, SUITE 1019
SEATTLE, WA 98101

GREEN & NORWOOD PLLC


ATTN: MATTHEW GREEN
2722 EASTLAKE AVENUE EAST
SUITE 350
SEATTLE, WA 98102

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GUARDIAN SECURITY
1743 1ST AVE S
SEATTLE, WA 98134

INTEGRA/ELECTRIC LIGHTWAVE
18110 SE 34TH ST
BLDG ONE STE 100
VANCOUVER, WA 98683-9497

INTERNAL REVENUE SERVICE


PO BOX 7346
PHILADELPHIA, PA 19101-7346

INTERNAL REVENUE SERVICE


SPECIAL PROCEDURES
915 2ND AVE., M/S W244
SEATTLE, WA 98174

IT SOURCE
1010 S 336TH ST, SUITE 108
FEDERAL WAY, WA 98003

JAMESON BABBITT STITES LOMBARD


ATTN: ALAN BORNSTEIN
801 SECOND AVE.
SUITE 1000
SEATTLE, WA 98104

JOHANNA RIVADENEIRA
6530 HAYES STREET
HOLLYWOOD, FL 33024

JUDE OVERO
222 WEST 122ND STREET
APT. 4-A
NEW YORK, NY 10027

KABBAGE LOC
925B PEACHTREE ST. NE #1688
ATLANTA, GA 30309

KATHRYN DEHAN
9212 227TH AVE. EAST
BUCKLEY, WA 98321

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KELSEY HOBBS
521 STADIUM PL. S
SEATTLE, WA 98104

KENT STATION RETAIL, LLC


C/O GREEN & NORWOOD PLLC
2722 EASTLAKE AVENUE EAST
SUITE 350
SEATTLE, WA 98102

KNIGHT CAPITAL, LLC


9 EAST LOCKERMAN ST.
SUITE 3A-543
DOVER, DE 19901

KURT VELGUTH
5716 15TH AVENUE NE, APT. B
SEATTLE, WA 98105

LAFAWN SMITH
607 WILLIAMS AVENUE SOUTH, #21
RENTON, WA 98047

LASHER, HOLZAPFEL, SPERRY & EBBERSON


601 UNION ST. SUITE 2600
SEATTLE, WA 98101

LAURA BREYMAN
5122 162ND PLACE SE
BELLEVUE, WA 98006

LESTER PITLE
4825 45TH AVENUE S
SEATTLE, WA 98118

LIVENGOOD ALSKOG PLLC


ATTN: REBECCA LAUREN PENN
ATTN: DAVID BENJAMIN JOHNSTON
PO BOX 908
KIRKLAND, WA 98083

LUMEON
10 LEAKE ST
LAMBETH
LONDON SE1 7NN, UK

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MAGNOZZI & KYE, LLP
ATTN: MARK MAGNOZZI
23 GREEN ST. STE 302
HUNTINGTON, NY 11743

MANTIS
187 WOLF ROAD
SUITE 101
ALBANY, NY 12205

MARCIE HAMRICK
1238 NW BLAKELY COURT
SEATTLE, WA 98177

MCKESSON MEDICAL SUPPLIES


9954 MAYLAND DRIVE
RICHMOND, VA 23233

MEAGAN BATCHELDOR
18909 11 TH AVENUE COURT E
SPANAWAY, WA 98387

MERCHANT CASH & CAPITAL LLC


DBA BIZFI FUNDING
460 PARK AVENUE SOUTH
10TH FLOOR
NEW YORK, NY 10016

MERCHANT FUNDING SVCS


30 BROAD ST. 14TH FL.
NEW YORK, NY 10004

MERCK SHARP & DOHME CORP


1 MERCK DR, WHITEHOUSE STATION
WHITEHOUSE STATION, NJ 08889

MISS SUDSY
2310 MILDRED ST. SW SUITE 126
UNIVERSITY PLACE, WA 98466

NAIDICH WURMAN LLP


111 GREAT NECK ROAD
SUITE 214
GREAT NECK, NY 11021

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NEW ERA LENDING, LLC
1201 NORTH ORANGE ST.
SUITE 762
WILMINGTON, DE 19801

NORIMA CONSULTING US
11590 W. BERNARDO COURT
SUITE 200
SAN DIEGO, CA 92127-1662

NORTHUP PLACE, LLC


C/O AZOSE COMMERCIAL PROP
8451 SE 68TH STREET, STE 200
MERCER ISLAND, WA 98040

NU-CENTURY MAINTENANCE SYSTEMS


16541 REDMOND HWY, PMB#355-C
REDMOND, WA 98052

NUON NOP CLEANING


1112 S DAWSON ST
SEATTLE, WA 98108

NURA ADAM
14205 SE 36TH ST. #100
BELLEVUE, WA 98006

PACIFIC INTERPRETERS
707 SW WASHINGTON, SUITE 200
PORTLAND, OR 97205

PACIFIC NORTHWEST SHREDDING


3215 LAFAYETTE AVE S
SEATTLE, WA 98144

PACIFIC OFFICE AUTOMATION INC


14747 NW GREENBRIER PARKWAY
BEAVERTON, OR 97006

PATSY BRITTO
9900 WEST SAMPLE ROAD
CORAL SPRINGS, FL 33065

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PERFECTSERVE, INC.
10024 INVESTMENT DRIVE
SUITE 200
KNOXVILLE, TN 37932

PHYSICIANS INSURANCE
43406 BUSINES PARK DRIVE
TEMECULA, CA 92590

PIERCE COUNTY BUDGET & FINANCE


950 FAWCETT AVE, STE 100
TACOMA, WA 98402

PITNEY BOWES INC


800 VINIAL ST # B201
PITTSBURGH, PA 15212

POWER UP LENDING GROUP, LTD


111 GRAT NECK ROADD
SUITE 216
GREAT NECK, NY 11021

PROPEL INSURANCE
925 FOURTH AVENUE, SUITE 3200
SEATTLE, WA 98104-1159

PUGET SOUND BUILDING MAINTENANCE LLC


MERCER ISLAND, WA 98040

PUGET SOUND ENERGY


PO BOX 91269
BELLEVUE, WA 98009

PUGET SOUND ENERGY


355 110TH AVE NE
BELLEVUE, WA 98004

QUEST DIAGNOSTICS
8403 FALLBROOK AVENUE
WEST HILLS, CA 91304

RECOLOGY CLEANSCAPES INC.


7303 8TH AVE S
SEATTLE, WA 98108

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RENATA BUKHMAN, ESQ.
17 STATE ST. STE 4000
NEW YORK, NY 10004

RH LYNNWOOD CORP CENTER ASSOC LLC


PO BOX 5003
BELLEVUE, WA 98009-5003

ROXANNE HO
6917 47TH STREET COURT W
UNIVERSITY PLACE, WA 98466

RTR RECOVERY
ATTN: JACOB VERSTANDIG
122 EAST 42ND ST.
SUITE 2112
NEW YORK, NY 10168

RUBICON MD, INC.


524 BROADWAY, 11TH FLOOR
NEW YORK, NY 10012

SANJIV MATTA
9900 WEST SAMPLE ROAD
CORAL SPRINGS, FL 33065

SANOFI PASTEUR INC


1 DISCOVERY DR
SWIFTWATER, PA 18370

SATURN FUNDING LLC


C/O MCA SERVICING
ATTN: STEVEN BERKOVITCH
40 EXCHANGE PL. STE 1306
NEW YORK, NY 10005

SATURN FUNDING, LLC


333 7TH AVENUE, FLOOR 3
NEW YORK, NY 10001

SMART DATA SOLUTIONS, INC.


960 BLUE GENTIAN ROAD
EAGAN, MN 55121

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SPOKEN COMMUNICATION
2101 FOURTH AVENUE, SUITE 620
SEATTLE, WA 98121

STANFORD DOSIMETRY LLC


1204 RAYMOND ST
BELLINGHAM, WA 98229-2416

STEPHANIE BRACAMONTE
4905 NARROW WAY NE
SAINT MICHAEL, MN 55376

STERICYCLE INC.
28161 N. KEITH DRIVE
LAKE FOREST, IL 60045

TACOMA PUBLIC UTILITIES


PO BOX 11010
TACOMA, WA 98411-1010

TACOMA PUBLIC UTILITIES


3628 SOUTH 35TH STREET
TACOMA, WA 98409

TANYA KNIGHT
27224 23RD AVENUE S
FEDERAL WAY, WA 98003

TASC
2302 INTERNATIONAL LANE
MADISON, WI 53704

TECHNOLOGY FINANCE CORPORATION


7077 E. MARILYN RD
BLDG 3 STE 125
SCOTTSDALE, AZ 85254

THERACOM LLC
150 N FIELD DR.
TWO CONWAY PARK STE 200
LAKE FOREST, IL 60045

TRA MEDICAL IMAGING


1304 FAWCETT AVE., SUITE 100
TACOMA, WA 98402

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TURNBULL & BORN PLLC
ATTN: BRIAN BORN
COMMERCE BUILDING, SUITE 1050
950 PACIFIC AVE.
TACOMA, WA 98402

TVT CAPITAL LLC


8 HUNTERS LANE
ROSLYN, NY 11576

UNION AVE INVESTORS LLC


ATTN: DANA CARLISLE
PO BOX 394
TACOMA, WA 98401

UNIVERSAL MECHANICAL SERVICE


8901 WILLOWS RD
REDMOND, WA 98052

US BANK EQUIPMENT FINANCE


13010 SW 68TH PKWY #100
PORTLAND, OR 97223

US BANK EQUIPMENT FINANCE


1310 MADRID STREET
MARSHALL, MN 56258

VANGUARD CLEANING SYSTEMS OF WA


6912 220TH STREET SW, STE. 306
MOUNTLAKE TERRACE, WA 98043

WA ATTORNEY GENERAL'S OFFICE


LABOR & INDUSTRIES DIV.
ATTN: DIANA CARTWRIGHT
800 FIFTH AVE. STE 2000
SEATTLE, WA 98104

WA DEPT OF L&I
PO BOX 44171
OLYMPIA, WA 98504-4171

WA DEPT OF L&I
ATTN: DAVID JOHNSON
PO BOX 44510
OLYMPIA, WA 98504

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WA DEPT OF L&I
ATTN: DAVID JOHNSON
7273 LINDERSON WAY SW
OLYMPIA, WA 98501

WAVE BUSINESS
401 PARKPLACE CENTER # 500
KIRKLAND, WA 98033

WELLS FARGO FINANCIAL LEASING


800 WALNUT STREET
MAC N0005-044
DES MOINES, IA 50309

YELLOWSTONE CAPITAL LLC


30 BROAD ST. 14TH FLOOR
NEW YORK, NY 10004

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5/17/18 4:51PM

United States Bankruptcy Court


Western District of Washington
In re Qliance Management Inc. Case No.
Debtor(s) Chapter 7

CORPORATE OWNERSHIP STATEMENT (RULE 7007.1)

Pursuant to Federal Rule of Bankruptcy Procedure 7007.1 and to enable the Judges to evaluate possible disqualification or
recusal, the undersigned counsel for Qliance Management Inc. in the above captioned action, certifies that the following
is a (are) corporation(s), other than the debtor or a governmental unit, that directly or indirectly own(s) 10% or more of
any class of the corporation's(s') equity interests, or states that there are no entities to report under FRBP 7007.1:

None [Check if applicable]

May 17, 2018 /s/ Catherine J. Reny


Date Catherine J. Reny 43058
Signature of Attorney or Litigant
Counsel for Qliance Management Inc.
Wenokur Riordan PLLC
600 Stewart St
Suite 1300
Seattle, WA 98101
206-492-7084 Fax:206-219-4141
cat@wrlawgroup.com

Software Copyright (c) 1996-2018 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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