Vanguard Landing, Inc. Estate & Financial Fact Finder

Transcription

1 Vanguard Landing, Inc. Estate & Financial Fact Finder A guide to life planning for a family member with an Intellectual Disability Securities and Insurance offered through Infinex Investments, Inc. Member FINRA/SIPC Infinex Investments is not affiliated with Vanguard Landing TO BE COMPLETED (AS MUCH AS POSSIBLE) BY CLIENT 1

2 Dear Vanguard Landing Applicant, The purpose of this fact finder is so that Vanguard Landing can gauge how much planning your family has done with regards to your family member with an intellectual disability. Vanguard Landing has contracted with Mr. Chris Jennings, Financial Advisor with Infinex Financial Group, and Mr. Scott Alperin, Estate Planning Attorney with MIDGET PRETI ALPERIN PC, to perform the review. We know life happens and plans change all the time. The information you provide will help Vanguard Landing gauge the ability to continue to pay tuition expenses when and if major life events happen while your family member participates with programs on our campus. Please don t let this questionnaire intimidate you. It is going to ask for a lot of information but much of it you can provide via attached legal documents and financial statements. Again, to cut down on the need to manually fill out a lot of this questionnaire, please provide us with as much supporting documentation as possible. Please be sure to include all pages of statements and legal documents. We simply need the Declarations Page of any insurance policies, which are normally found on page 3 of the policy. Please check off and attach any and all of the following: Estate Documents Please let us know what documents you have already had prepared for yourself and the potential resident. Please check the bullet beside each document you have had prepared. Please include a copy of the latest documents or statements with the completed application. Parent/Guardian Will Power of Attorney Medical Directive Trust Resident Will Power of Attorney Medical Directive Trust Guardianship: Type: Revocable/Irrevocable/Other Type: Revocable/Irrevocable/Other Name of Guardian Financial Documents Please let us know what accounts or insurance policies that you or that the potential resident owns. We also need to know income related information so please include a copy of your last two years federal tax returns with this questionnaire. Last 2 Years Federal Tax Returns (Just the return, no supporting documents needed) Bank Statements (Savings, Checking, Certificates of Deposit, Money Market) Brokerage Accounts (All Statement Pages) Retirement Accounts (All Statement Pages) Individually Held Stock, Bonds, Mutual Funds, Annuities (All Statement Pages) Individual or Employer Provided Life Insurance (Declaration or Summary Page) Individual or Employer Provided Disability Insurance (Declaration or Summary Page) Individual or Employer Provided Long Term Care Insurance (Declaration or Summary Page) 2

3 Also, please attach the most current financial statements showing balances and holdings if possible. All of this will help our team assist each family to insure the best chance at being able to afford the tuition to Vanguard Landing for as long as the individual wants to stay! General Information Item Father Mother Full Legal Name Date of Birth City and State of Birth Social Security Number Marital Status Driver's License # DL# Expiration Date Street Address City, State, Zip County Home Phone Cell Phone Work Phone (Ext) Address Occupation Employer Years at Current Employer Employer Address City, State, Zip Gross Annual Income Smoker? Date created or last review Do you have a Family Trust? Do you have a Special Needs Trust? If the person with a disability is over 18, are you this person s guardian? Have you made arrangements for your own long term care? List All Children Full Legal Name Gender Date of Birth Social Security Number General Comments: 3

4 Person(s) With Disabilities Item First Second Full Legal Name Date of Birth Place of Birth Social Security Number Address City, State, Zip Home Phone Occupation Average Monthly Income Employer Is this person married? Name of Spouse Date of Marriage Place of Marriage (State) Is this a Shelter Workshop Program? If so, who operates the Program? Is Person enrolled in PASS Program? Type of Disability If this person lives with you, do you charge for room and board? If yes, how much per month? Do you have any Gov't benefits below? If so, what amount? Supplemental Security Income (SSI) Social Security Disability Income Social Security Medicaid Medicare State Assistance Program (VA Waiver?) Total Government Check Per Month Carried on Family Health Insurance? Trust Account? Monthly Trust Account Income? Military Pension? Amount of Monthly Military Pension? Amount family saves per month for this individual Amount individual saves per month for themselves? Burial life service plan? If so, cost or amount per month? Any anticipated inheritance? If so, how much and from whom? Please attach list of other major assets that have been declared to SSI. IN ORDER TO PLAN FOR THE FUTURE, THE FINANCIAL ADVISOR AND ESTATE PLANNING ATTORNEY WILL LOOK AT THE FAMILIES RESOURCES AND THEN IF NEEDED LOOK FOR WAYS TO HELP REALLOCATE THOSE RESOURCES SO THAT THE PERSON WITH THE DISABILITY WILL HAVE A HIGHER PROBABILIY TO HAVE ADEQUATE FUNDS TO COVER TUITION. 4

5 Family Financial Team: Vanguard Landing knows that advice is often warranted when handing these types of matters. Please list anyone you would consider your advisor in these areas. Please leave blank if you don t have someone helping you with your Estate Planning, Financial Advising, or Tax Planning. Estate Planning Attorney Name: Company: Phone: Financial Advisor Name: Company: Phone: Accountant/Tax Preparer Name: Company: Phone: PARENT, RESIDENT, LEGAL GUARDIAN ASSETS & LIABILITES LIABILIITES (These include credit cards, car & boat loans, personal loans, lines of credit) Type Lender Who is Liable? Balance Avail. Credit Min. Payment Rate REAL ESTATE OWNED Description of Property Owner/Title Fair Market Value Amount Owed Monthly Payment Rate AVOID FILLING THIS PART OUT SIMPLY ATTACHED ANY APPLICABLE STATEMENTS AND STATE SEE ATTACHED BELOW Banking (Checking, Savings, Certificates of Deposit, Money Market) Name of Institution Type Owner Amount NON-Retirement Accounts (Brokerage Accounts, Individually held Stocks, Bonds, Mutual Funds, Annuities, etc.) Name of Institution Type Acct. Number Owner Amount 5

6 Personal Retirement Accounts (Traditional IRA, ROTH IRA, 401k, 403b, 457, Thrift Savings Plan) Name of Institution Type Owner/Title Beneficiary Current Value Deposits/Withdrawals? Pensions Owner Company/Sponsor Planned Retirement Age Payment at Retirement Current Monthly Payment Current Value Life Insurance Insured Owner Company Death Benefit Beneficiary Type (Term/Perm) Premium Cash Value Business Interest Do you own or have any interest in a private company? % Ownership Total Current Value Business Description 6

7 Other Company Benefits (ex ESOP, other defined benefits) Do you or the resident have any potential inheritances? Yes No Description: Governmental Assistance: A Special Needs Trust is only needed to protect eligibility for certain types of governmental benefits. The information you provide in this section will help us ensure that special needs planning is appropriate for the person you have identified. From what government programs is this person currently receiving assistance? (For example, Medicaid, Medicare, Social Security, Supplemental Security Income (SSI), Supplemental Security Disability Income (SSDI), rental assistance/hud, food stamps, etc.) Please be careful to distinguish between Medicaid and SSI, which are meanstested programs, and Medicare and SSDI, which are federal entitlement programs. Did this person receive any public aid or assistance before turning 18? If so, what kind of assistance? Yes No Local Office/Contact Name & Case Number: If this person is not receiving Medicaid, how are his/her medical expenses being met? 7