HomeMy WebLinkAbout12-17-10
IN THE COURT OF CONrSON PLEAS OF CUI~ERLAND COUNTY, Pffi~iNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
TRUST FOR NORMA O. FRAME
Attorney for Petitioner:
Bruce C. Bankenstein
48 South Duke Street
York, PA 17401
(717) 843-0961
Fax (717) 843-0699
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PETITION FOR CREATION OF A TRUST
NOW comes Your Petitioner, by her attorney, Bruce C.
Bankenstein, and presents this Petition whereof the following is a
statement:
1.
Norma 0. Frame is a single, adult individual residing at 91
Courtyard Drive, Carlisle, Cumberland County, Pennsylvania.
2.
Petitioner is physically disabled and is the proposed
beneficiary of the trust requested to be established pursuant to
this Petition.
3.
Petitioner suffers from Central Nervous System vasculitis with
partial blindness for which she has been determined to be disabled
1
by the Social Security Administration and is receiving social
security disability benefits.
4.
No guardian has been appointed for Petitioner.
5.
Petitioner has no available parent nor living grandparent.
6.
Petitioner has settled legal action that she had pursued with
net proceeds therefrom being anticipated to be approximately
$50,000.00.
7.
Owning the aforesaid assets will render Petitioner ineligible
for prospective benefits, including, but not limited to, medical
assistance, waiver funding and social security supplemental
security income, if such assets are not consumed or protected.
8.
Petitioner proposes to protect the aforesaid assets by placing
them in the proposed Norma Frame Special Needs Trust which is
attached as the Addendum hereto and made a part hereof.
9.
All persons who are proposed to be the Trustee and the various
successor Trustees of this trust have consented to serve in that
capacity as set forth in the Consents signed by them and attached
hereto as Exhibits "A", "B" and "C".
2
10.
The purposes of the proposed trust are set forth therein, and
generally are to set aside a fund which may be used for purposes
which are generally not for the primary support of the Petitioner
but will supplement any governmental benefits to which Petitioner
may otherwise be entitled.
11.
Federal law permits a disabled person under the age of 65 to
deposit her own money into a trust which is not intended to be used
for her primary support, and such a trust will not be considered to
be a resource of such person so as not to adversely affect such
person's eligibility for any governmental benefit to which she may
otherwise be entitled so long as such trust (a) is established by
a parent, grandparent, legal guardian or court, and (b) provides
that all amounts remaining in the trust upon the death of its
beneficiary will be distributed to the state up to the amount of
all medical assistance paid by the state on behalf of the
beneficiary. 42 U.S.C. ~1396p(d)(4)(A). A copy of the entire
subsection (d) is attached hereto as Exhibit "D"
12.
The proposed Norma Frame Special Needs Trust constitutes a
special needs trust under 62 P.S. X1414.
13.
The corpus of the proposed trust will be generated from the
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aforesaid net settlement proceeds.
14.
Placing these funds in the proposed trust meets the federal
law in that the trust is a non-support trust and Paragraph 10
thereof requires the trust remainder to be distributed to the state
up to the amount of all medical assistance paid by the state on
behalf of Petitioner, thereby protecting these funds from being
considered to be a resource of Petitioner in determining her
eligibility for various governmental benefits.
15.
The Pennsylvania Department of Public Welfare has determined
that it has no objection to the proposed Norma Frame Special Needs
Trust as a special needs trust as stated in the letter of Lisa B.
Dees, Assistant Counsel, Governor's Office of General Counsel for
the Department of Public Welfare, dated December 15, 2010, a copy
of which is attached hereto as Exhibit "E".
16.
Petitioner does not receive supplemental security income
benefits from the Social Security Administration so that no review
of the proposed Norma Frame Special Needs Trust may be obtained at
this time from the Social Security Administration.
17.
The provisions of Paragraph 12 of the proposed Norma Frame
Special Needs Trust will be accomplished by paying from the
4
aforesaid net settlement proceeds the sum of $69,152.99 to the
Department of Public Welfare in satisfaction of its claim for
assistance as agreed by the Department in its letter of September
9, 2010, issued to Petitioner's trial counsel for the aforesaid
legal action which agreement was pursued in the administration of
the settlement thereof. A copy of said letter of September 9,
2010, is attached hereto as Exhibit "F".
Petitioner respectfully requests Your Honorable
Court to enter an Order establishing the trust attached as the
Addendum hereto, and confirming the payment to the Department of
Public Welfare in satisfaction of its claims.
Respectfully submitted,
MANIFOLD & BANKENSTEIN
By.
uce C. Bankenstein
Attorney for Petitioner
Supreme Court I.D. #27025
48 South Duke Street
York, PA 17401
(717) 843-0961
Fax (717) 843-0699
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The undersigned hereby verifies that the statements made in
the foregoing Petition are true and correct to the best of the
personal knowledge or information and belief of the undersigned.
The undersigned understands that false statements herein are made
subject to the penalties of 18 Pa.C.S. Section 4904, relating to
unsworn falsification.
Date : ~(Y..w • !~, o?Ol0 ~•
Norma ame
ADDENDUM TO PETITION
IN THS COURT OF CONNON PLEAS OF CUNBSRLAND COUNTY, PENNSYLVANIA
IN RE:
No.
TRUST FOR NORMA 0. FRAME
NORMA FRANK SPECIAL NSSDS TRUST
THIS TRUST is established by Order of this Court entered in
the above-captioned proceeding on ,
20_, which shall be subject to the following terms and
conditions, to wit:
1. The Trustee of this Trust is Andrew 0. Mitchell of
91 Courtyard Drive, Carlisle, Pennsylvania 17013. The Successor
Trustee of this Trust is Beatrice Renee Hebert of 11251 Eva Drive,
Gulfport, Mississippi 39503. The Second Successor Trustee is J.
Edward Dagen of 1205 Fleetwood Drive, Carlisle, Pennsylvania 17013.
The term "Trustee" as used herein shall refer to the then serving
trustee of this Trust, whether it be the aforenamed Trustee, or the
Successor Trustee, or the Second Successor Trustee, or any other
person serving as such trustee.
2. The beneficiary of this Norma Frame Special Needs
Trust is Norma 0. Frame who currently resides at 91 Courtyard
Drive, Carlisle, Cumberland County, Pennsylvania, and shall
hereinafter be referred to as "Beneficiary". Beneficiary, whose
1
birth date is February 2, 1955, is disabled as defined in Title XVI
of the Social Security Act, 42 U.S.C. ~1382c(a)(3). Beneficiary is
currently receiving disability benefits from the Social Security
Administration.
3. This Trust shall be known as the Norma Frame Special
Needs Trust. This Trust is established pursuant to 42 U.S.C.
§1396p(d)(4)(a) and 62 P.S. §1414. As a result, all assets held in
or owned by this Trust are exempt from being included in the
determination of Beneficiary's eligibility for or the amount of
medical assistance under a state plan for the same or other
governmental benefits, and such assets shall in no way be deemed to
have been or to be available to Beneficiary.
4. The initial corpus of this Trust is anticipated to
be approximately $50,000.00. The same will be derived from a
portion of net settlement proceeds recovered by Beneficiary from
legal action she had pursued.
5. For the duration of the life of Beneficiary, the
Trustee may pay or apply for the sole benefit of Beneficiary such
amounts from the net income and principal of this Trust as the
Trustee in the exercise of the Trustee's absolute, complete and
unfettered discretion deems advisable for the welfare of
Beneficiary as hereinafter set forth. In making such distributions
to or for the benefit of Beneficiary, and as the Trust principal
and income are not to be used in place of any statutory benefits,
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the Trustee shall take into consideration all other resources
available to Beneficiary, including any benefits to which
Beneficiary is, or may be, entitled through public assistance,
medical assistance, or from any other governmental or other
resources. The Trustee may hold, withhold and retain any or all of
the income and principal of this Trust as the Trustee, in the
exercise of the Trustee's absolute discretion, shall deem advisable
for the uses and purposes herein set forth. All distributions from
the Trust. must be for the sole benefit of Beneficiary.
6. In exercising the discretionary powers herein
conferred on the Trustee, the Trustee shall be guided by the
following statement of Settlor's purposes and intentions. It is
Settlor's expectation that the Trust income and principal will not
be made available to provide primary support for Beneficiary.
Therefore, the Trustee is directed to investigate other sources of
support available to Beneficiary and to take whatever steps
necessary to enroll Beneficiary for such benefits or assistance.
The Trust principal and income may be used only as a supplement to,
and shall not replace, any statutory or other governmental benefits
to or for which Beneficiary is, may be or may become eligible,
including, but not limited to, medical assistance, public
assistance, supplemental security income, or the like. The Trustee
may make Trust distributions to or on Beneficiary's behalf in such
a way that Beneficiary's life will be enriched and made more
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enjoyable, including providing recreational and vacation
opportunities for Beneficiary. The Trustee is authorized to make
Trust distributions to or on Beneficiary's behalf to increase
Beneficiary's quality of life and standard of living, to assist in
the treatment of the Beneficiary's disability, and to pay or
provide for Beneficiary's special needs. Special needs shall
include, but not be limited to, medical expenses, dental expenses,
nursing and custodial care, psychiatric or psychological services
or both, clothing, recreational therapy, occupational therapy,
physical therapy, vocational therapy, durable medical needs,
prosthetic devices, special rehabilitative services or equipment,
disability related training, education, transportation and required
travel expenses (including vehicle purchase), dietary needs and
supplements, related insurance, and other goods and services that
may be specified as special needs by the Pennsylvania Department of
Public Welfare. The Trustee may also use the income and principal
of this Trust to purchase or fund an irrevocable funeral account or
fund to be restricted to pay the funeral or burial expenses, or
both, of Beneficiary, if no other provision has been made for the
same. It is Settlor's desire that Beneficiary be able to maintain
contact with any siblings and other family members, and the Trustee
may expend Trust income and principal for transportation costs for
Beneficiary or other family members to facilitate such contact.
The Trustee is authorized to expend the Trust estate to procure
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more sophisticated medical, dental, ophthalmological and other
similar treatment than may otherwise be available to Beneficiary
and to seek private rehabilitative and educational training;
however, the Trust principal and income may not be used in any
manner to provide for basic medical care and is not to be used to
replace medical assistance or similar statutory or other
governmental benefits to or for which Beneficiary is or may become
eligible. Subject to the intentions herein stated, the Trustee is
authorized to expend such amounts of income and principal of the
Trust for goods and services for the support of Beneficiary if and
only if the statutory or other governmental benefits to or for
which Beneficiary is, may be or may become eligible prove to be
inadequate for Beneficiary's basic support or are discontinued or
do not otherwise cover or provide for such goods or services for
Beneficiary; however, any such expenditure shall be at the
absolute, complete and unfettered discretion of the Trustee, and
the Trustee shall have no duty to make any such expenditure. The
Trustee is authorized to expend such amounts of income and
principal as shall enable Beneficiary to achieve Beneficiary's
maximum potential and to lead as comfortable a life as possible.
To that end, it is Settlor's desire, without it being legally
binding, that the Trustee may expend the income and principal of
this Trust in ways that shall protect, enforce and expand the
rights of Beneficiary, and to provide advocacy for Beneficiary.
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Furthermore, any expenditure from the Trust must have a reasonable
relationship to the needs or circumstances of Beneficiary. Settlor
desires the Trustee to exercise the discretionary power conferred
on the Trustee hereunder in a manner which will provide flexibility
in the administration of the Trust under conditions from time to
time existing, and in exercising such powers, the discretion of the
Trustee shall be conclusive as to the advisability of any
distribution of income or principal, and as to the person to or for
whom such distribution is to be made, and the same shall not be
subject to judicial review. Therefore, the Trustee may not and
shall not be compelled in any manner by any person, court or
governmental agency to expend any of the Trust income or principal
for the replacement or reimbursement of any statutory or other
governmental benefits, or any support or other assistance, to or
for which Beneficiary is, may be or may become eligible, nor may
the Trustee be compelled to exercise the Trustee's discretionary
powers in favor of Beneficiary as a beneficiary of such statutory
or other governmental benefits, or any support or other assistance.
Furthermore, the Trustee is authorized to expend such amounts of
income and principal for the benefit of the Beneficiary as shall
best provide for the comfort and happiness of Beneficiary without
regard to the effect that such distributions might have upon the
interest of the takers of the remainder of this Trust.
7. In addition to the foregoing, the Trustee is further
6
hereby authorized to make distributions from the principal and
income of this Trust, in Trustee's absolute and unfettered
discretion, for the following purposes:
A. To purchase, repair, upgrade or specially
outfit a motor vehicle for the use and benefit by and for
Beneficiary.
B. To pay any condominium fees, condominium owner
association fees, homeowner association fees, or the like which may
be imposed upon or with regard to the residence of and owned by
Beneficiary.
C. To pay or provide for any reasonable and
necessary repairs to or maintenance, whether routine, structural or
extraordinary, of the residence of and owned by Beneficiary.
D. To pay premiums on any life insurance policy
covering Beneficiary's life.
E. To pay premiums for health insurance covering
Beneficiary.
8. Furthermore, in addition to the foregoing and
subject to the intentions herein stated, the Trustee is authorized
to expend such amounts of income and principal of this Trust, as,
in the Trustee's absolute and unfettered discretion, are
appropriate or necessary for the Beneficiary's health, safety,
welfare, education and treatment, which may include goods and
services for the support of Beneficiary, if and only if the same
7
are not provided by a public agency or government program, or the
statutory or other governmental benefits to or for which
Beneficiary is or may then be eligible for which the same would
otherwise be provided are discontinued in general or for
Beneficiary.
9. Before the Trustee may distribute any of the
principal of this Trust in excess of Ten Thousand ($10,000.00)
Dollars for any of the uses or purposes set forth above, Trustee
shall give written notice of such intention to the following
agencies if such agency provides the stated benefit: the
Pennsylvania Department of Public Welfare, or any successor thereof
which administers medical assistance, and to the Social Security
Administration, or any successor thereof which administers
supplemental security income. If no objection to such distribution
is received from either of those agencies within twenty (20) days
following the date of the said notice, the Trustee may make said
distribution.
10. This Trust shall terminate upon the death of
Beneficiary. Upon such termination, the Trustee shall distribute
pro-rata all remaining principal and accrued income to any state
which had provided medicaid, also known as medical assistance, to
or on behalf of Beneficiary under any such state's plan under Title
42 of the United States Code or any similar federal law up to the
total of all such medicaid paid to or on behalf of Beneficiary. If
any funds remain in this Trust after such distribution to a state
8
or states, such remainder shall be distributed as follows:
A. One-half (~) thereof, in trust, unto the
Trustee of the Stephen 0. Frame Special Trust which Beneficiary
established by original Trust Agreement dated December 23, 1996,
and amended and reconfirmed by Second Restated Trust Agreement
dated July 15, 2009, for the benefit of Beneficiary's son, Stephen
0. Frame as set forth in said Restated Trust Agreement, as part of
that Trust for the uses and purposes and under the terms and
conditions as therein set forth, so long as such Trust is in
existence at the time of such distribution. In the event the
Steven 0. Frame Special Trust is not in existence at the time of
said distribution, then this one-half (~) share of any remainder of
this Norma Frame Special Needs Trust shall be distributed unto
Beneficiary's son, Andrew 0. Mitchell, if he is living at the time
of such distribution, and if he is not then living, then unto his
issue who are living at the time of such distribution, per stirpes.
B. One-half (~) thereof unto Beneficiary's son,
Andrew 0. Mitchell, if he is living at the time of such
distribution, and if he is not then living, then unto his issue who
are living at the time of such distribution, per stirpes. If
Andrew 0. Mitchell is not living at the time of such distribution
and leaves no issue who are then living, then this one-half (~)
share of the remainder of this Norma Frame Special Needs Trust
shall be distributed, in trust, unto the Trustee of the aforesaid
9
Stephen 0. Frame Special Trust as part of that Trust for the uses
and purposes and under the terms and conditions as therein set
forth.
11. In the event of the change of any state or federal
law or regulation or in the event of the occurrence of any event
which is beyond the control of Trustee, and if either such event
temporarily or permanently disqualifies Beneficiary from receiving
or being eligible for public assistance, medical assistance,
supplemental security income, waiver programs, or any other
statutory or other governmental benefits for which Beneficiary is,
may be or may become eligible, then Trustee, in Trustee's absolute,
sole and unfettered discretion, may, and Trustee is hereby
specifically granted the power to, amend this Trust Agreement to
the least extent necessary to maintain or restore Beneficiary's
eligibility for any of the aforesaid statutory or other
governmental benefits and to maintain the purposes, intentions-and
use of this Trust as hereinbefore set forth.
12. Before any assets of Beneficiary may be transferred
to this Trust, all liens and claims in favor of the Pennsylvania
Department of Public Welfare for repayment of cash and medical
assistance shall first be satisfied therefrom. A copy of this
Trust Agreement shall be directed to:
The Special Needs Trust Depository
Attention: Manager, TPL Section
P.O. Box 8486
Harrisburg, Pennsylvania 17105-8486
10
13. A. The initial Trustee of this Trust shall be
Andrew 0. Mitchell. Upon the death of Andrew O. Mitchell, or if he
resigns or no longer qualifies to serve as Trustee of this Trust
for any reason, then Beatrice Renee Hebert, Successor Trustee,
shall thereupon administer this Trust as Trustee and shall have the
duties and powers of Trustee as herein set forth. In the event
both of the aforenamed Trustee and Successor Trustee hereunder die,
resign or do not qualify or no longer qualify to serve as Trustee
of this Trust for any reason, then J. Edward Dagen, Second
Successor Trustee, shall thereupon administer this Trust as Trustee
and shall have the duties and powers of Trustee as herein set
forth.
8. The last serving Trustee of this Trust may
appoint in writing a natural person or a corporate fiduciary with
trust facilities to succeed such last serving Trustee as the
Trustee of the Trust.
14. This Trust shall not be subject to anticipation or
to voluntary or involuntary alienation.
15. Trustee shall invest the principal of this Trust in
compliance with the Prudent Investor Rule as currently set forth in
the Pennsylvania Probate, Estates and Fiduciaries Code, or any
subsequent amendment or restatement thereof in force at the time of
such investment. Furthermore, Trustee shall have the following
11
powers in addition to those vested in it by law and by other
provisions of trust, applicable to all property, whether principal
or income, exercisable without court approval, and effective until
actual distribution of all property:
A. To hold and retain any or all of the assets of
this Trust, real or personal, without regard to any principal of
diversification or risk.
B. To sell at public or private sale, to exchange,
or to lease for any period of time, any real or personal property,
and to give options for sales, exchanges or leases, for such prices
and upon such terms or conditions as Trustee deems proper.
C. To allocate receipts and expenses to principal
or income or partly to each as Trustee from time to time thinks
proper in Trustee's sole discretion.
D. To compromise any claim or controversy.
16. This Trust is and shall be irrevocable, except that
the same may be modified by further order of Court.
17. Subject to the approval of Trustee, anyone may add
property, real or personal, to the principal of this Trust by Deed,
Will or otherwise. In the event the same should be or include life
insurance proceeds payable to this Trust or the applicable Trustee
of this Trust under the terms of any life insurance policy, said
proceeds shall be paid, in trust, to the then serving Trustee
hereof by the applicable life insurance company without liability
12
or further responsibility on the part of such life insurance
company. Notwithstanding the foregoing, additions to this Trust of
any kind or nature shall not be accepted by Trustee after
beneficiary attains the age of sixty-five (65) years.
18. The Trustee shall be entitled to receive
compensation for service hereunder, which compensation shall be
charged against or payable from both principal and income of this
Trust, at such rates as may be reasonable and customary. If the
Trustee is a corporate fiduciary, then such Trustee's compensation
shall be at such rates as may be provided in such Trustee's
published fee schedule in effect at the time said services are
performed.
19. The situs of this Trust for administrative and
accounting purposes shall be in the County of Cumberland and
Commonwealth of Pennsylvania, and all questions pertaining to the
construction or validity of the provisions of this instrument shall
be governed by the laws of that Commonwealth.
13
CONSENT TO SERVE A3 A TRUSTEE
I, Andrew O. Mitchell, hereby consent to serve as the initial
Trustee of the Norma Frame Special Needs Trust which is being
requested to be established by the Court of Common Pleas of
Cumberland County, Pennsylvania.
Andr Q .
(Address) /~ ~ ,~~,~ ~~-.
~~,[L sr ~ P~ / Tor 3
EXHIBIT "A"
CONSENT TO SBRVB AS A TRt1ST8$
I, Beatrice Renee Hebert, hereby consent to serve as the
Successor Trustee of the Norma Frame Special Needs Trust which is
being requested to be established by the Court of Common Pleas of
Cumberland County, Pennsylvania.
Beatrice Renee Heber^t
(Address) ~ ~ ~ S 1 /-~ {J~ ~!''
~'~~- l~pot-~ , ry~.S- 39.503
EXHIBIT "8"
CONSEIQT TO 3ERV8 AS A TRUSTEY~
I, J. Edward Dagen, hereby consent to serve as the Second
Successor Trustee of the Norma Frame Special Needs Trust which is
being requested to be established by the Court of Common Pleas of
Cumberland County, Pennsylvania.
~~
J. E and Dagen
(Address) ~ °~ ds ~~W~ `vr~'x
EXHIBIT "C"
EXHIBIT ~D"
United States Code Annotated
Title 42. The Public Health and Welfare
Chapter 7. Social Security (Refs & Annos)
Subchapter XIX. Grants to States for Medical Assistance Programs
4z U.S.C.A. § i396P
§ i396p. Liens, adjustments and recoveries, and transfers of assets
(a) Imposition of lien against property of an individual on account of medical
assistance rendered to him under a State plan (text deleted)
(b) Adjustment or recovery of medical assistance correctly paid under a State plan
(text deleted)
(c) Taking into account certain transfers of assets (text deleted)
(d) Treatment of trust amounts
(1) For purposes of determining an individual's eligibility for, or amount of, benefits under a
State plan under this subchapter, subject to paragraph (4), the rules specified in paragraph
(3) shall apply to a trust established by such individual.
(2)(A) For purposes of this subsection, an individual shall be considered to have established
a trust if assets of the individual were used to form all or part of the corpus of the trust and if
any of the following individuals established such trust other than by will:
(i) The individual.
(ii) The individual's spouse.
(iii) A person, including a court or administrative body, with legal authority to act in place of
or on behalf of the individual or the individual's spouse.
1
8XHI8IT "D"
(iv) A person, including any court or administrative body, acting at the direction or upon the
request of the individual or the individual's spouse.
(B) In the case of a trust the corpus of which includes assets of an individual (as determined
under subparagraph (A)) and assets of any other person or persons, the provisions of this
subsection shall apply to the portion of the trust attributable to the assets of the individual.
(C) Subject to paragraph (4), this subsection shall apply without regard to--
(i) the purposes for which a trust is established,
(ii) whether the trustees have or exercise any discretion under the trust,
(iii) any restrictions on when or whether distributions may be made from the trust, or
(iv) any restrictions on the use of distributions from the trust.
(3)(A) In the case of a revocable trust--
(i) the corpus of the trust shall be considered resources available to the individual,
(ii) payments from the trust to or for the benefit of the individual shall be considered income
of the individual, and
(iii) any other payments from the trust shall be considered assets disposed of by the
individual for purposes of subsection (c) of this section.
(B) In the case of an irrevocable trust--
(i) if there are any circumstances under which payment from the trust could be made to or
for the benefit of the individual, the portion of the corpus from which, or the income on the
corpus from which, payment to the individual could be made shall be considered resources
available to the individual, and payments from that portion of the corpus or income-
(I) to or for the benefit of the individual, shall be considered income of the individual, and
(II) for any other purpose, shall be considered a transfer of assets by the individual subject
to subsection (c) of this section; and
(ii) any portion of the trust from which, or any income on the corpus from which, no payment
could under any circumstances be made to the individual shall be considered, as of the date
of establishment of the trust (or, if later, the date on which payment to the individual was
foreclosed) to be assets disposed by the individual for purposes of subsection (c) of this
section, and the value of the trust shall be determined for purposes of such subsection by
including the amount of any payments made from such portion of the trust after such date.
(4) This subsection shall not apply to any of the following trusts:
(A) A trust containing the assets of an individual under age 65 who is disabled (as defined
in section 1382c(a)(3) of this title) and which is established for the benefit of such individual
by a parent, grandparent, legal guardian of the individual, or a court if the State will receive
2
EXHIBIT "D"
all amounts remaining in the trust upon the death of such individual up to an amount equal
to the total medical assistance paid on behalf of the individual under a State plan under this
subchapter.
(B) A trust established in a State for the benefit of an individual if-
(i) the trust is composed only of pension, Social Security, and other income to the individual
(and accumulated income in the trust),
(ii) the State will receive all amounts remaining in the trust upon the death of such individual
up to an amount equal to the total medical assistance paid on behalf of the individual under
a State plan under this subchapter, and
(iii) the State makes medical assistance available to individuals described in section
1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to
individuals for nursing facility services under section 1396a(a)(10)(C) of this title.
(C) A trust containing the assets of an individual who is disabled (as defined in section
1382c(a)(3) of this title) that meets the following conditions:
(i) The trust is established and managed by a nonprofit association.
(ii) A separate account is maintained for each beneficiary of the trust, but, for purposes of
investment and management of funds, the trust pools these accounts.
(iii) Accounts in the trust are established solely for the benefit of individuals who are
disabled (as defined in section 1382c(a)(3) of this title) by the parent, grandparent, or legal
guardian of such individuals, by such individuals, or by a court.
(iv) To the extent that amounts remaining in the beneficiary's account upon the death of the
beneficiary are not retained by the trust, the trust pays to the State from such remaining
amounts in the account an amount equal to the total amount of medical assistance paid on
behalf of the beneficiary under the State plan under this subchapter.
(5) The State agency shall establish procedures (in accordance with standards specified by
the Secretary) under which the agency waives the application of this subsection with
respect to an individual if the individual establishes that such application would work an
undue hardship on the individual as determined on the basis of criteria established by the
Secretary.
(6) The term "trust° includes any legal instrument or device that is similar to a trust but
includes an annuity only to such extent and in such manner as the Secretary specifies.
Current through P.L. 111-264 (exGuding P.L. 111-203, 111-257, and 111-259) approved 10-8-10
3
gXHIBIT "O"
u~c.,15. Z!!~l~ 11:21A
COMMONWEALTH OF PENNSYLVANIA
GOVERNOR'S OFFICE OF GENERAL COUNSEL
December 15, 2010
('V'ia Facsimile-717-843-0699)
Bruce C. Bankenstein, Esquire
MANIFOLD & BANKENSTEIN
48 South Duke Street
York, PA 17401
Hard Copy by Mail
Re: Norma Frame Special Needs Ttust
Dear Attorney Bankenstiez~:
vo.
2
Please be advised that I have reviewed the Special Needs Trust that was prepared on
behalf of Norma Frame. The Commonwealth of Fetmsylvania, Department of Public Welfare
has no objection to this Special Needs Trust ("SNT'~.
The disabled beneficiary's assets that are used to fund the SNT will not be considered an
available resource in determining Norma )aYame's eligibility for Medical Assistance. If Ms.
Frame 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 documexitation regarding the funding of tb~is SNT and any
subsequent additions to the SNT.
Thank you for your attention and cooperation with the Department. Tf you have any
questions, please feel free to contact me.
Sincerely,
L~cJ CL~~.~-'
Lisa B.' Dees
Assistant Counsel
C: Susan Naylor, TPL, SNT Depository
OFFICE of CHIEF CoUNSEI. 1 DEPARTMENT OF PUBLIC wELFaRE
3' I'L. WC-9T, HEALTH & YVELFARE BLGG. ~ 7' & FORSTER STREETS ~ HARRtSEUItG, F4 17120
ph: 71~-783-2g40 I Fx: 717-772-0717 ~ wv+w,~ow.state.oa.us
EXHIBIT "E° 12/15/2010 WED 12:27 (T%/12% NO 8603] X002
Sep. 9. 2010 3:36PM Third Party Liability
crn~uxoNwPxn~ oP Pe+Nmv~wu
DEPAR7MEH7 Of PUBLIC WELFARE
BUREAU OF PROGRAM INrEGRRY
DMlIDN OF TNRD PART'/ L.UERJ7Y
GAlUAL1V UlYT
P.O.lOx 6/E6
IW WBBURA. PA 1718SS/06
September 9, 2010
ANGINO 6 ROVNER PC
NEIL J ROVN$R ESQUIRE
4503 NORTH FRONT STREET
HARRISBURG PR 17110-1708
Re: Norma frame
CIS ~1: 790153250
Incident Date: 05/01/2006
Dear Neil J, Rovnez, Esquire:
No.5622 P. 2
The Department of Public Welfare maintains a claim in the amount of
$136,699.06 for the above-referenced incident.
The Department has agreed to reduce its claim by 33 1 33 plus a prorate
share of expenses and accept the net payment of $69,152.99 to satisfy the
total claim amouriC.
Checks should be sonde payable to the Department oL Public Welfare and
seriL Lo my attention at the above address. Wo rsqu~at that r-ith all
tsanaadttal of funds, you provide the Department With a copy of the final
diatributd.on ahaet.
In the event you har-e already brought or will bring any action resulting
in a further recovery, we xeseroe the right to seek recovery of any
additional unpaid portion of our medical/cash claim. This settlement in no
way affects our future rights.
Thank you for your cooperation in this matteY. It you have any further
questions, please coritaet me.
Sincerely, j~
~ilw.twL1 ! .yLM.~
Karin L. Tyler
Claims Investigation Agent
717-772-6619
717-772-6553 FAX
EXHIBIT "F"
f
IN TH8 COIIRT OF CONN:ON PL8A8 OF CUD®SRLAND COIINTY, P8NN3YLVANIA
ORPHANS' COIIRT DIVISION
IN RE: No.
TRUST FOR NORMA 0. FRAME Previous Judge: None
CERTIFICATION OF 38RVIC8
I, the undersigned Attorney for the designated party in the
above-captioned action, do hereby certify that on this day, a true
and correct copy of the foregoing Petition in the above-captioned
matter was served by first class mail, postage prepaid thereon,
upon the following persons at the following addresses:
Lisa B. Dees, Esquire
Special Needs Trust Review
Department of Public Welfare
Office of General Counsel
P.0. Box 2675
Harrisburg, PA 17105
Karin L. Tyler
Claims Investigation Agent
Department of Public Welfare
Bureau of Program Integrity
Division of 3rd Party Liability
Casualty Unit
P.0. Box 8486
Harrisburg, PA 17105
Date: /°7-/~--lD ~ _.
Bruce C. Bankenstein
Attorney for Petitioner
48 South Duke Street
York, PA 17401
(717) 843-0961
Fax (717) 843-0699