Qliance Bankruptcy

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
5/17/18 4:51PM

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?
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
5/17/18 4:51PM

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
Contact phone 206-492-7084 Email address cat@wrlawgroup.com
43058 WA
Bar number and State
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
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
Software Copyright (c) 1996-2018 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

5/17/18 4:51PM

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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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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.
Part 3: Accounts receivable

10. Does the debtor have any accounts receivable?
No. Go to Part 4.
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.
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.
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.
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.
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.
Part 9: Real property

54. Does the debtor own or lease any real property?
No. Go to Part 10.


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Name
Part 10: Intangibles and intellectual property

59. Does the debtor have any interests in intangibles or intellectual property?
No. Go to Part 11.

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.

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

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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

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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
UCC-1
No
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
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

No
No Contingent
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
UCC-1
No
No Contingent
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
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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Debtor Qliance Management Inc. Case number (if know)

Name

No
No Contingent
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
UCC-1
No
No Contingent
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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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
Cheryl Kilodavis Check all that apply.
9512 4th Ave. NW Contingent
Seattle, WA 98117 Unliquidated
Disputed

Yes
Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 20
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Name
Christopher Baumann Check all that apply.
10130 Idaho Avenue Contingent
Everett, WA 98204 Unliquidated
Disputed

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

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

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.
Philadelphia, PA 19101-7346 Unliquidated
Disputed

Yes
Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 20

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Name
Kathryn DeHan Check all that apply.
9212 227th Ave. East Contingent
Buckley, WA 98321 Unliquidated
Disputed

Yes
LaFawn Smith Check all that apply.
607 Williams Avenue South, #21 Contingent
Renton, WA 98047 Unliquidated
Disputed

Yes
Meagan Batcheldor Check all that apply.
18909 11 th Avenue Court E Contingent
Spanaway, WA 98387 Unliquidated
Disputed

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

Yes

5/17/18 4:51PM

Name
Stephanie Bracamonte Check all that apply.
4905 Narrow Way NE Contingent
Saint Michael, MN 55376 Unliquidated
Disputed

Yes
Tanya Knight Check all that apply.
27224 23rd Avenue S Contingent
Federal Way, WA 98003 Unliquidated
Disputed

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.
Olympia, WA 98504-4171 Unliquidated
Disputed
Last 4 digits of account number 6949 Is the claim subject to offset?

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
Adam's Interpreting Services Contingent
PO Box 6122 Unliquidated
Bellevue, WA 98008 Disputed
Basis for the claim: Notice Only
Is the claim subject to offset? No Yes

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Name
Aidarex Pharmaceuticals LLC Contingent
595 North Smith Street Unliquidated
Corona, CA 92880 Disputed
Airgas Inc. Contingent
West Division 2349495 Unliquidated
4401 Airport Way S Disputed
Seattle, WA 98108
Alice Franck Contingent
6335 Wilson Avenue S Unliquidated
Seattle, WA 98118 Disputed
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
Basis for the claim:
Alston & Bird LLP Contingent
1201 West Peachtree St Unliquidated
Suite 4900 Disputed
Atlanta, GA 30309
Basis for the claim: Legal services
Ann Thurley Contingent
1915 2nd Ave. #1002 Unliquidated
garnished bank account SS funds ($5250);
Last 4 digits of account number atty fees + filing fee
Bankers Healthcare Group, LLC Contingent
201 Solar Street Unliquidated
Syracuse, NY 13204 Disputed

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Name
BeavEx, Inc. Contingent
6901 S 194th St Unliquidated
Kent, WA 98032 Disputed
Benjamin McLaughlin Contingent
7501 Greenwood Avenue N #306 Unliquidated
Carena, Inc Contingent
Carol Radio Contingent
3805 206th Place NE Unliquidated
Sammamish, WA 98074 Disputed
Center for Diagnostic Imaging Contingent
Seattle, WA 98124-6924 Disputed
Cheryl Kilodavis Contingent
9512 4th Ave. NW Unliquidated
Basis for the claim: Payments made to Kent Station
Christopher Gaynor Contingent
6250 1st Avenue S Unliquidated

5/17/18 4:51PM

Name
CICS Employment Services, Inc. Contingent
1220 SW Morrision St. #505 Unliquidated
Portland, OR 97205 Disputed
CIGNA Life Insurance Co. of NA Contingent
Two Liberty Place Unliquidated
1601 Chestnut Street Disputed
Philadelphia, PA 19192
CIGNA Medical Insurance Contingent
Two Liberty Place Unliquidated
1601 Chestnut Street Disputed
Philadelphia, PA 19192
City of Lynnwood Contingent
Lynnwood, WA 98046-5008 Disputed
Colo (Zayo Group) Contingent
4772 Walnut St. Suite 100 Unliquidated
Boulder, CO 80301 Disputed
Colonial Life Contingent
245 4th St #206 Unliquidated
Bremerton, WA 98337 Disputed
Comcast Business Contingent
Last 4 digits of account number 6663

5/17/18 4:51PM

Name
Concur Contingent
62157 Collections Center Drive Unliquidated
Chicago, Il 60693 Disputed
Davis Wright Tremaine LLP Contingent
1201 3rd Ave Unliquidated
Duo TEC Contingent
2960 4th Ave S #112 Unliquidated
Edward Gregory Steadman Contingent
9900 W. Sample Rd. Ste. 300 Unliquidated
Pompano Beach, FL 33065 Disputed
EIN Cap, Inc. Contingent
160 Pearl St. 5th Floor Unliquidated
New York, NY 10005 Disputed
Basis for the claim: QMG
Electric Lightwave Contingent
300 Elliott Ave W STE 580 Unliquidated
Emma Swingle Contingent
8212 Corliss Avenue N Unliquidated

5/17/18 4:51PM

Name
Epax Systems, Inc Contingent
7767 Lemona Ave Unliquidated
Van Nuys,, CA 91402 Disputed
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
(2017-ongoing)
Erika Bliss Contingent
1915 2nd Ave. #1002 Unliquidated
Basis for the claim: Payments made to Kent Station
Evergreen Radia LLC Contingent
1521 NE 128th St #200 Unliquidated
Kirkland, WA 98034 Disputed
Expedia/Tower 333 LLC? Contingent
333 108th Ave NE Unliquidated
Basis for the claim: lease: 333 108th Ave. NE, Bellevue
First Choice Health Network Contingent
600 University St #1400 Unliquidated
First Premier Funding, LLC
c/o Schweet Linde & Coulson Contingent
Attn: Laurin S. Schweet Unliquidated
575 S. Michigan St. Disputed
Seattle, WA 98108

5/17/18 4:51PM

Name
Gemini Diversified Services Contingent
18350 Mt Langley St #101 Unliquidated
Fountain Valley, CA 92708 Disputed
GRE 509 Olive LLC Contingent
509 Olive Way, Suite 1019 Unliquidated
Basis for the claim: commercial lease: 509 Olive Way, Suite 1607, Seattle
Guardian Security Contingent
1743 1st Ave S Unliquidated
Integra/Electric Lightwave Contingent
18110 SE 34th St Unliquidated
Bldg One Ste 100 Disputed
Vancouver, WA 98683-9497
IT Source Contingent
1010 S 336th St, Suite 108 Unliquidated
Federal Way, WA 98003 Disputed
Kabbage LOC Contingent
925B Peachtree St. NE #1688 Unliquidated
Atlanta, GA 30309 Disputed
Kelsey Hobbs Contingent
521 Stadium Pl. S Unliquidated

5/17/18 4:51PM

Name
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
Knight Capital, LLC Contingent
9 East Lockerman St. Unliquidated
Suite 3A-543 Disputed
Dover, DE 19901
Kurt Velguth Contingent
5716 15th Avenue NE, Apt. B Unliquidated
Lasher, Holzapfel, Sperry & Ebberson Contingent
601 Union St. Suite 2600 Unliquidated
Laura Breyman Contingent
5122 162nd Place SE Unliquidated
Lester Pitle Contingent
4825 45th Avenue S Unliquidated
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

5/17/18 4:51PM

Name
Mantis Contingent
187 Wolf Road Unliquidated
Suite 101 Disputed
Albany, NY 12205
Basis for the claim: judgment?
Marcie Hamrick Contingent
1238 NW Blakely Court Unliquidated
McKesson Medical Supplies Contingent
9954 Mayland Drive Unliquidated
Richmond, VA 23233 Disputed
Merchant Cash & Capital LLC
dba BizFi Funding Contingent
460 Park Avenue South Unliquidated
10th Floor Disputed
New York, NY 10016
Merchant Funding Svcs Contingent
30 Broad St. 14th Fl. Unliquidated
Merck Sharp & Dohme Corp Contingent
1 Merck Dr, Whitehouse Station Unliquidated
Whitehouse Station, NJ 08889 Disputed
Miss Sudsy Contingent
2310 Mildred St. SW Suite 126 Unliquidated
University Place, WA 98466 Disputed

5/17/18 4:51PM

Name
Norima Consulting US Contingent
11590 W. Bernardo Court Unliquidated
Suite 200 Disputed
San Diego, CA 92127-1662
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,
Bellevue
Nu-Century Maintenance Systems Contingent
16541 Redmond Hwy, PMB#355-C Unliquidated
Redmond, WA 98052 Disputed
Nuon Nop Cleaning Contingent
1112 S Dawson St Unliquidated
Pacific Interpreters Contingent
707 SW Washington, Suite 200 Unliquidated
Pacific Northwest Shredding Contingent
3215 Lafayette Ave S Unliquidated
Pacific Office Automation Inc Contingent
14747 NW Greenbrier Parkway Unliquidated
Beaverton, OR 97006 Disputed

5/17/18 4:51PM

Name
PerfectServe, Inc. Contingent
10024 Investment Drive Unliquidated
Suite 200 Disputed
Knoxville, TN 37932
Physicians Insurance Contingent
43406 Busines Park Drive Unliquidated
Temecula, CA 92590 Disputed
Pitney Bowes Inc Contingent
800 Vinial St # B201 Unliquidated
Pittsburgh, PA 15212 Disputed
Power Up Lending Group, LTD Contingent
111 Grat Neck Roadd Unliquidated
Suite 216 Disputed
Great Neck, NY 11021
Propel Insurance Contingent
925 Fourth Avenue, Suite 3200 Unliquidated
Puget Sound Building Maintenance LLC Contingent
Unliquidated
Mercer Island, WA 98040 Disputed
Puget Sound Energy Contingent

5/17/18 4:51PM

Name
Quest Diagnostics Contingent
8403 Fallbrook Avenue Unliquidated
West Hills, CA 91304 Disputed
Recology CleanScapes Inc. Contingent
7303 8th Ave S Unliquidated
RH Lynnwood Corp Center Assoc LLC Contingent
Bellevue, WA 98009-5003 Disputed
Roxanne Ho Contingent
6917 47th Street Court W Unliquidated
University Place, WA 98466 Disputed
Rubicon MD, Inc. Contingent
524 Broadway, 11th Floor Unliquidated
Sanofi Pasteur Inc Contingent
1 Discovery Dr Unliquidated
Swiftwater, PA 18370 Disputed
Smart Data Solutions, Inc. Contingent
960 Blue Gentian Road Unliquidated
Eagan, MN 55121 Disputed

5/17/18 4:51PM

Name
Spoken Communication Contingent
2101 Fourth Avenue, Suite 620 Unliquidated
Stanford Dosimetry LLC Contingent
1204 Raymond St Unliquidated
Bellingham, WA 98229-2416 Disputed
Stericycle Inc. Contingent
28161 N. Keith Drive Unliquidated
Lake Forest, IL 60045 Disputed
Tacoma Public Utilities Contingent
Tacoma, WA 98411-1010 Disputed
TASC Contingent
2302 International Lane Unliquidated
Madison, WI 53704 Disputed
TheraCom LLC Contingent
150 N Field Dr. Unliquidated
Two Conway Park Ste 200 Disputed
Lake Forest, IL 60045
TRA Medical Imaging Contingent
1304 Fawcett Ave., Suite 100 Unliquidated
Tacoma, WA 98402 Disputed

5/17/18 4:51PM

Name
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,
Tacoma;
Last 4 digits of account number judgment 7/13/2017 Pierce Cty #17-2-08490-1
Universal Mechanical Service Contingent
8901 Willows Rd Unliquidated
Redmond, WA 98052 Disputed
US Bank Equipment Finance Contingent
13010 SW 68th Pkwy #100 Unliquidated
Basis for the claim: 2 Koncia C654e
Last 4 digits of account number 10 Canon IR500
Vanguard Cleaning Systems of WA Contingent
6912 220th Street SW, Ste. 306 Unliquidated
Mountlake Terrace, WA 98043 Disputed
Wave Business Contingent
401 Parkplace Center # 500 Unliquidated
Kirkland, WA 98033 Disputed
Wells Fargo Financial Leasing Contingent
800 Walnut Street Unliquidated
MAC N0005-044 Disputed
Des Moines, IA 50309
Yellowstone Capital LLC Contingent
30 Broad St. 14th Floor Unliquidated
Basis for the claim: judgment in Erie County, NY #803808/2017 on
Last 4 digits of account number 3/21/2017

5/17/18 4:51PM

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

5/17/18 4:51PM

Name
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

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

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

5/17/18 4:51PM

Name
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

5/17/18 4:51PM

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

5/17/18 4:51PM

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

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


5/17/18 4:51PM
Additional Page to List More Codebtors

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

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

G
2.9 Cheryl Kilodavis 9512 4th Ave. NW Mantis D

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

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

G
2.13 Cheryl Kilodavis 9512 4th Ave. NW Christopher D

Seattle, WA 98117 Baumann E/F 2.3
G


5/17/18 4:51PM

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

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

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

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

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

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

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
G


5/17/18 4:51PM

2.22 Erika Bliss 1915 2nd Ave. #1002 Northup Place, LLC D
G
2.23 Erika Bliss 1915 2nd Ave. #1002 Yellowstone Capital D

G
2.24 Erika Bliss 1915 2nd Ave. #1002 Kent Station Retail, D
G
2.25 Erika Bliss 1915 2nd Ave. #1002 Saturn Funding LLC D 2.5
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

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


5/17/18 4:51PM

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

G
2.31 Erika Bliss 1915 2nd Ave. #1002 Knight Capital, LLC D
G
2.32 Erika Bliss 1915 2nd Ave. #1002 Mantis D

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

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

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

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

G


5/17/18 4:51PM

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

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

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

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


5/17/18 4:51PM

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

5/17/18 4:51PM
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

5/17/18 4:51PM
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

5/17/18 4:51PM
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.

5/17/18 4:51PM
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

none
9.3. Vietnam Dental Outreach Computers

Program
Nov. 2017 $5,500.00

none
9.4. Ghanaian and Malian Schools Computers

Dec. 2017 $6,000.00

none
9.5. DAWN (Domestic Abuse Computer equipment, furniture, office

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

5/17/18 4:51PM
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
former lessor and judgment
creditor
Part 7: Previous Locations
14. Previous addresses

5/17/18 4:51PM
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

5/17/18 4:51PM
Electronically
Paper
521 2nd Place North, Suite PC;
103 March 2016-May 2017
Kent, WA 98032
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper
2420 S. Union Ave., Suite PC;
100 March 2016-June 2017
Tacoma, WA 98405
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper
15419 NE 20th Street PC;
Bellevue, WA 98007 March 2016-June 2017
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper
19401 40th Ave. West PC;
Lynnwood, WA 98036 March 2016-May 2017
1915 2nd Ave., #1002
Seattle, WA 98101
Electronically
Paper
333 108th Ave. NE, Suite PC;
M150 March 2016 - September 2016
Bellevue, WA 98004
1915 2nd Ave., #1002
Seattle, WA 98101

5/17/18 4:51PM
Electronically
Paper
2318 4th Ave. PC;
Seattle, WA 98121 March 2016-June 2017
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

5/17/18 4:51PM
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


5/17/18 4:51PM
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.
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.
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.

5/17/18 4:51PM
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?

5/17/18 4:51PM
No
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
member and President
30.2 Erika Bliss

. 1915 2nd Ave. #1002
Seattle, WA 98101 $14,583 April 2017 salary
member, CEO
31. Within 6 years before filing this case, has the debtor been a member of any consolidated group for tax purposes?
No
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
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.
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

5/17/18 4:51PM
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
600 Stewart St
Suite 1300
Seattle, WA 98101
206-492-7084 Fax: 206-219-4141
cat@wrlawgroup.com
Name of law firm

5/17/18 4:51PM

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

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

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
CONCUR
62157 COLLECTIONS CENTER DRIVE
CHICAGO, IL 60693
CORPORATION SERVICE COMPANY

PO BOX 2576
SPRINGFIELD, IL 62708

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
EPAX SYSTEMS, INC

7767 LEMONA AVE
VAN NUYS,, CA 91402

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

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

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

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

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

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
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

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
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

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

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

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

5/17/18 4:51PM

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.
600 Stewart St
Suite 1300
Seattle, WA 98101
206-492-7084 Fax:206-219-4141
cat@wrlawgroup.com

Qliance Bankruptcy

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Qliance Bankruptcy

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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

Official Form 201

1. Debtor's name Qliance Management Inc.

2. All other names debtor

1915 2nd Ave. #1002

King Location of principal assets, if different from principal

Number, Street, City, State & ZIP Code

5. Debtor's website (URL)

Debtor Qliance Management Inc. Case number (if known)

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

B. Check all that apply

8. Under which chapter of the Check one:

9. Were prior bankruptcy No.

10. Are any bankruptcy cases No

Debtor Qliance Management Inc. Case number (if known)

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

12. Does the debtor own or No

Statistical and administrative information

13. Debtor's estimation of . Check one:

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

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

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

Debtor Qliance Management Inc. Case number (if known)

Request for Relief, Declaration, and Signatures

17. Declaration and signature

Executed on May 17, 2018

X /s/ Erika Bliss Erika Bliss

Catherine J. Reny 43058

Wenokur Riordan PLLC

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

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)

Official Form 202

Declaration and signature

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

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

Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 5 of 70

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)

Official Form 206Sum

Part 1: Summary of Assets

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

1a. Real property:

1b. Total personal property:

1c. Total of all property:

Part 2: Summary of Liabilities

3a. Total claim amounts of priority unsecured claims:

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

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

Case 18-11999-CMA Doc 1 Filed 05/17/18 Ent. 05/17/18 16:53:01 Pg. 6 of 70

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)

Official Form 206A/B