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HomeMy WebLinkAbout10-29-08In re. George A. Gilmer Special Needs Trust) A Petition in the Orphan's Court, ) Court of Common Pleas, ) SS: Cumberland County, Pennsylvania ) Parties in Interest: George A. Gilmer 550 Brown Lane Enola, PA 17025 Social Security Regional Office III Attn: Mandy Stokes, SSI Program Expert P.O. Box 8788 ~~ ~.'-' ~ = Philadelphia, PA 19101 - = -- ~~ `=~' - Commonwealth of Pennsylvania ~' ~ Governor's Office of General Counsel ~ ' ~.a Attn: Lisa B. Dees, Assistant Counsel T' { 3~d FL. West, Health and Welfare Bldg. ~y ~..} 7`h & Forster Streets ~,,, Harrisburg, PA 17120 ~ ORPHAN'S COURT DIVISION No. OAS ~ ~(~~ Petition to Settle Special Needs Trust for the Exclusive Benefit of George A. Gilmer, a disabled person, to appoint Bart W. Holmes, Esquire Trustee, and to authorize withdrawal of twenty-five thousand dollars ($25,000.00) from principal for a handicapped equipped automobile and for handicapped equipment for same. To the Honorable, the Judees of the Said Orphan's Court Division: Facts relied upon: Petitioner, George A. Gilmer, a resident of Cumberland County, Pennsylvania, at 550 Brown Lane, Enola, 17025, who is an adult, disabled individual, as defined in Title XVI of the Social Security Act, 42 U.S.C. Section 1832(c)(a)(3), hereinafter referred to as "Beneficiary," was injured in an automobile accident and collected a settlement from the tortfeasor at Gilmer v. Paige Longstreth, Lehigh County Docket No. 2003-C-271 l'~., said money now deposited in an interest bearing account at Northwest Savings Bank, in the amount of $45,723.18, account number 2656005408 (October 2, 2008 statement oaf account attached as Exhibit A). Beneficiary seeks to establish a Special Needs Trust with the settlement proceeds, to exempt these assets from being included in the determination of Beneficiary's eligibility for, or amount of, medical benefits under a State Plan under the Act (Petitioner"s Consent attached at Exhibit B). The Trust is established in accordance with a special provision of Title XIX of 1:he Act, specifically 42 U.S.C. Section 1396p(d)(4)(A), as amended by the Omnibus Budget Reconciliation Act of 1993 (and any federal or state regulations or other rules promulgated pursuant to that provision) and 62 P.S. Section 1414 Special Needs Trusts, and therefore, the property directed to this Trust shall in no way be deemed to be available to Beneficiary for purposes of determination of benefits. Request for Relief: 1) Beneficiary, having no living mother or father as otherwise required by Statute to establish a Special Needs Trust (Trust), requests the Orphan's Court to act as Settlor for said Trust (Trust Instrument attached as Exhibit C, in accordance with Cumberland County Rules of Orphan's Court Rule 12.6-1, Exhibits to Pe;tition), ordering the deposit of an initial $20.00 dollars into the Trust account (check attached at Exhibit D)(Trust account location to be determined); and, 2) Appoint Bart W. Holmes, Esquire, of 17 Logans Run, Enola, PA 17025, Cumberland County, to act as Trustee (Trustee), without compensation (i['rustee's written consent to act as Trustee is attached as Exhibit E), and; 3) To authorize disbursement from the principal of the Trust, for the purposf; s~==-_--- purchasing ahandicapped equipped automobile and related equipment, the amount of up to $25,000.00 (Social Security Administration and Commonwealth of Pennsylvania Department of Public Welfare consents are attached as Exhibits F and G, respectively). By: -~, Bart .Holm s, Esq ire Attorney for Petitioner 17 Logans Run, Enola, PA 17025 717-802-5756 (cellular) ID# 85071 Date: 0 ~~` NORTHWEST • SAVINGS BANK Where peuple make the difference. - ~ _ - ~ - ~.;s I,,,IIi,,,lll,,,,,ll,,,li,,,1,111,,,1,1.,1.„I~i,l,,,,ll„I,II S ~ DONALD JONES ESCROW AGENT FOR n~ m GEORGE A GIIMER D CIO JONES &HENNINGER ~ 339 W GOVERNOR RD FRNT 201 c HERSHEY PA 17033-2097 a PRlVK)US BALANCE 48, 873.01 ogre ~ oro2/oe 0 J 0 J T 0 ACCOUNT NUMBER STATEMENT DATE 2656005408 10/2/2008 AMO ~~~ V~ ~ SERVIC! CNARO! orHeR oeWri orwa u,eon~ INTEREST EARNED BALANCE TNIe STATEMENT 0.00 0.00 0.00 50.17 45,723.18 DESCRMTKNi eNk'~ oeror» orMC„~on,» ornc~ c~ e'~ANCe CN~K NO . AMOUNT 50.17 48, 723.18 / 'r ~ •~, c '- - i - r:~ ~ - .~ . , %~ . _ - / - L_ i I ; , INTEREST EARNED FROM 9/3/2008 THROUGH 10/2/2008 DAYS IN PERIOD 30 AVERAGE BALANCE ANNUAL PERCENTAGE YIELD EARNED 45,673.01 INTEREST PAID THIS YEAR 1.35 INTEREST WITHHELD THIS YEAR 552.94 APPLY FOR A LOAN ON-LINE AT NOR rHV'/ESTSAVINGSBANK.COM 0.00 OR CALL 1 877-672-5678, M-F 7 AM-8 PM OR S, 8 AM-1 PM. CONSENT OF GEORGE A, GIL1~lER, ~~ DIS~IBLED PERSON ~~ND BENEFICI,aRY OF ;~ PROPOSED SPECIAL NEEDS TRUST BEFORE THE ORPHAN'S COURT OF CL11~iBERLAND COUNTY, PENNSYLV~~I~fIA I, George A. Gilmer, having received a financial settlement as a result of an automobile accident, in the matter of George A. Gilmer v. Paige Longstreth, Lehigh County, Pennsylvania, Docket No. ?003-C-2711, and wishing to establish with the s~ttle~ment proceeds a Special Needs OBRA Trust for my sole benefit, consent and agree tcl the jurisdiction of the Orphan's Court of Cumberland County, Commonwealth of Pennsylvania, for the establishment of said Special Needs Trust, the Trust to be established in accordance with a special provision of Title XIX of the Act, specifically 42 U.S.C. Section 1396p(d)(4)(A), as amended by the Omnibus Budget Reconciliation Act of 1993 (and any federal or state regulations or other rules promulgated pursuant to that provision) and 62 P.S. Section 1414 Special Needs Trusts, so that the property directed to this Trust shall in no way be deemed to be available to me, the sole Beneficiary, for purposes of determination of benefits under Social Security or the Commonwealth of Pennsylvania, Department of Public Welfare. I further request and consent that the Court appoint Bart W. Holmes, Esquire, of 17 Logans Run, Enola, PA 17025, Cumberland County, to act as Trustee (Trustee), without compensation. And finally, I request and consent that the Court authorize Bart W. Holmes, Trustee, at his sole discretion, to withdraw from the principal of the Trust up to the amount c-f - -~ - - $25,000.00, for the purpose of purchasing a handicapped equipped. ~d related handicapped equipment for the vehicle, for my sole benefit. -` George A. Gilmer, Petitioner and Nutar}~ Public: Cindy L. Hadcby, Nohry PubNa Epl P~nn~tJOio Tvrp., CumOMMIW CowAy ,~ v DECL~~R~~TIOiY OF OBRA '93 SPECI~~L ~1EEllS DIS~~BILITY TRCST FOR THE BENEFIT OF GEORGE A. GIL~IER This Declaration of Trust (the "Trust") is established by the Orphan's Court of the Cuurt of Cummon Pleas, Cumberland County, Pennsylvania, hereafter refcrrecl to as "Settlor," and Bart W. Holmes, Esquire, as original Trustee, who shall hereafter be referred to as "Trustee," for the benefit of George A. Gilmer, a disabled person, and by Decree dated the day of , 2008, Settlor, upon signing of this Trust Agreemc;nt and without consideration on Settlor's part, transfer and deliver to the Trustee the sum of twenty dollars ($20.00 dollars), receipt of which is acknowledged, and other certain assets which, together with the interest thereon, shall constitute the trust estate. The trust estate shall be held, managed, administered, and distributed by the Tnastee as hereinafter provided solely for the benefit of George A. Gilmer, who resides at 550 Brown Lane, Enola, Cumberland County, Pennsylvania 17025, who is an adult, disabled individual as defined in Title XVI of the Social Security Act (the "Act"), 42 U.;i.C. Section 1832(c)(a)(3), hereinafter referred to as "Beneficiary." This Trust is established in accordance with a special provision of Title :KIX of the Act, specifically 42 U.S.C. Section 1396p(d)(4)(A), as amended by the Omnibus Budget Reconciliation Act of 1993 (and any federal or state regulations or other rules promulgated pursuant to that provision) which exempts the assets held in the Tn.~st from being included in the determination of Beneficiary's eligibility for, or amount of, medical _ _ benefits under a State Plan under the Act, and in accordance with 62 P.S. Section 1414 ~__-___ Special Needs Trusts, and therefore, the property directed to this Trust shall in no way be deemed to have been or to be available to Beneficiary. -- Bart W. Holmes, Esquire, shall serve hereunder as trustee, for no fee, and hold the sum awarded pursuant to the Orders and any other property acceptable to the trustee which is added to this Trust, and shall manage, invest and reinvest said property, shall collect the income therefrom and shall distribute the net income and principal in accordance with the following provisions: FIRST: A. During disabled Beneficiary's lifetime, all distributions from tt~e Tnist must be for the sole benefit of the disabled individual in compliance with 62 P.S. Section 1414. Payments shall be made of such parts or all or none of the net income and principal as the tnistee shall determine in the trustee's sole and absolute discretion, solely for the special needs of the disabled Beneficiary, subject to the provisions of Item Second herein, except that any distribution from principal shall require obtaining appro~ al from the Settlor, the Orphans' Court Division of the Cuurt of Common Pleas or uther appropriate cuurt, following due notice to all interested parties including the Department of Pr~iblic Welfare and the Social Security Administration. All payments for the Beneficiary's special needs shall be reasonably and rationally related to the disabled Beneficiary's individual disabilities. Any income which is not distributed shall be accumulated and may be (but is not required to be) added to the principal. B. Upon the First to occur of Beneficiary's death or the earlier termination of this Trust, tI1C IfustCe ShAll pay to the State of Pennsylvania, Department of Public Welfare, or any successor agency, and/or any other state which has provided Beneficiary with medical care under a state medical assistance program, as a beneficiary hereunder, an amount which is equal to the lesser of the amount paid to Beneficiary under such plan or plans From the time of creation of this Trust until his death or earlier termination of this Trust (as finally determined by such state or states), or the balance remaining in the Tnist, in accordance with 42 U.S.C. Section 1396p(d)(4)(A). Any portion of the Tnist estate remaining after reimbursement to the Commonwealth as required under this Item shall be paid to Margaret Swab, of 550 Brown Lane, Enola, Cumberland Country, Pennsylvania 17025, or if Ms. Swab should predecease Beneficiary, to Beneficiary' heirs at law under the laws of the Commonwealth of Pennsylvania. Upon the Benefic:iary's death the Trustee shall notify in writing the Third Party Liability Unit of the Pennsylvania Department of Public Welfare: Department of Public Welfare Third Party Liability Casualty Unit Special Needs Trust Repository P.O. Box 8486 Harrisburg, PA 17105 SECOND: A. The trustee has discretion to determine whether or to what extent principal or income shall be distributed to or used for the benefit of Beneficiary (subject to the limitation in section First. A. involving limitations on distribution of principal without leave of court), without further leave of Court after the initial establishnnenE o~-====__~_----` the Trust, and the trustee sTiaTf-consicTeir the resources and sources of funds available to ____ Beneficiary through any state or federal public assistance program in exercising this discretion. In making this determination, the trustee shall consider that the purpose of the Trust is not to supplant public assistance benefit, but to supplement those benefits by providing only for Beneficiary's needs, that is, to provide the extra and supplemental care for Beneficiary which will not disqualify him from any local, state or federal benefits. B. The term "special needs" refers to the maintenance of Beneficiary's good health, safety and welfare when, in the discretion of the trustee, such needs are not provided by any public assistance agency or other public or private source. Such needs may include but are not limited to extra and supplemental medical and dental care, physical and mental health care, nursing and custodial care, therapies, nutrition, socialization, transportation, maintenance, education, equipment, therapeutic travel and recreation and the like over and above the amount of benefits he otherwise receives frorn any local, state or federal government or from any other private or public source. C. The payments authorized in paragraphs A. and B. of this Item shall specifically include the following; (I) Payments for the improvement and/or maintenance of a residence suitable for Beneficiary's special needs, such payments to include all reasonable expenses of insuring, improving, modifying and/or maintaining said residence or of otherwise improving Beneficiary's physical living environment. (2) Payments for the purchase, modification and/or maintenance of a specially equipped van or other vehicle for Beneficiary, with title to such vehicle to be held by the Trust, such payrncnts to include the reasonable costs oti purchasing, financing, insuring, maintaining and operating said vehicle for Beneficiary's benefit. THIRD: The trustee and Settlor are expressly authorized to receive additional property or monies from Beneficiary or any other person and to administer and distribute it as part of this Tn~st. FOURTH: This is a discretionary, non-support trust. No principal or income of the Trust shall be anticipated, assigned or encumbered. The Trust shall not be liable for any debt, contract or engagement of any beneficiary nor subject to any legal process. No part of this Trust estate shall be construed as being subject to the claims of the beneficiary's voluntary or involuntary creditors. The trustee shall deny any request by any public or private entity to disburse Trust funds to support or other care that such entity has the obligation to provide to the Trust beneficiary. Any discretion under this document, if exercised or not exercised, shall be conclusive upon all persons concerned so long as such discretion is exercised in good faith. FIFTH: If Beneficiary's testamentary estate, exclusive of his residence and tangible personal property, shall be insuffi_c~rit~ his debts, funeral expenses, and expenses of the administration of his estate, but only after the satisfaction of the requirements of FIRST (B)(reimbursement of the State of Pennsylvania, Department of Public Welfare, or any successor agency), the trustee may in the sole discretion of the trustee pay any part or all of such debts and expenses out of the principal of this Trust but none of said debts or expenses shall be enforceable against the trustee by reason of this provision. SIXTH: All estate, inheritance and other death taxes and any interest and lpenalties thereon imposed by reason of Beneficiary's death on property forming the princiipal of this trust at Beneficiary's death shall be paid out of the principal of the trust without apportionment or reimbursement. In addition the trustee shall have the power but not the duty to pay from the principal of such trust, either directly or to the personal representative of Beneficiary's estate, as much of such taxes, and interest and penalties thereon, on the balance of his gross estate for tax purposes as the trustee may determine in order to facilitate the settlement of Beneficiary's estate. But no part of SIXTH shall be permitted until after the satisfaction of the requirements of F[RST (B)(reimbursement of the State of Pennsylvania, Department of Public Welfare, or any successor agency). No beneficiary shall be required to refund any part of such taxes, interest or penalties. SEVENTH: ;ill income derived from assets received as principal of this Trust during Beneficiary's lifetime which has accnied when such assets become subject ro this Trust but which is received by the trustee thereafter, whether the same is legally principal or income, shall be applied in accordance with the provisions herein set forth For the distribution of income. EIGHTH: The trustee shall have the following powers during the administration and until the completion of this Trust and any trusts hereunder in addition to any powers given the tntstee by law which the trustee may exercise in the sole discretion of the trustee and without court approval: A. To retain and invest in all forms of real and personal property, including stock, common trust funds and mutual funds of any kind, and including real property to be used as a residence suitable for Beneficiary's special needs notwithstanding the fact that such property is non-income producing, without restriction to investments authorized by law. B. To sell at public or private sale for cash or credit, to exchange, or to lease for any period of time, any real or personal property, to give options for sales, exchanges or leases and to allocate premiums from the sale of options to income or principal. C. To take any and all action which the fiduciary deems necessary to prevent, abate, "clean up" or otherwise respond to any actual or potential violation of any federal, state or local law, rule or ordinance affecting any property held in this Trust - -~-~ ~-=:rtfathd tQ the generation, use, treatment, storage, disposal, release, discharge of, or contamination by, any materials or substances that are prohibited or regulated by federal, ~- state or local law or that pose a hazard to the environment or human health, and to charge the expense thereof to the principal or to income or partly to each. D. To compromise or settle claims without obtaining Beneficiary's consent. E. To make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share, giving consideration to such extent as the trustee determines to the federal income tax basis of such property. F. Subject to the limitations in section First A., in the sole discretion of the tnistec to apply payment of income or principal to which Beneficiary is entitled hereunder directly for his benefit or to pay it to his natural guardian or legally appointed guardian or such other person as the tnistee selects to disburse it For Beneficiary's benefit. The receipt of the person so selected shall be a complete discharge for the; tnistee therefore. G. To repair and maintain any real or pci~tiunal property and to charge the expense to income or principal. H. To arrange for the services of any public or private organization established to assist disabled persons, to monitor Beneficiary's living conditions, evaluate his needs and identify available social, financial, developmental or other programs, and to charge the expense thereof either to principal or to income or partly to each, without liability for any act or omission of any such individual or organization or for any act or omission made in reliance on the advice of such individual or organization provided such person or organization w•as retained with reasonable care and prudence. I. To retain legal or professional assistance in establishing and administering this Tntst and accomplishing its purpose, and to charge the expense thereof either to principal or to income or partly to each, and without liability for any ac;t or omission of any such individual for any act or omission made in reliance on the advice of such individual provided such person or organization was retained with reasonable care and prudence. J. To register investments in nominee name or to hold investments in bearer form. NINTH: All reasonable expenses in establishing, maintaining, administering, and defending this Trust, including but not limited to reasonable attorneys' fees, accounting fees, and costs shall be proper charges to the Trust. TENTH: The situs of this Trust is Pennsylvania and all questions pertaininf; to the validity, construction, interpretation and adm nti stration o~ this Trust shall be determined in accordance with the laws of Pennsylvania and the applicable laws of the United States. ELEVENTH: A. This Trust shall be subject to the continuing jurisdiction of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. B. The Court having jurisdiction of this Trust and the trustee vvith the approval of said Court may amend this Trust so that it conforms with 42 U.S.C. Section 1396p(d)(4)(A), 62 P.S. Section 1414 Special Needs Trusts, and any related statutes or regulations, consistent with the provisions and purposes of OBRA '93 and any amendments thereto. e. ~~nything hereinbefore to the contrary notwithstanding, thetrustee with the approval of said Court, shall have the discretion to terminate this Trust at any time if the trustee in its sole and absolute discretion determines that the continuance of the Trust is impractical, uneconomical or for other reasons unwise. Upon such early termination the trustee shall make any distribution required under Item FIRST, para'raph B, and any remaining principal shall hc• distributed directly to Beneficiary, ur, if Beneficiary is legally incapacitated, to the guardian of his estate or other legal representative in accordance with the Order of said Court. TWELFTH: This Trust ,hall be in•evocable. Notwithstanding any common law or statutory provisions to the contrary, neither Beneficiary's nor any legal representative acting for Beneficiary shall have the right to alter, amend or revoke any provision of this Trust, or to withdraw any funds from this Trust. THIRTEENTH: A. The guardian of Beneficiary's estate shall have the power to remove the trustee, provided that the said guardian appoints another tn~stee, bank or tn~st company to serve in its place. Any successor trustee may likewise be removed and replaced. There shall at all times be a trustee serving hereunder. B. The original trustee, Bart W. Holmes, Esquire, declines to be compensated for his services, but this shall in no way prevent a future trustee from receiving compensation for the performance of its functions as trustee hereunder in accordance with its schedule of fees in effect from time to time during the period in which its services are performed. C. All trustees shall be required to enter bond or other securil:y in this jurisdiction, and the cost of said bond shall be paid out of the income or principal of the trust. IN WITNESS WHEREOF, the Settlor and Trustee have caused this Decl;~ration of Trust to be executed. Attest: Orphans' Court Judge, Settlor By: t~ttest: Bart W. Holmes, Trustee By: 6 I'NrS ;dUlTl f.,. tE ,1i't.A ~)F ' itfi :)r.)l is".tEN! ~.Iinr~~.ES Cc')~UH ~:17,tUI~nLhl .1N0 LvC;^ILY I'~I(JM t:,1NK fO LYGFIf f~) .: 1,fK',YITN '.`,1t7K AriLAS t30fH ~.tF f 1N17 ftt( Ii DRAWEE: SOVEREIGN BANK ~ Sovereign Bank PAY ~~ K K- K k k M: 1. k Y M 1;>O . t)Q PERSONAL MONEY ORDER y~'~ NOT TO EXCEED $1,000.010 ! ~~ I ~ (~( ; , (Ja i ~.1 C f `titi„t, n t i)~, ~:. r DOLLARS t r. - ~ t ~ r. r r ~ - ~ ::'0 . u0 TO THE ~~F•'tLI~L ~lEf::Ut; (f1IJ`~I' la, t:;ILf'ILk ORDER OF PURCHASER INFORMATION • NAME ,PRINT) ~.,~, I~'00320891~' II:23L37269i~: i200i2458811' CONSENT OF PROPOSED TRUSTEE I, Bart W. Holmes, Esquire, of 17 Logans Run, Enola, Cumberland County, Pennsylvania, [ 7025 (717-802-5756), hereby consent to appointment as original Trustee, without compensation, of the Special Needs Trust for the sole benefit of George A. Gilmer, at In re. Gcor~e ,~. Gilmer Special Necdti Trust, in the Orphan's Cuurt of Cumberland Cuunty Pennsylvania, to serve in accordance with the provisions of the proposed Trust at Appendix C of this Petition. Bart W. Holmes, Esquire: ~ ~. ~-1- Date: ' '~~`_~_ Attorney [D No.: 85071. v ~L SgCG~ J/ i ~\ '~~ ~I III ,~2 SOCIAL SECURITY Refer to: S?D3B-1 Regional Office I[I P. O. I3ux 8788 Philadelphia, PA 19101 July 8, 2008 tiir. Bart W. Holmes, Esquire 17 Logans Run Enola, Pennsylvania 17025 Dear Attorney Holmes, Thank you for submitting the subject draft trust for George A. Gilmer. Your letter dated May 1 S, 2008, was misdirected and has just been received by me for review. Without a signed release, I can't release any information due to privacy. However, I can tell you how SSA views the trust submitted. Unfortunately, as currently written, it fails to meet the Medicaid exception which is commonly referred to as a special needs trust. Any assets held in this trust would be a countable resource for SSI purposes. Specifically, trusts which contain the assets of the beneficiary and that aze established January 1, 2000, or later are subject to the new trust provisions enacted on December 14, 1999, under PL 1.06-169. There is an exception for trusts that are established under section 1917(d) (4) (A) of the Social ;Security Act, commonly referred to as special needs trusts. For this exception to apply, all of the following conditions - -~ -- -- for the trust must be met • Established with the assets of an individual under age 65 and who is disabled; an~i • Established for the benefit of such individual by a parent, grand azen le al and P >y g guazdian or a court; • The trust provides that the State will receive all amounts remaining in the trust upon the death of the individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State Medicaid plan. Since FIFTH and SIXTH do not clearly reflect that the payment of funeral expenses and miscellaneous estate administration expenses, along with the power to pay non-trust taxes to settle the beneficiary's estate will only be made after the required reimbursement under FIRST, section B, it would not meet all of the criteria. Only the following types of administrative expenses maybe paid from the trust prior to reimbursement ofinedical assistance to the State: • 'T'ars due from the trust to the State or Federal goy ernment because of the death Hof the beneficiary; ~ Reasonable fees for administration of the trust estate such as an accounting of the trust to a court, completion and filing of documents, or other required actions associated with terniination and wrapping up of the trust. The following expenses and payments are examples of some of the types nut permitted prior to reimbursement of the State for medical assistance: • Payment of debts owed to third parties; • Funeral and estate expenses; and • Payments to residual beneficiaries. The Social Security Administration does not object to the purchase of a vehicle. However, if a vehicle is purchased using the trust's assets, the trust should retain ownership or a lien on the vehicle. The Social Security Administration (SSA) does not administer the Medicaid program. The State is responsible for evaluating the trust and determining if the individual is eligible for Medicaid (i.e., Medicaid is NOT automatic). This is true even though SSA normally makes a Medicaid determination in a Section 1634 state (which Pennsylvania is). Once the trust is revised, you may want to obtain the State's review for Medicaid purposes. I hope this information is helpful. If you have any questions or need to discuss, give me a call at 215-597-043 S. Sincerely, ~; Mandy Stokes SSI Program Expert -- - - _ __ SSI Program Support Team, --- -~----- Philadelphia Region, SSA i ~~, ~ ~~ ,.. COMMONWEALTH OF PENNSYLVANIA GOVERNOR'S OFFICE OF GENERAL COUNSEL October 8, 2008 ~'ia Facsimile Bart Holmes, Esquire Sc;nior Claims Legal Counsel NESRO Regional Practice Group Nationwide Insurance 1000 Nationwide Drive Harrisburg, PA 17110 Hard Copy by Mail Re: George Gilmer Special Needs Trust Dear Attorney Holmes: Please be advised that I have reviewed the Special Needs Trust prepazed on behalf of George Gilmer. Please be advised that the Commonwealth of Pennsylvania, Dep:utment of Public Welfare has no objection to this trust. The disabled beneficiary s assets that aze used to fund the Spuci~Naed~~'rust (SNT) will not be considered an available resource in determining his eligibility for Medical Assistance if he applies for such benefits in the future. However, if the disabled beneficiary has other assets that are not part of the SNT, the County Assistance Office (CAO) may determine that the disabled beneficiary is not eligible for Medical Assistance. In order to assist the Department in making its determination of Medical Assistance eligibility, please provide to the CAO (with a~ copy to me) the documentation regarding the funding of this SNT and any subsequent additions to the SNT. 1 have also reviewed your petition for distribution from principal in the amount of $25,000.00 in order for Mr. Gilmer to purchase a handicap accessible van. The Department does not object to a distribution from this Trust's principal for the purchase of a van. T'hanlc you for your attention and cooperation with the Department. If you have any questions, please feel free to contact me. Sincerely, ~~~,. ~; r , ~ ,iii ~ • ~. ~t.~ ~ Lisa B. Dees , Assistant Counsel -.. ~ L '.. ~. ._IJ I r... ~I -1_i i ,a~/N.~~r'b~l ;f.-lti'~LJ,~~ VERIFICATION I, George A. Gilmer, having reviewed the foregoing Petition and Exhibits, swear or affirm under penalty of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities, that the statements of fact in this Petition are true and correct to the best of my knowledge or belief, and to the extent that any statement in this Petition is a conclusion of law, I have relied upon advice of counsel in making it. George-A:-.~ilmer: Date: r''4 ~ r! ''~ ~ /