HomeMy WebLinkAbout03-01-10~ ~
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. / 9 ~ of U
IN RE: IRREVOCABLE SPECIAL NEEDS TRUST FOR THE BENEFIT OF
JOHN WILLIAM KOELSCH, A MINOR
PRELIMINARY DECREE
AND NOW, this day of
2009, a hearing on the Petition for
Approval of Trust and Expenditure of Principal is hereby scheduled for the,
of , 2009 at m., Court Room
Carlisle, Pennsylvania.
BY THE COURT:
J.
day
271084 244087-1
~ ~
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. ~C1 `-~ of Z~ ~
IN RE: IRREVOCABLE SPECIAL NEEDS TRUST FOR THE BENEFIT OF
JOHN WILLIAM KOELSCH, A MINOR
DECREE
Now, this day of , 2009, in consideration of the
annexed Petition For Approval of Trust and Expenditure of Principal, it is hereby ORDERED
and DECREED that the Court:
A. Approves the John William Koelsch Special Needs Trust, under which Univest
National Bank and Trust Co. is appointed Trustee.
B. Approves the payment from principal of the counsel fee and costs to Timoney
Knox, LLP in the amount of $4,653.25 together with such other time expended and costs
incurred directly related to this Petition and any hearings.
C. Approves payment from principal of up to $12,000.00 for the purchase of an
irrevocable burial reserve.
D. Approves the allocation of the trustee commissions to be paid to Univest National
Bank and Trust Co., 70% to principal and 30% to income commencing upon receipt of funds in
the trust.
BY THE COURT
J.
271084 244087-1
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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IN RE: IRREVOCABLE SPECIAL NEEDS TRUST FOR THE BENEI~'~F ~
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JOHN WILLIAM KOELSCH, A MINOR °~'
PETITION FOR APPROVAL OF TRUST AND EXPENDITURE OF PRINCIPAL
TO THE HONORABLE JUDGES OF THE SAID COURT:
George M. Riter, Counsel for Petitioner, Univest National Bank and Trust Company,
Trustee, respectfully submits the following:
1. John William Koelsch was born on April 18, 1993. He is currently 16 years old
and resides at a residential facility in Pittsburgh. John F. Koelsch is the natural guardian of John
William Koelsch and resides at 36 Jefferson Street, Duncannon, Pennsylvania, 17020.
2. John F. Koelsch, individually and as Executor of the Estate of Kristy Koelsch,
deceased, by and through his trial attorneys, Villari, Brandes & Kline, P.C. filed a Plaintiff's
Petition for Leave to Compromise or Settle a Wrongful Death Action Pursuant to PA. R.C.P.
2206 and for Approval of Structured Settlement with the Court of Common Pleas, Cumberland
County, Docket No. 04-4744.
3. Kristy Koelsch died testate on May 24, 2005 from metastatic breast cancer,
survived by her husband, John Koelsch and their two children, Janelle Koelsch and John William
Koelsch, a minor.
271084
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4. The Court entered an Order dated September 28, 2009, attached hereto as Exhibit
"A'', and subsequently modified on October 6, 2009, attached hereto as Exhibit "B" approving
the settlement, in the matter of John F. Koelsch, individually and as Executor of the Estate of
Kristy Koelsch vs. Angela Soto-Hamlin, M.D. et al., for the distribution of $132,942.16 to John
William Koelsch, a minor, by and through his parent and natural guardian, John F. Koelsch.
The Special Needs Trust for the benefit of John William Koelsch was executed on
October 6, 2009 by John F. Koelsch, parent and natural guardian of John William Koelsch.
Univest National Bank and Trust Co., subsequently accepted it's appointment as Trustee. The
Special Needs Trust was reviewed by the Commonwealth of Pennsylvania Department of Public
Welfare (DPW) and approved. A copy of the trust is attached hereto as Exhibit "C, " and a copy
of the letter from DPW approving the Special Needs Trust is attached hereto as Exhibit "D."
5 In accordance with the Order dated October 6, 2009, cash of $132,942.16 will be
placed in the Special Needs Trust for the benefit of John William Koelsch
6. The minor's parent engaged George M. Riter, Esquire, of Timoney Knox, LLP to
represent him to prepare the Special Needs Trust document for his son, participate in the
finalization of the settlement, and assist with determining the appropriate trustee, and prepare all
additional documents including this petition and related legal work. A copy of the engagement
letter dated August 20, 2009, is attached hereto as Exhibit "E."
7. Petitioner anticipates a bill in the amount of $4,653.25 from Timoney Knox, LLP
for representation and legal services performed regarding the instant Petition, plus costs directly
related thereto but incurred after the date of the invoice, which Petitioner requests be paid from
principal. A copy of the detailed time and billing statement through November, 2009, is attached
hereto as Exhibit "F." The Petitioner requests authority to pay this invoice together with all
271084
3
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other time expended and costs incurred directly related to this Petition from principal of the
Trust.
8. To facilitate planning in the event of the death of the beneficiary, the Trustee
requests the Court's permission to expend up to $12,000.00 of principal for an irrevocable burial
reserve for John William Koelsch. Any unused funds will be maintained in principal.
9. John requires constant care and supervision to keep him safe. Due to his
disability, John receives medical benefits through Medicaid that pay for, among other things, his
placement at a residential facility in
10. To assist the trustee with the financial affairs of the trust, the trustee would
request the Court's permission to allocate the trustee commissions 70% to principal and 30% to
income. A copy of the fee schedule for Univest National Bank and Trust Co., is attached as
11. By letter dated February 12, 2010 via certified mail, return receipt, a copy of
which is attached hereto as Exhibit "H", counsel provided notice of the filing of this Petition,
together with a copy to the following:
Lisa B. Dees, Esquire
Department of Public Welfare
Office of Legal Counsel
3rd Floor West; Health and Welfare Bldg
7th & Forster Streets
Harrisburg, PA 17120
12. The minor's parent has consented to this Petition and said consent is attached
hereto.
WHEREFORE, the Petitioner requests that this Court enter the proposed Decree,
attached hereto, accepting this trust and other relief sought to avoid multiple petitions, as
follows:
271084
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A. Approves the John William Koelsch, under which Univest National Bank and
Trust Co., is appointed Trustee.
B. To approve payment from principal of the counsel fee to Timoney Knox, LLP in
the amount of $4,653.25 together with such other time expended and costs incurred directly
related to this Petition.
D. To approve payment from principal of up to $12,000.00 for the purchase of an
irrevocable burial reserve.
E. To approve the allocation of the trustee commissions to be paid to Univest
National Bank and Trust Co., 70% to principal and 30% to income commencing upon receipt of
funds in the trust.
Respectfully Submitted,
TIMONEY KNOX, LLP
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Geo e M. Riter
Attorney ID #3 8601
Timoney Knox, LLP
PO Box 7544
400 Maryland Drive
Fort Washington, PA 19034
(215) 646-6000
271084
5
VERIFICATION
I, Michael A. Kerns, Trust Officer of Univest National Bank and Trust Co., Trustee of the
Irrevocable Special Needs Trust for the Benefit of John William Koelsch, hereby verify that the
statements made in the foregoing document are true and correct to the best of my personal
knowledge, or information and belief. This verification is made subject to the penalties of 18 Pa.
C.S.A. §4904 relating to unsworn falsification to authorities. „ ~ /~
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IVIic ael A. K `s, Trust Officer
Uni est 'onal Bank and Trust. Co.
Date: Pv~~~72Y TZO~
271084
6
CONSENT
I, the undersigned parent and natural guardian of John William Koelsch, hereby consent
to the counsel fee as set forth in the Petition, purchase of the irrevocable burial certificate, ,the
allocation of the Trustee commissions, and all other relief set forth in the attached Petition.
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F. Koelsch
Date: ~ ~ ~ ~ ~~~
z~~oga
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
JOHN F. KOELSCH, individually
and as Executor of the
ESTATE OF KRISTY KOELSCH .
Plaintiff
vs.
ANGELA SOTO-HAMLIN, M.D., et al.
Defendants.
CIVIL ACTION - LA W
Docket No.:04-4744
JURY TRIAL DEMANDED
ORDER FOR ALLOCATION AND DISTRIBUTION OF SETTLEMEIV'T PROCEEDS
And now, this ~ ~ ~ da of
__ Y ~ , 2009, upon
consideration of the outstanding Petition for Leave to Compromise or Settle a Wrongf cl Death
Action Pursuant to Pa.R.C.P. 2206, the proposed settlement with all defendants having a gross
value of $1,350,000.00 is hereby approved, to be allocated and distributed as follows:
(a) To: 'Villari, Brandes & Kline, P.C. $ 60,975.14
Reimbursement for Costs
(b) To: Villari, Brandes & Kline, P.C.
$ 540,000.00
Counsel Fee
(40% of Counsel Fees or $216,000 shall be paid as a referral fee to Handler,
Henning and Rosenberg)
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(c) The balance, the sum of $748,024.86, hereby allocated 75% to the Wrongful
Death Action and 25% to the Survival Action, and shall be distributed as follows:
i. Wrongful Death Action
1. $561,768.64 for claims under the Wrongful Death Act, to be divided
as follows:
a. $295,884.32 to John Koelsch, as Beneficiary of the Estate of
Kristy Koelsch
b. $132,942.16 to Janelle Koelsch, as Beneficiary of the Estate of
Kristy Koelsch
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
JOHN F. KOELSCH, individually
and as Executor of the
ESTATE OF KRISTY KOELSCH
Plaint
vs.
ANGELA SOTO-HAMLIN, M.D., et al.
Defendants.
CIVIL ACTION -LAW
Docket No.:04-4744
JURY TRIAL DEMANDED
ORDER. FOR MODIFICATION OF THE COURT'S SEPTEMBER 28,-2009 ORDER ~ ~ ~~~ --
FOR ALLOCATION AND DISTRIBUTION OF SETTLEMENT PROCEEDS
And now, this
day of _ ~ , 2009, upon
consideration of Plaintiff s Petition for a Modification of the Court's September 28, 2009 Order
for Allocation and Distribution of Settlement Proceeds, it is hereby Ordered that the Petition is
APPROVED. The September 28, 2009 Order for Allocation and Distribution of Settlement
Proceeds will be modified to reflect that the $132,942.16 payable to John William Koelsh, as a
Wrongful Death Beneficiary of the Estate of Kristy Koelsch, will be held in an escrow account
pending approval of a Special Needs Trust.
J.
Distribution:
Peter M. Villari, Esq.
Nicole T. Matteo, Esq.
VILLARI, BRANDES & KLINE, P.C. ,,G .~,, ~.~ „~r
161 Washington Street Suite 400 ~~'~~~ ~~`" ~ ' : ' ~~ .f` ~ ~~~D
~ ~l7 ~Evi 1t":1~:2'y djl t'r " ''. 4 i .. '' ; ~: i`0 `~-''E~ 4i'1y ~'i`~lt~
Conshohocken, PA 19842
8~ ~h~ s$3~ of Jii;L'~ .n~;i~' ~.~ Cad#~~~2~ Qa.
Craig Stone, Esquire ibis ... '~.~•~- ~ o#-•~-.......,
Marshall, Dennehey, Warner, Coleman & Goggin
4200 Crums Mill Road, Suite B
IRREVOCABLE SPECIAL NEEDS TRUST
FOR THE BENEFIT OF JOHN WILLIAM KOELSCH
THIS AGREEMENT AND DECLARATION OF TRUST is made and entered this
~_day of ac T 2009, by and between John F. Koelsch, parent and natural
guardian of John William Koelsch, a minor, and Univest National Bank and Trust Co.,
(hereinafter referred to as "Trustee"). This Trust is for the benefit of John William Koelsch,
Beneficiary, who is a handicapped and disabled minor (hereinafter referred to as "Beneficiary").
The Trust shall be known as"'The John William Koelsch Special Needs Trust."
BACKGROUND
A. John William Koelsch is a minor individual, born on April 18, 1993, is a
disabled individual within the definition of 42 U.S.C. §1382c(a)(3) and it is likely that he will
never be able to live independently or be competent to handle his own affairs.
B. The primary and express purpose of this irrevocable Trust is to provide
extra, supplemental and emergency care, maintenance, and education in addition to and over
and above any parental legal obligation of support and the funds and/or benefits Beneficiary
otherwise receives or is entitled to as a result of his disability, from any local, state, or federal
government or any other private agencies, any of which provide services or benefits to
handicapped and/or disabled persons (herein called "public benefits"). It is the express purpose
of this Trust to use the Trust Estate only to supplement other benefits received by the
Beneficiary and no part of the Trust Estate shall be used to supplant or replace private health
insurance benefits and public assistance benefits of any local, state or federal agency which has
a legal responsibility to serve persons with disabilities which are the same or similar to the
impairments suffered by the Beneficiary herein.
C. It is the further express purpose of this Trust to provide benefits for the
Beneficiary without interfering with or reducing the benefits to which he is entitled from any
local, state, or federal government, or any other private agency, any of which provide services or
benefits to disabled and/or handicapped persons and to maximize the benefits to the Beneficiary.
This Trust is declared to be a Special Needs Trust and shall be for the sole benefit of Beneficiary.
The purpose of this Special Needs Trust shall be to maintain and support Beneficiary's health,
safety, welfare, education and treatment when such items, products, or services are not provided
by a public agency or government program.
D. Currently, there exist basic living needs, including but not limited to a
suitable home, specially equipped van or other appropriate vehicle, dental care and outdoor
recreation and the like, which public benefit programs for the Beneficiary do not provide. It is
vitally important that the Beneficiary continue to have these programs in order to maintain a
level of benefits which are not likely to be depleted prior to the Beneficiary's death, especially
since the cost of care (not including any emergency needs) is high. In this event, there would be
no coverage for emergencies or supplementation for basic needs. The following Trust provisions
should be interpreted in light of these concerns and the stated intent.
zb~us3-~
E. This Trust is established in recognition of the fact that Beneficiary has a
disability that renders him incapable of providing for his own care or custody and which
constitutes a substantial handicap. In making distributions to the Beneficiary for his special
needs, as herein defined, the Trustee shall take into consideration the applicable resource
limitations of the public assistance programs for which Beneficiary is eligible.
TERMS
I. TRUST ASSETS. The initial property of this Trust shall consist of the net settlement
proceeds distributable to the Trustee to be held, administered and distributed pursuant to the
terms of this Agreement and Declaration of Trust by Order of Court Approving Compromise of
Disputed Claims of Minor in that certain action entitled John F. Koelsch, individually and as
Executor of the Estate of Kristy Koelsch v. Angela Soto-Hamlin, M.D., et al., as Court of
Common Pleas, Cumberland County, Pennsylvania, Docket No. 04-4744. Additional property
may be transferred to this Trust from time to time which, upon acceptance by Trustee, shall
similarly be held by Trustee in accordance with and subject to alI the terms and conditions of this
Trust Agreement, provided, however, that Trustee shall not accept additions to this Trust which,
when combined with the existing assets of the Trust, will cause the total assets of this Trust to
exceed the amount that appears reasonably necessary to meet the special needs of the
Beneficiary. However, no additions may be made to this Trust after the beneficiary has reached
age sixty-five (65), unless authorized and appropriate under the then-existing law.
II. DISPOSITIVE PROVISIONS. The Trustee shall hold, invest and reinvest the
principal of the Trust listed on the annexed schedule and collect the income therefrom, pay all
taxes and other charges that may be made properly against the trust, and distribute the net
income and principal as follows:
A. During the life of Beneficiary, Trustee may pay to Beneficiary, or apply
for Beneficiary's benefit, so much of the income of the Trust Estate as Trustee, in Trustee's sole
discretion, deems necessary, appropriate or advisable for the satisfaction of Beneficiary's special
needs as herein defined, and any income not so distributed may, but need not, be added to the
principal. As used in this Agreement, "special needs" refers to the requisites for maintaining the
Beneficiary's good health, support, education and maintenance, taking into account benefits
available under the laws of the Commonwealth of Pennsylvania, or of any other State,
Commonwealth of the United States or the United States, or from any other source, including,
but not limited to, private health insurance, any of which provide services or benefits to
handicapped and/or disabled persons. "Special needs" is further defined in Paragraph II. C.
herein.
B. During the life of the Beneficiary, Trustee may only pay to, or apply for
Beneficiary's benefit, so much of the principal of the Trust, upon proper petition to the Court
having jurisdiction over the Trust and upon receipt of Court approval of the use of principal for
Beneficiary's special needs as herein defined. Trustee may not use any principal from the Trust
without Court approval and proper notice in accordance with Paragraph VIII. H. herein.
261660-1 2
C. Special needs shall include, but shall not be limited to: medical, dental and
diagnostic expenses and related work, programs of training, education, transportation and
required travel expenses, and treatment, nursing and custodial care, family respite/skilled nursing
care, psychiatric/psychological services, recreational therapy, occupational therapy, speech
therapy, physical therapy, vocational therapy, durable medical needs, prosthetic devices,
medicines and essential dietary needs and supplements, for which there are no private or public
funds otherwise available; medical procedures that are desirable in Trustee's discretion, even
though they may not be necessary or Life-saving; supplemental nursing care and special
rehabilitative services or equipment, differentials in the cost, for shelter or medical equipment or
medical care, between shared and private rooms in institutional settings; care appropriate for
Beneficiary that assistance programs may not or do not otherwise provide and such personal non.-
publicly funded items such as clothing, furniture, required and necessary custodial
companionship and cultural expenses. Trustee shall be under no obligation to expend principal
or income for such needs, but if Trustee, in Trustee's discretion, decides to do so, in no case shall
Trustee pay or reimburse any amounts to the federal or state governments, or any subdivision
thereof except as provided herein.
Trustee's discretion:
In making such distributions, the following shall apply to the exercise of
(1) Beneficiary shall have no right to control the amount or frequency
of any distributions from this Trust.
(Z) Trustee may, but is not required to, make any distributions from
this Trust for the support, health, maintenance and education of the Beneficiary.
(3) Beneficiary shall have no right to compel distribution of income or
principal. Trustee is prohibited from making any distribution which will reduce or render
Beneficiary ineligible for any public benefits.
(4) In making distributions to the Beneficiary for his special needs, as
herein defined, Trustee shall take into consideration the applicable resource limitations of the
public assistance and private health insurance programs for which Beneficiary is eligible.
Furthermore, in accordance with 62 P.S. § 1414(b)(3)(ii) expenditures from the trust must have a
reasonable relationship to the needs and requirements of the beneficiary.
D. No part of the income or corpus of the Trust created herein shall be used
to supplant or replace any public assistance benefits of any county, state, federal or other
governmental agency which has a legal responsibility to serve persons with disabilities which are
the same or similar to the impairment(s) of the Beneficiary herein. For purposes of determining
the Beneficiary's Medicaid eligibility, no part of the principal or undistributed income of the
Trust Estate shall be considered available to said Beneficiary. In the event the Trustee is
required by the Beneficiary or any person or entity on the Beneficiary's behalf to release
principal or income of the Trust to or on behalf of the Beneficiary to pay for equipment,
medication, or services which Medicaid is authorized to provide (were it not for the existence of
this Trust), or in the event Trustee is requested by the Beneficiary or any person or entity on the
Beneficiary's behalf to petition the Court or any other administrative agency for the release of
Trust principal or income for this purpose, Trustee is authorized to deny such request and is
authorized in its discretion to take whatever administrative or judicial steps may be necessary to
261660-1 3
continue the Medicaid eligibility of the Beneficiary, including obtaining instructions from a
Court of competent jurisdiction ruling that the Trust corpus is not available to the Beneficiary for
Medicaid eligibility purposes. Any expenses of Trustee in this regard shall be paid from the
principal of the Trust Estate. The Trustee shall not be held responsible for any discretionary
payment of an expense or obligation that is later determined to have been properly payable by
any insurance or governmental entity or pursuant to any government benefit or other program.
E. The payments herein authorized shall specifically include:
(1 } The payment from principal for the purchase of a residence, including,
architectural costs and the improvements to the residence necessary to make the residence
handicapped-accessible and properly equipped for the safe and appropriate care of Beneficiary,
given his special needs, i.e., lifts, transfer devices, ramps, etc. Trustee must petition and receive
Court approval for all expenditures from principal for the purchase and sale of any real estate,
any modifications to a residence, the payment of taxes, maintenance, insurance and related
expenses. The Trustee may set forth a budget for the Court's review and approval. Trustee is
permitted to make additional payments from income or principal, if necessary, for the payment
of taxes, utilities and for insuring and maintaining of said residence in sound condition, subject
to Court approval. If the Trustee in the Trustee's discretion deems it appropriate, Trustee may
purchase the residence and obtain a mortgage and the Trust shall be permitted to pay all
mortgage related expenses. Title to the residence shall be held in the name of the Trust or the
Trustee under this Trust. In the event members of the Beneficiary's family members (excluding
siblings under the age of 18), relatives, friends and acquaintances, etc., should reside at any time
at the residence purchased and owned by this Trust, such persons shall pay to the Trustee a
proportionate share of the expenses associated with residing in, and the maintenance of, the real
property, such as, but not limited to, payment for taxes, mortgage payments, a rental fee if there
is no mortgage on the property (fee to be a reasonable amount to be determined by the Trustee in
its discretion), insurance, utilities and property maintenance costs. The Trustee shall have
discretion, should the circumstances warrant, to adjust the proportionate share of the expenses
provided for above, due to the fact that a disproportionate share of said expenses are directly
related to the beneficiary's needs. If the trust assets are utilized to remodel and adapt the family
residence, then that portion of the value of the family residence house shall be deemed a trust
asset and must be secured by judgment lien, secured note, deed reflecting percentage ownership
interests or otherwise.
(2) A payment from principal for ahandicapped-accessible vehicle with
complete modifications to accommodate Beneficiary's needs. Trustee is permitted to make
additional payments from income or principal, if necessary, for the maintenance, repair, gas,
insurance and all other expenses directly related to the maintenance and operation of the van or
such other appropriate vehicle for the benef t of the Beneficiary. To the extent Trust assets are
used to purchase a vehicle for the Beneficiary, the Trustee shall secure the Trust's contribution
by filing a lien of record against the title to the vehicle. Furthermore, title shall be in the name of
the appropriate responsible parent and natural guardian of the Beneficiary or such other
individual or Court appointed guardian.
(3) Prepayment of funeral and burial expenses.
(4) Payments for the continued services of a life care planner, or other
similar expert agencies and individuals to assess and monitor Beneficiary's needs and to provide,
261660-I 4
recommend and/or facilitate the provision of care, testing, monitoring, treatment, equipment,
assistive devices, educational devices, therapy, transportation, etc., to meet the life care needs of
the Beneficiary. Such payments may be made from principal should income from the Trust be
insufficient to cover such expenses.
In hiring such agents to determine the Beneficiary's needs, what benefits
are available for Beneficiary and what payments will not jeopardize those benefits, the Trustee
shall be able to rely in good faith on the recommendations and findings of the experts.
F. Trustee shall be required to perform the following duties during the period
of time that it serves as Trustee of the Trust;
(1) Trustee shall be required to file the appropriate petition with the
Court having jurisdiction over this Trust regarding any use of principal.
(2) Trustee may engage the services of a life care planner, or other
similar expert agencies and individuals, to visit the Beneficiary and Beneficiary's family, to
inspect and review all aspects of the Beneficiary's care, condition (physical and mental),
environment, health care and medical and related equipment needs, as well as facilitate and assist
with medical coverage and any other appropriate benefit.
(3) Trustee shall prepare any necessary income tax returns and provide
tax information to the parent and natural guardian or other Court appointed guardian of the
beneficiary. The Beneficiary may be required to include in his taxable income part or ail of the
taxable income earned by this trust during the Beneficiary's lifetime (including realized capital
gains), report such income on his personal income tax return and pay the income tax due with
respect to such income, under the Internal Revenue Code or other tax jurisdiction. To the extent
that the Beneficiary is required to include in his taxable income any portion of the income earned
by this Trust and pay the income tax due with respect to such income, the trustee shall pay to
Beneficiary's parent and natural guardian or such other appropriate guardian, or to the tax
authorities, from principal, without further court approval an amount equal to the increase in
income taxes, and interest and penalties thereon, payable because the Beneficiary is required to
include all of or a portion of the income of this Trust in his taxable income. However, if under
applicable laws the Trust is permitted to retain the tax consequences of the operation of the
Trust, the Trustee may, in its sole discretion, file the income tax return in whole or in part in the
Trust's name and pay the income tax due out of principal without the need for further court
approval. After the Beneficiary's death, income taxes shall be paid under ordinary fiduciary
income tax rules.
(4) If any distribution under the terms of this agreement would create a
taxable event for the beneficiary that would make the beneficiary ineligible for public assistance
programs from any government agency, the Trust shall be responsible for the payment of taxes
attributable the distribution.
G. Upon the death of the Beneficiary:
(1) Trustee shall pay out of the Trust Estate to the Commonwealth of
Pennsylvania, Department of Public Welfare (DPW), or any other such governmental entity
entitled to reimbursement an amount equal to any unpaid valid lien for medical assistance
261660-1
provided to the Beneficiary to the extent, and only to the extent, as required by 42 U.S.C.
§ 1396(p)(d)(4)(A). If more than one state has provided medical care subject to repayment under
42 U.S.C. § 1396(p)(d)(4)(A) and the balance remaining in the Trust is insufficient to pay each of
those states in full, the balance to be paid shall be on a pro-rata basis to such states.
(2) Trustee may, in Trustee's discretion, pay out of the Trust Estate the
Beneficiary's last illness and funeral expenses, attorney's fees and other costs incurred in
administering the Beneficiary's probate estate, other obligations incurred for the Beneficiary's
support and any estate, inheritance taxes or death taxes (including interest and penalties thereon)
arising by reason of the Beneficiary's death. However, such payments are subordinate to the
repayment requirements of Social Security or the Commonwealth of Pennsylvania, Department
of Public Welfare or that of any state or territory of the United States.
H. Upon the death of Benef ciary, Trustee shall distribute the then-remaining
principal, together with any accrued, accumulated and undistributed income, if any, of the Trust
Estate, net of any and all expenses related to the administration of the Beneficiary's estate and
any and all liens, if any, and any and all inheritance and estate taxes, together with any interest
and penalties to Beneficiary's heirs-at-law, their identities and respective shares to be determined
according to the laws of the Commonwealth of Pennsylvania, then in effect relating to the
succession of separate property not acquired from a parent, grandparent or previously deceased
spouse. However, the interest of any legal parent of the Beneficiary, who is or would be
considered an intestate heir, who has not paid or provided child support to the Beneficiary, shall
have his intestate interest reduced by ten percent (10%) per year that such parent failed to pay
child support, whether or not mandated by a Court, even if this results in no inheritance for such
parent or any of such parent's legal heirs.
III. TERMINATION OTHER THAN UPON DEATH OF BENEFICIARY. In the
event that it is determined, by a court of competent jurisdiction, that this Trust renders the
Beneficiary ineligible to receive any governmental assistance benefits or private health benefits,
or that notwithstanding the provision set forth in Paragraph V below, this Trust maybe subject to
garnishment, attachment, execution or bankruptcy proceedings by a creditor of said Beneficiary
or by the federal or state government, or any agency or subdivision thereof, then Trustee shall
terminate this Trust and distribute the remaining principal and accrued income to such person, or
friend of the court, as the court may direct (but in no event to a creditor of Beneficiary). The
court may direct that such recipient conserve, manage and distribute the proceeds of the former
Trust Estate for the benefit of Beneficiary in accordance with the provisions set forth in this
Trust for his benefit. In determining whether the existence of this Trust for the benefit of
Beneficiary has the effect of rendering him ineligible to receive any governmental assistance
benefits or private health insurance benefits to which he would otherwise be entitled, Trustee is
hereby granted full and complete discretion to initiate administrative and/or judicial proceedings
for the purposes of determining eligibility, and all costs related thereto, including reasonable
attorneys' fees and costs, shall be a proper charge to the Trust Estate. This paragraph is subject
to the terms set forth in Paragraph II. G. herein.
IV. DISABILITY PROVISION. If at the time fixed in this Agreement, or selected by
Trustee under the provisions hereof, for any distribution of income or principal, any beneficiary
entitled thereto shall be a minor, shall have been adjudicated as incompetent, or shall be, in the
sole judgment of Trustee, otherwise unable to apply such income or principal to his own best
interest and advantage, the right to the property to be distributed shall vest in such beneficiary,
261660-1 6
but during the existence of such disability the income or principal to which such beneficiary is
entitled may be retained by Trustee, who in that event shall hold, invest or reinvest it and use as
much of such income or principal as Trustee, in its sole discretion, may deem appropriate for the
support, maintenance, education and welfare of the beneficiary, either by the payment of bills
directly, or by payment to such persons as Trustee may select, without the intervention of a
guardian, committee or other fiduciary. The receipts of such payees shall be a full and complete
discharge of Trustee with respect to such payments. Upon termination of the disability, the
unexpended income and principal shall be distributed to the beneficiary. If the beneficiary dies
during the existence of the disability, the unexpended income and principal shall be distributed to
the personal representatives of his estate, subject to the terms set forth in Paragraph II. G. herein.
V. SPENDTHRIFT PROVISION.
A. As long as the income or principal to which any beneficiary may be
entitled is in the possession of Trustee and not actually distributed by them, such beneficiary
shall not have the right to anticipate or alienate such income or principal by assignment or by any
other means, it shall be free and clear of the beneficiary's debts and obligations, and shall not be
taken, seized or attached by any process whatsoever.
B. Should Trustee so desire, Trustee may, as a condition precedent, withhold
payments of principal or interest under this Trust until personal order for payment is given or
personal receipt furnished by each such Beneficiary as to such Beneficiary's share. Trustee may,
however, deposit in any bank designated in writing by a Beneficiary, to such Beneficiary's
credit, income or principal payable to such Beneficiary. Nothing contained in this Paragraph
shall be construed as restricting in any way the exercise of any power of appointment granted
hereunder. Furthermore, because this Trust is to be conserved and maintained for the special
needs of the Beneficiary throughout his life, no part of the corpus thereof, neither principal nor
undistributed income, shall be construed as part of the Beneficiary's estate or be subject to the
claims of voluntary or involuntary creditors for the provisions of care and services, including
residential care, by any public entity, office, department or agency of Commonwealth of
Pennsylvania or any State, or Commonwealth of the United States or the United States or any
governmental agency.
VI. APPLICATION FOR BENEFITS.
A. In the event Beneficiary is unable to do so himself, in the exercise of best
judgment and fiduciary duty, Trustee shall assist, the parent and natural guardian or such Court
appointed guardian, in seeking support and maintenance for Beneficiary from all available public
and private resources, including but not limited to, Social Security Administration benefits,
Veteran's Administration benefits, Supplemental Security Income (SSI), U.S. Civil Service
Commission benefits, old age survivor and disability program (OASDI), Medicare and Medicaid
benefits, and private health insurance and in that regard, Trustee may collect, expend and
account for separately all such benefits, but not co-mingle them with funds of the Trust Estate.
Trustee shall not be obligated to or responsible for the application for such benefits. Trustee
shall take into consideration applicable resources and income limitations of any of these public
programs or private agencies for which the Beneficiary is eligible in determining whether to
make any discretionary distributions hereunder. Payments or distributions from this Trust which
will result in the loss of governmental or other benefits to which Beneficiary is or may be
entitled are expressly forbidden. The Trustee shall not be held responsible for any discretionary
261660-I 7
payment of an expense or obligation that is later determined to have been properly payable by
any insurance or governmental entity or pursuant to any government benefit or other program.
B. Trustee may invest in and hold property which is used as the principal
residence, furniture, handicapped-accessible vehicle and other items meeting the "special needs"
of the Beneficiary despite the fact that such property is non-productive of income. Any such
property may also be used by persons providing care for Beneficiary without charge for the use
of such property, provided such use is for the benefit and further assistance of the Beneficiary,
subject to the provisions of Paragraph II. E. (1).
C. All public assistance benefits of Beneficiary and all earnings of
Beneficiary shall not be co-mingled with other Trust assets but any such funds transferred or
paid to Trustee shall be separately held by Trustee. Nothing in this provision shall be construed
to require the addition to the Trust Estate of either public assistance benefits or earnings received
by, or on behalf of, Beneficiary.
VII. TRUST IRREVOCABLE. This Trust shall be irrevocable and shall not be
altered, amended, revoked, or terminated except by the Trustee as (1) is permitted by law while
retaining the irrevocable nature of this Trust, and (2) necessary to respond to the requirements of
the administrative agency with the authority to dispense public benefits or regulate this Trust or
Trustees. This Trust is subject to the continuing jurisdiction of the relevant Orphans' Court of
Common Pleas, including the Court's right to modify or terminate, for cause shown, although
this Trust is otherwise irrevocable.
VIII. POWERS OF TRUSTEES. During the continuance of the Trust established
hereunder, and after its termination for the purpose of making final distributions, Trustee, and its
successors, shall have the following powers, which they may exercise as often as they may deem
advisable without application to or approval by any court, except to the extent such powers have
been limited by the Court having jurisdiction over this Trust Estate:
A. To invest the Trust assets in such legal and authorized investments as
permitted in accordance with the Prudent Investor Rule and the Principal and Income Act, as
adopted and amended, in the jurisdiction having jurisdiction over this Trust, during the term of
the Trust, using judgment and care under the circumstances then prevailing that persons of
prudence, discretion and intelligence exercise in the management of their own affairs, not in
regard to speculation but in regard to the permanent disposition of their funds, considering the
probable income as well as the probable safety of their capital, always maintaining the
Beneficiary's needs as the purpose of the Trust. Trustee shall be permitted to administer the
Trust in accordance with §8103 et seq. of the Pennsylvania Probate Estates and Fiduciaries Code.
B. To sell and convey all or any part of any real estate which may at any time
be held hereunder, at public or private sale, at such time or times, for such price or prices, and
upon such terms as to cash or credit, as they deem proper and upon proper approval from the
Court having jurisdiction over this Trust, free and clear of all trusts and limitations; and to satisfy
of record any mortgage belonging to the Trust.
C. To retain, to hold unregistered, to sell, to invest, to resell and to reinvest,
all or any part of the Trust assets which may come into their hands, in such manner and in such
stocks, whether common or preferred, bonds, obligations, investment companies, investment
trusts, partnership interests (general or limited), mutual funds, or other real or personal property,
261660-1
and upon such terms and for such length of time, as Trustee shall deem best for the interests of
the Trust, it being intended hereby to give Trustee full and complete authority to hold, possess,
manage, control, sell, convey, encumber, tease for such term, as authorized by statute.
However, the Trustee is not permitted to invest any of the Trust assets in the stock of the then-
serving Corporate Trustee or its parent company, affiliates, successors or assigns at any time
unless specifically authorized to do so by the Court having jurisdiction over this Trust.
D. To borrow such sums of money as may be required for the purposes of the
Trust, to secure the loan by a pledge or mortgage of all or any part of the Trust property; and to
execute an accompanying bond, plain or collateral notes, or other evidences of indebtedness.
E. To employ such accountants and attorneys, as Trustee, in its discretion,
deems appropriate and to pay said advisors their customary and normal hourly rates or such other
fees and to pay for same out of income or principal or partly each, including the costs and fees of
counsel to prepare this Trust document and to counsel the family and Trustee on the terms and
ramifications of this Special Needs Trust and any court appearances and for counsel to interpret
issues arising under this Trust and its terms. Other agents or advisors may be engaged after
obtaining proper Court approval.
F. To select one or more depositories and to authorize payment out of any
accounts on checks signed by such person or persons as they may designate in writing, and to
delegate to such person or persons as they may designate in writing access to any safe deposit
box or boxes they may rent.
G. To determine whether money or property coming into their possession
shall be treated as principal or income; to charge or apportion expenses and losses to principal
and/or income in such manner as they may deem just and equitable, in accordance with
applicable law; and to bind beneficiaries and distributees by their judgment therein.
H. Trustee shall be obligated to f le a copy of the Trust, upon approval by the
Court with the Special Needs Trust Depository, TPL Section, ATTN. Manager, P.O. Box 8486,
Harrisburg, Pennsylvania, 17105-8481. Trustees must also notify the Special Needs Trust
Depository, TPL Section of any amendment to the Trust and when the Trust terminates. The
Department of Public Welfare of the Commonwealth of Pennsylvania and/or any other state
must receive notice of any and all petitions for the use of principal and the filings of any account
with the Court.
I. If the size of the principal is such that it does not warrant the cost of
continuing this Trust, or if its administration would be otherwise impractical Trustee may
prepare and file an account with the Court and only upon Court approval terminate this Trust and
make distribution to such individuals as the Court directs in its order. This paragraph is subject to
the terms set forth in Paragraph II. G. (1) herein.
IX. TRUSTEE'S LIEN. Trustee shall have the first lien upon the Trust for any tax,
charge, claim or payment which it, as Trustee, may be required to liquidate and discharge.
X. TRUST ACCOUNTS. Trustee shall be entitled at any time to have a judicial
settlement of its accounts in the Court having jurisdiction over the Trust. Trustee must file an
261660-I 9
accounting with the Court upon the termination of the Trust or upon a change of the situs of the
Trust or upon a change of the Trustee of the Trust.
XI. "TRUSTEE" DEFINED; WAIVER OF BOND. Wherever in this Trust the term
"Trustee" has been used, the term shall mean the Corporate Trustee that at the time is entitled
and qualified to act as such, whether originally appointed, substituted or succeeding, except a
Trustee specifically excluded with respect to any power or provision. The initial Trustee shall
not be required to file bond or give security in any jurisdiction in which it may act. However, in
the event of a change in the Corporate Trustee for any reason, the current Trustee must file the
appropriate petition with the Court and demonstrate the financial stability of the successor
Corporate Trustee in order for the Court to determine whether or not a fiduciary bond will be
required.
XII. DEFINITIONS.
A. Whenever appropriate in this Trust, the singular shall be interpreted to include
the plural, and vice versa; the masculine to include the feminine, and vice versa; and each of
them to include the neuter, and vice versa.
B. For all purposes hereunder, the word "property" shall be taken to include real
and personal property and any interests of any kind in any real or personal property.
XIII. HEADINGS FOR REFERENCE. The headings or titles preceding the paragraphs
of this Agreement are provided only for convenience of reference and shall not be used to restrict
or explain the meaning, purpose or effect to any of the provisions to which they refer.
XIV. TRUSTEE AND SUCCESSOR TRUSTEE.
A. Number and Classes of Trustee. The Trust shall at all times be administered
by a Corporate Trustee.
B. The named trustee is the original Trustee hereunder. If the Trustee shall fail or
cease to serve, the Guardians shall select a successor Trustee and file the appropriate petition
with the Court to obtain the Court's approval of the proposed successor Trustee. At all times
there shall be a Corporate Trustee.
C. No person dealing with Trustee shall be required to see to the application of
any purchase monies, other consideration, or loan proceeds; or to inquire into the validity,
necessity or propriety of any transaction to which Trustee may be a party.
D. No person acting as Trustee shall participate in any discretionary decision
which may result in a distribution to such Trustee as a beneficiary or which would fulfill a
support obligation of such Trustee.
E. Trustee and Successor Trustees Appointment:
1. Initial Appointment of Trustee. The initial Trustee is specified at the
beginning of this Agreement. By execution and delivery of this Agreement the Trustee
261660-1 j Q
undertakes, faithfully and to the best of its ability, to participate in the administration of the Trust
strictly in accordance with the applicable law and the provisions of this Agreement.
2. Subsequent Appointment of Trustee. The Guardians at any time and from
time to time shall have the power to fill any vacancy in the office of Trustee by a corporation
eligible to fill such vacancy by petitioning the Court for approval of the appointment of a
corporation eligible to hold the office of Trustee.
F. Successor Trustee Not Responsible For Acts of Predecessor No successor
Trustee shall be obligated to examine the accounts, records, or acts of a previous Trustee, nor
shall any such Trustee in any way or manner be responsible for any act or omission to act on the
part of any such previous Trustee. Any claim or action against any such Trustee shall, in any
event, be filed by a beneficiary in the appropriate court.
G. Resi ng ation: Any Trustee may resign at any time but only with court
approval and the appointment of a successor Trustee. Should a corporate fiduciary resign as
Trustee of any trust under this Agreement, the procedure for appointment of a successor Trustee
shall be the same as that in Subparagraph I.6. of this Article, with the exception of the last
sentence in such paragraph.
H. Compensation: The Corporate Trustee shall receive compensation in
accordance with its standard schedule of fees in effect from time to time or as otherwise agreed,
but not to exceed the standard schedule of fees, during the period while its services are
performed. The Corporate Trustee shall disclose all fees and ancillary costs and charges related
to using its proprietary investment funds and common trust funds.
I. Substitution: The Corporate Trustee of the Trust may be removed for any of
the reasons stated herein. Any such removal shall be accomplished by a writing setting forth the
grounds for removal and the successor Corporate Trustee signed by the Guardians and the
acceptance of the successor Corporate Trustee. The Guardians shall file the appropriate petition
with the Court setting forth the reasons for the change in Corporate Trustee and requesting Court
approval. The change shall only be effective upon receipt of Court approval. A Corporate
Trustee maybe removed upon any one of the following grounds:
1. There exists a difference in the domicile of the Corporate Trustee and that
of one or more of the beneficiaries, such that greater convenience to the beneficiaries or their
families can be achieved by changing the Corporate Trustee; or
2. The costs of the administration of the Trust can be reduced by the removal
of the Corporate Trustee and the appointment of a successor Corporate Trustee; or
3. The Trust administrator appointed to the Trust established hereunder has
less than five (5) years of trust administration experience or is changed more frequently than
every three (3) years; or
4. The investment officer appointed to the Trust established hereunder has
less than five (5) years of investment experience or is changed more frequently than every three
(3) years; or
261660-1
5. The Corporate Trustee merges with a larger entity, and/or there exists such
friction and differences between the beneficiaries and the Corporate Trustee with respect to the
proper administration and management of the Trust as, in the opinion of counsel for the Trust,
would make a change of the Corporate Trustee appropriate and desirable. Not withstanding prior
provisions of this paragraph, in the event that the exercise by the beneficiaries of, or the right of
the beneficiaries to exercise the foregoing power of removal, or the participation of any
beneficiary in such exercise or right to exercise, shall at any particular time have the effect of
making the whole or any part of the Trust Estate of the Trust taxable to any one or more of the
beneficiaries for income, gift or estate tax purposes under the United States Internal Revenue
laws enforce and effect at such time, then such beneficiaries shall not have at such time the right
to exercise or participate in the exercise of such power and shall be deemed not to have exercised
or participated in the exercise of the same.
6. Furthermore, the Beneficiary's parents or guardians may initiate this right
of removaUappointment for any reason upon written notice to the current trustee and acceptance
by the successor trustee, subject to Court approval; however, such power may not be exercised
more often than once every twenty-four (24) months.
XV. EXCLUSION OF ENVIRONMENTAL LIABILITY. The Trustee shall not. be
liable for any loss or depreciation in value sustained by the Trust as a result of the Trustee
acquiring any real property upon which there is later discovered to be hazardous materials or
substances requiring remedial action pursuant to any federal, state or local environmental Iaw,
unless the Trustee contributed to the loss or depreciation in value through willful default, willful
misconduct or gross negligence.
XVI. SI'TUS OF TRUST. This Agreement has been executed and accepted in the
Commonwealth of Pennsylvania which is hereby designated as the original situs of the Trust
herein provided. Trustee may at any time change the situs of a Trust to another jurisdiction only
after obtaining Court approval of the change; provided, however, that the law of the original situs
shall control the construction and administration of the Trust after the change unless Trustee,
unanimously, agree that the law of the new situs shall control.
XVII. ACCEPTANCE OF TRUST. Trustee acknowledges receipt of the monies,
investments, securities, policies and other property listed in Schedule "A", accept the Trust
hereby created, and agrees to carry out the provisions of this Agreement.
IN WITNESS WHEREOF, John F. Koelsch, Parent and Natural Guardian of John
William Koelsch, and the Trustee, have hereunto set their hands and seals the day and year first
above written.
(SEAL)
ohn F. Koelsch, Parent and Natural
Guardian of John William Koelsch, a Minor
261660-1 12
ACCEPTANCE BY TRUSTEE
I, Michael A. Kerns, Trust Officer with Univest National Bank and Trust Co., hereby
accept this Trust. „ ~ ,,~.,
Witness/Attest:
~ j~'' ~,`ti`~ `°P
By: ,./ `'~ ~~~G'' (SEAT,)
Mic a ems, Trust Officer
Uni t National Bank and Trust Co.
261660-1 13
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF MONTGOMERY
ss.
On this ~ ~~ day of C~C~~I~~~ , 2009, before me, a Notary Public in
and for the Commonwealth and County aforesaid, personally appeared. the within-named John F.
Koelsch, known to me (or satisfactorily proven) to be the person named in the foregoing
instrument, who acknowledged that he signed this Irrevocable Special Needs Trust, as the parent
and natural guardian of John William Koelsch, for his act and deed and desired that the same
might be recorded as such.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal.
~.
(SEAT:)
Notary Public
NOTARIAL SEAL
HELEN F. KLINEPETER, Notary Public
Penn Twp., Perry County
any Commission Expires Nov. 21, 2009
267083-1 1 4
AFFIDAVIT
i COMMONWEALTH OF PE1V'NSYLVANIA
ss
COtJN'TY OF C"~ ~ cv `'c~v ~-~.~~+~ .
On this, the ~ s~ day of C,-~c-• ~-~, 2009, before me, the undersigned Officer,
personally appeared, Michael A. Kerns, Trust Officer, on behalf of Univest National Bank and
Trust Co., known to me or (satisfactorily proven) to be an Officer of Univest National Bank and
Trust Co., whose name is subscribed to the within instrument and that he executed same and that
he duly acknowledged that he executed same for the purposes therein contained.
IN V'i~[TNESS WHEREOF, I hereunto set my hand and official seal.
NOTARY PUBLIC ~~
My commission expires: ~ ~ ~--a ~ ~..
CC}MiVit~NWirAt~'fii-t t~F 9~'~.~l~t~"'~I.VANIA
~io4arsai Seai
Victoria A Msupf~~~. ~tot2ary Public
Souderton Boro, Mr~~tc~mery County
My CcxrEmis.~ic-are r~x~~r~~ .,an~8, 2012 -
. Member: p~;s1t~ ~, - ~; , E~=;rc~r.I=~ESCjra r}f hlc~iaries - - ..
j 261660-1
~`
IRREVOCABLE SPECIAL NEEDS TRUST
FOR THE BENEFIT OF JOHN WILLIAM KOELSCH, MINOR
SCHEDULE A
Cash ........................................ ....$132,942.16
Note: Figures are approximate pending final approval of the trial Court.
261660-1
DEC. 23. 2009 5.47PM
r~
COMMQNWEALTH OF PENNSYLVANIA
GQVERNOR'S OFFICE OF CENERAI COUNSEL
Via Facsfmfle (2xS-591-8252)
George M. Biter, Esquixe
'f~oneyKnox, LLP
P.O. Box 7544
Fort Washington, PA 19034
hard Copy by Mail
December 23, 2009
Na, 6386 F. 2
ate: Irrevocable Specfal Noeds'~~ruust for the Benefit of John Wfllfam ~oelgch
pear Attorney triter:
Please be advised that I have re~vie~ved the Txxevocable Special Needs Trust far the
Benefit of John William Koelscb. The Commonwealth of Pezmsylvania, Department of Public
Welfare has no objection to thzs Special Needs Trust ("SNT"},
John Koelsch's assets that were used to fund the SNT will not be considered an available
resource in determining his eligibility for Medical Assistance. Yf robn Koelgch hag other assets
that are not part of the SNT, the County Assistance Office ("GAO") may deteizni~Ie that he is not
eligible for Medical Aasista~nce. In order to assist the Department i,xt making its determination of
Medical Assistance eligibility, please provide to the CAO (with a copy to me) the documentation
zegarding the funding of this SNT amd any subsequent additions to the SNT.
Thank you for your attention and cooperation with the Department, If you have any
questions, please feel free to contact me.
c: 'Z'PL
Sincerely,
Lisa B. Dees
Assistant Counsel
OFFICE OF CMIEF COUlAlSEL I aEPARTMENT OE PUBLIC WELFARE
;i FL, vd$:-:T, NEkI.TH s?~ ~+V$LFAa$ PI.gG, 17' ' ~ FGRSTER STREETS ~ HARRISBURG, RA ],7120
~h: 7~,7-7$$-~Cpq I FK~ 717-772-0717
IMON EY OX p
~~
Attorneys a t L a w
Thomas J. Timoney
Mark E. Weand, Jr.
Michael O'Hara Peale, Jr.t
Charles J. Weiss
James M. Jacquette
Herman J. Weinrich"
John J. McAneney*t#
George M. Ritert
Scott H. Wolpert*
Richard L. Caplan
Catherine M. Harper
David S. Reno
Michael E. Eisenberg'
Joseph T. Thlroway
Mark F. Waimer
Ann Thornburg Weiss
Karen Schecter Dayno*t
Thomas A. Boulden
Carol A. Crisci
Jean Bond Brown
Kevin P. Schmidt*
Joshua 5. Ganz*
Of Counsel
John P. Knox
John V. Hasson
Edward T. Egan+
August 20, 2009
Mr. John Koelsch
36 Jeffers.~r~ Street
Duncannon, PA 17020
400 Maryland Drive
P.O. Box 7544
Fort Washington, PA 19034-7544
www.timoneyknox.com
E-mail: griterC~timoneyknox.com
Telephone: 215-646-6000
Facsimile: 215-646-0379
Direct Dial No.: 215.540.2632
Direct Facsimile No.: 21 5.591.8252
RE: Representation -Estate of Kristy Koelsch
Dear Mr. Koelsch:
In accordance with Timoney Knox, LI,P's internal guidelines and the
requirements of the Pennsylvania Rules of Professional Conduct which govern the
activities of all lawyers, this letter is to confiri;~ Timoney Knox, LLP's representation of
you, as well as to establish the terms of that representation.
" Member rU Bar
Member NY, D.C. Bars As you can appreciate, it is essential that Timoney Knox, LLP's clients have the
+Member MD, D.C. Bars same understanding of the client/attorney relationship as the firm. You have engaged us
t LLM Taxation to represent you, as Executor, and assist in the administration of the Estate of Kristy
# cPA Koelsch, regarding issues you will face in your capacity as Executor, assisting as legal
counsel in the administration, preparation of inheritance tax returns, correspondence to
entities regarding date-of--death values and related services. We will look to the estate
primarily for payment of our services.
Our ..firm will be pleased to represent you on the following terms:
1. Ali services will be billed at our standard hourly rates. My hourly rate is
$365.00 per hour. The rates of other lawyers wrio may be assigned to this matter range
from $200.00 to $375.00 per hour and will also be billed in units of one-tenth of an hour.
The rate for paralegals who may be assigned to this matter is $180.00 per hour and will
also be billed in units of one-tenth of an hour. The rates are subject to change from time
to time. We reserve the right to terminate representation for failure to receive payment
for invoices in a timely manner. The term "services" includes such items as advice,
negotiating sessions, the review of documents, the preparation of documents, revision and
LANCASTER OFFICE editing of documents, meetings and conferences with you, investigation, court
132 E. Chestnut Street
Lancaster, PA 17602 appearances, trial and related activities.
Telephone: 717- 393-1400
facsimile: 717- 393-8565
266702-1
John Koelsch
August 20, 2009
Page 2
2. It is customary for us to receive a retainer for fees, however, that
requirement has been waived in this case. We will be paid from the estate account, which
we will maintain, although you will be the signatory. Therefore, as invoices are
submitted, a check will be remitted to you, with a copy of the invoice, for approval and
payment.
3. It is the firm's practice to bill estates at certain stages, rather than on a
monthly basis. I generally submit an invoice for each matter the firm handles for a client
in which I state the value of the time spent and describe the work performed. Payment of
invoices is expected within thirty (30) days of the invoice date and Timoney Knox, LLP
reserves the right to charge interest on any bill outstanding more than sixty (60) days
from the invoice date and to cease work on your behalf if payment is not received within
ninety (90) days of the invoice date.
4. It is the firm's practice to maintain files for seven (7) years after any
litigation or indefinitely when it pertains to general matters including, but not limited to,
estate and tax planning. However, seven years after the termination of the engagement,
the firm reserves the right to destroy the file without any subsequent notice to you. If you
wish to obtain the file after the completion of the engagement, you should request so at
that time.
If the foregoing terms are acceptable to you, please sign the enclosed copy of this
letter and return it to me in the envelope provided.
We look forward to representing you in this matter.
Sincerely,
C~-
George M. Biter
Enclosures
I, JOHN KOELSCH, Executor of the Estate of Kristy Koelsch, agree to and
accept the terms of the foregoing fee arrangement.
KOELSCH
Prebill Number: 88138
Billing Timekeeper: GMR George M. Riter,
Client: 17081 Koelsch, John: Special Needs T
Matter: 00001 Koelsch, John: Special Needs T
Bill Format: JGMR Shows Atty Initials, Date, Description,
Hours
Begin Date: 01/01/1984 End Date: 11/30/2009
Date of Last Bill 01/01/1900 Fee Schedule: STDR
Date of Last Statement 01 /01 /1900 Fee Agreement: Hourly
Date of Last Payment 01 /01 /1900
Amount of Last Payment $0.00
A/R Aging:
0 - 30 $0.00
31 - 60 $0.00
61 - 90 $0.00
91 - 120 $0.00
121 & up $0.00
Action to be taken:
[ ]None - No bill at this time Why?
[)Full Detail (Fees and Expenses as shown in Bill Format)
[ ]Expense Only (Hold Fees)
[ ]Summary Bill (Paragraph supplied by Attorney to summerize Fees & Expenses) -overrides Bill
[ )Summary with Expense (Paragraph supplied by Attorney to Summarize Fees; Detail of Expenses) -
overrides Bill Format
Prepaid Balance:
$0.00
Trust Balance:
$0.00
Remarks:
TIMONEY KNOX, LLP
P.O. Box 7544
400 Maryland Drive
Fort Washington, PA 19034-7544
Tel (215) 646-6000
Fax (215) 646-0379
Federal Tax I.D. 23-1339676
December 21, 2009
John William Koelsch
John William Koelsch Special Needs Trust
36 Jefferson Street
Duncannon, PA 17020
Re: 17081 - 00001 John William Koelsch Special Needs Trust
Prebill Number 88138
Professional Services through 11/30/2009
Date ~ x Description Hours
GMR 07/22/2009 Telephone conference with Nicole re: new case that was settled and 0.50
two children and trust.
JBB 08/03/2009 Telephone conference with Nicole Matteo re status of litigation 0.80
settlement and various issues related to Trust and deceased mother;
Receipt and review of documents from Matteo.
_.
,. ~.,: < ~ ~ ~ ,,r
..K
JBB 08/09/2009 Analysis of mother's will for flexibility to transfer son's money into 0.40
Special Needs Trust; Status update and questions to George M. Riter,
Esquire.
..._.
.
. '~ j~~ t
.~'.
.. ~,
@~ 3~m. ep
JBB 08/12/2009 Extended Telephone conference with John Koelsch re information 0.30
about his son and daughter.
..
F :r , . ~ ; . ~~ ~~ ~ 0~2 355
.
. r
a ~~ ~ 4
s
GMR 08/17/2009 Intraoffice conference with Jean Bond Brown re: Koelsch Estate. u
0.20
~1l~U/7009 ~ Z~~ 1~0 2.10` ~-:~:~ a. ~.
JBB 08/20/2009 Preparation of first draft of Special Needs Trust. 2.10
.._._.
'`. .`
t ~ ~~ ~ s ._s ,, 00
. _ ......... ~ ...> ~ ~. ~..... . A„ ~~~ ~ ~
a~, .~.
. .
JBB 08/21 /2009 Intraoffice conference with George M. Riter, Esquire re draft Trust;
0.90
Telephone conference with John Koelsch re choice of Trustee;
Revisions to Special Needs Trust.
a ~ o.so o s ~s~~.oo ~... ~ k
!
GMR 08/26/2 9
00 Intraoffice conference with paralegal and Nicole VB&K re: estate ~
0.50
administration.
17081 Koelsch, John: Special Needs T Invoice# 88138 Page 2
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JBB 09/16/2009 :
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Intraoffice conference with George
M. Riter, Esquire re status. , 5 ~??~:? ,...
aes,
0.20
't9/21/2009
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JBB 09/21/2009 ...
Telephone conference with Nicole Matteo re planned filing of ,
0.30
supplemental petition regarding allocation of payoff for Law Cash
loans, discussion re possibility that Estate could challenge interest
rate.
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GMR 09/22/2009 Review and Revisions to proposed SNT; Intraoffice conference with 0.30
Jean Bond Brown to finalize and also discuss the settlement loan and
petition for relief from Nicole Matteo of VB&K.
GMR 09/22/2009 o
Review Law Cash document and discuss w/Jean Bond Brown
0.40
options and course of action to try to compromise.
+~
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JBB 09/22/2009 Receipt and review of Correspondence from Nicole Matteo and copy I.20
of Supplement to the Petition re Allocatino of LawCash Lien;
Analysis of Supplement and its effect on Estate and Special Needs
Trust; calculation of net expected to John William Koelsch; Review
George M. Riter, Esquire's suggested revisions to Special Needs
Trust; Revisions to Trust incorporating same.
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GMR
09/30/2009 Telephone conference with Nicole Matteo, Esq. of VB&K re. recent 0.50
Court hearing approving settlement, issues on loan, allocation on
loan, children's interests and concerns on benefits and update on
material from father; Intraoffice conference with Jean Bond Brown
re: estate, minors, Univest, meeting and petition to Court to approve
~. Trust for autistic child.
GMR 09/30/2009
,~. ..
Receipt and review of several a-mails on trust.
0.10
« 'R
.
GMR 10/0l /2009 z.,
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Intraoffice conference with Jean Bond Brown on estate, loan, trust,
i ...
0.20
etc.
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JBB 10/05/2009 Analysis of changes requested by Univest; Intraoffice conference 0.70
with George M. Riter, Esquire re same; Revisions to Trust document.
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JBB 10/06/2009 Telephone conference with John re execution of Trust document; 0.50
Intraoffice conference with George M. Riter, Esquire re Univest's
requesting changes to/clari
fications of Trust language.
qp
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., ~ ,. .~::, ~ `~'~ ... ~ ..~ .., . 355~Oa~ °35.50
GMR 10/08/2009 .m~
Receipt and review of copy of Court Order re: allocation of John's 0.10
share in escrow pending approval of SNT.
G~R 012d%20"09 ~ ~ ~ ~ ~0~2~ 0.2~ 3~5.Q0 .®. ~~~ ~"' 71:~Q0
GMR 10/20/2009 Intraoffice conference with Jean Bond Brown re: estate 0.20
administration; Review and Revisions to language in Trust.
KK
GMR 10/21/2009 Intraoffice conference with Thomas J. Timoney, Esquire on status 0.30
17081 Koelsch, John: Special Needs T Invoice# 88138 Page 3
and Intraoffice conference with LGB, the paralegal assigned to
estate, re: administration issues, tax returns, etc.
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GMR 10/21/2009 Intraoffice conference with Jean Bond Brown on Letters 0.30
Testamentary, short certificates, etc.; Receipt and review of multiple
e-mails from Nicole of Villari et al. on settlement, trusts and estate
paperwork.
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JBB 10/21/2009 Receipt and review of Correspondence from Michael Kerns re 0.80
Univest acceptance of Trust; Correspondence with Kerns sending
him Trust for signature; Correspondence with Nicole Matteo re status
of Trust.
,.
JBB 10/21/2009 Multiple conversations with Nicole Matteo re status of 0.50
settlement/allocation between estate and individuals, estate
administration documents and information.
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10/26/2009 Review file with George M. Riter, Esquire and Jean Bond Brown re
0.20
status of petition and letter to Department of Public Welfare
. 9.
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JBB
10/26/2009 Correspondence with Nicole Matteo re status; Intraoffice conference ,~
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0.40
with George M. Riter, Esquire and paralegal re trust approval
process.
MR ,.
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10/27/2009 Intraoffice conference with Jean Bond Brown and paralegal on
,.
0.30
approval of Trust by DPW and Petition to approve Trust and
continue.
,
SWC 10/29/2009 Preparation of letter to DPW, Review File, Pre aration of Petition to
P 1.60
accept Trust, Conference with Jean Bond Brown
JBB 10/29/2009 Correspondence with Trustee requesting fee schedule; Receipt and 0.30
review of Correspondence from Trustee in return; Receipt and review
of fee schedule.
.~
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GMR 10/30/2009 Intraoffice conference with paralegal re: update on certain aspects of 0.20
estate that have been done such as an initial inheritance tax return.
ec~.. ~. ,..> ay,,, ,s~~~ ~ x~ .. ~ ~ ~ #r~~? fp o~ s. ' Or'~ ~. ~ 1~ 70.00 ~ f .. .. ~ 3
SWC 11/06/2009 Finalize Petition 0.70
IR ;gib}i°02009' « °'~'~ °7.20 0`20' 355..00
_~ ~ 71.00•
GMR . ~ ~ ~.~
11/09/2009 Review and Revisions to Correspondence to Mark Newell of DPW to
0.20
approve Trust; Review and Revisions to Petition to Court.
S~4t~ ~1~1/1OI2409 • °i~ ~° 120~~ 1.20 ~' ~° 170:4C"k `~ ~
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SWC 11 / 10/2009 Conference with Jean Bond Brown ,Correspondence with 1.20
Department of Public Welfare
3~, ~ .9. .x=v~~F, , x z ~¢ ~ EIS ~, ~ 1 J
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GMR
11/12/2009 Intraoffice conference with paralegal and review of Draft Petition. a
aa~,.,.
0.20
17081 Koelsch, John: Special Needs T Invoice# 88138 Page 4
m a
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SWC 11/13/2009 Review status with George M. Riter, Esquire ,
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3., A~i .JAS G
0.30
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SWC 11/25/2009 Telephone conference with Richard and George M. Riter, Esquire 0.30
concerning distribution of checks.
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SWC 11/25/2009 Telephone conference with Richard concerning percentage of money 0.20
that will be distributed
SWC 11/25/2009 Receipt and review email from Richard Kelley regarding breakdown 0.30
of special needs and estate monies
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GMR 11/30/2009 Intraoffice conference with paralegal re: receipt of funds from trial 0.10
counsel and payment of certain bills.
Expenses through 11/30/2009
IO/27/2009 FEDERAL EXPRESS CORP.; Federal Express Package from Ft, 28.53
Washington, PA to Duncannon, PA 10/1/2009
10/27/2009 FEDERAL EXPRESS CORP.; Federal Express Package from Ft. 13.72
Washington, PA 10/6/2009
Billing Summary
Total professional services
Total expenses incurred
Total of new charges for this invoice
Total balance now due
$42.25
$4,611.00
$42.25
$4,653.25
$4,653.25
. ~ ~ ~ ~ .
. ~
Living Trust
• Asset Management
• Payment of Bills
• Funire Distribution of Property
Testamentary Trust
s
• Initiated After Death
• Directed by Terms of Your Will i
Power-Of-Attorney
• Management of Financial Affairs
~~ i
Annual fees for these services are as follows:
Principal -annual rate charged on market value '.
1.20% on first $1,000,000;
.65% on next 1,000,000
.40% on next 3,000,000
~~i°~ n~inr C AAA nnn ~.
,~ *~ 1 w
l~o~~~ ox ~~p
A i i o r n e y s a i L a w
Thomas J. Timoney
Mark E. Weand, Jr.
Michael O'Hara Peale, Jr.t
Charles J. Weiss
James M. Jacquette
Herman J. Weinrich"
John J. McAneney"t#
George M. Ritert
Scott H. Wolpert"
Richard L. Caplan
Catherine M. Harper
David S. Reno
Joseph T. Thiroway
Mark F. Walmer
Ann Thornburg Weiss
Karen Schecter Dayno"t
Thomas A. Boulden
Carol A. Crisci
Jean Bond Brown
Kevin P. Schmidt"
Joshua S. Ganz•
Of Counsel
John P. Knox
John V. Hasson
Edward T. Egan+
Member ~U Bar
+rMember NY, D.C. Bars
+Member MD, D.C. Bars
February 12, 2010
400 Maryland Drive
P.O. Box 7544
Fort Washington, PA 19034-7544
www.timoneyknox.com
E-mail: griterC~timoneyknox.com
Telephone: 215-646-6000
Facsimile: 21 5-646-0379
Direct Dial No.: 21 5.540.2632
Direct Facsimile No.: 21 5.591.8252
VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND REGULAR MAIL
Lisa B. Dees, Assistant Counsel
Commonwealth of Pennsylvania
Office of General Counsel
Department of Public Welfare
3rd Floor West; Health and Welfare Bldg
7th & Forster Streets
Harrisburg, PA 17120
RE: Special Needs Trust for the Benefit of John William Koelsch, A Minor
Dear Ms. Dees:
I enclose a copy of a Petition for Approval of Trust and Expenditure of Principal
t LLMTa$aCPA for the Special Needs Trust fbo John William Koelsch, which will be filed in Cumberland
County
Within 20 days of the date of this letter, kindly provide me with a letter indicating
DPW's objection, if any or that DPW has no objections to the Petition, or a letter
indicating that DPW is waiving its notice period. If we have not received your objections
or a letter within the specified time, the Court may assume that you have no objections to
the Petition and may proceed to act on it.
Thank you for your attention and cooperation.
MOUNT CARMEL OFFICE
122 North Oak Street
Mount Carmel, PA 1 7851
Telephone: 570-339-4589
LANCASTER OFFICE
132 E. Chestnut Street
Lancaster, PA 1 7602
Telephone: 717- 393-1400
Facsimile: 717- 393-8565
~ incerely,
,~ ,
George M. Riter
GMR/sc
Enclosure
Cc: John F. Koelsch
276199 _ 1