[SEE CAPTION AT 1.3.1 ]
DECREE
Now, this day of , 20 , in consideration of the annexed Petition, it is hereby ORDERED and DECREED that ABC Bank, Trustee of the Special Needs Trust for the benefit of Lisa Dunn, a disabled Incapacitated Person, is authorized to use Trust principal for Lisa's special needs, to the extent not covered by insurance or payable from any other source and to the extent that Trust income is insufficient, as follows:
| A. | For Lisa's ongoing annual special needs for the next three years (a new Petition for Allowances to be filed upon the expiration of three years), as follows: |
| Gas/Oil for Specially Modified Van | $ 1,680/yr |
| Insurance on Specially Modified Van | 1,944/yr |
| Supplemental Home Nursing Care (LPNs, RNs) | 30,000/yr |
| Private Care Management Services | 2,000/yr |
| B. | For Lisa's one-time special needs as follows: | |
| Wheelchair Accessible Van W/ Lift | $42,000 |
| Construction of Wheelchair Ramps for Home | 6,000 |
| Specially Adapted Computer with Printer and Accessories | 1,800 |
| Computer Desk and Special Needs Bed | 4,000 |
J.
[SEE CAPTION AT 1.3.2 ]
PETITION FOR ALLOWANCES FROM
SPECIAL NEEDS TRUST
ABC Bank, Trustee of the Special Needs Trust for the benefit of Lisa Dunn dated 9/15/99, respectfully submits this Petition for Approval to Use Trust Principal for the Beneficiary's Special Needs, to the extent that income is insufficient and to the extent not covered by insurance or any other source, and in support thereof, Petitioner avers the following:
1. Lisa Dunn ("Lisa" or the "incapacitated person") was born on July 1, 1967. She is currently 32 years old and resides with her mother, Pamela Dunn, at 111 Pine Street, Philadelphia, Pennsylvania 19111. Her social security number is 111-11-1111.2. On September 1, 1994, Lisa was struck by a car while crossing Oak Street in Philadelphia.3. Lisa suffered traumatic brain damage in the accident and as a result, has severe and permanent cognitive and physical disabilities. She cannot walk or talk. Although she appears to recognize her family members and caregivers, she cannot speak or communicate in any effective way. She requires assistance for all of her daily needs (personal hygiene, feeding, dressing, etc). She will require 24-hour nursing and custodial care as well as significant medical care for the rest of her life. Her condition and required care are described in the reports of her neurosurgeon, Susan Smith, M.D. and neurologist, William Jones, M.D., copies of which are attached hereto as Exhibits "A" and "B" respectively.4. Following Lisa's injuries, Lisa was adjudicated a totally Incapacitated Person and Pamela Dunn, the incapacitated person's mother, was appointed Plenary Guardian of her Estate and Person, by Decree dated January 15, 1995 of the Honorable Anita S. Jones.5. Lisa's personal injury case, "Lisa Dunn, an Incapacitated Person, by the Guardian of her Estate, Pamela Dunn et al. v. Thomas White et al, (June Term, 1997, No. 3479)" settled with a net amount payable to Lisa as follows: a. Cash payment of $500,000, andb. Monthly, tax-free structured settlement payments of $3,350 per month, guaranteed for a minimum period of 10 years and life thereafter, to commence 9/1/99. 6. By Order dated July 2, 1999 ("Settlement Approval Order"), the Honorable Anita S. Jones approved the settlement and ordered distribution of the settlement proceeds to the Guardian of the Estate for distribution to a Corporate Trustee of a Special Needs Trust to be approved by the Orphans' Court Division. A copy of the said Order dated July 2, 1999 is attached hereto as Exhibit "C."7. Thereafter, Petitioner filed a Petition for Approval of a Special Needs Trust. By Decree dated August 15, 1999, the Honorable Anita S. Jones approved the proposed Special Needs Trust for Lisa and appointed ABC Bank, Trustee. A copy of Judge Jones' August 15, 1999 Decree is attached as Exhibit "D."8. Lisa has no assets other than the principal contained in the Special Needs Trust. The principal will grow through both investment growth and the addition of the monthly structured settlement payments of $3,350 per month. The current market value of the principal of the Trust, as set forth in the statement attached as Exhibit "E," is $520,000.9. Lisa also receives income in the form of SSI payments of $550 per month. Lisa's only other income will be the income earned on the investments in her Special Needs Trust, which is expected to be approximately $17,500 to $22,500 if the investment portfolio is allocated 65% equities/35% fixed income. Accordingly, after adding the structured settlement payments of $40,200 per year, the Trust corpus is still expected to grow, even after all Trust distributions and expenses requested herein.10. After being appointed Trustee, ABC contacted Life Care Managers, Inc. ("LCM"), a private case management service for disabled individuals, to evaluate Lisa's current condition and needs; and, after working extensively with Lisa's mother, the Trustee, and counsel, LCM has developed a current special needs care plan for Lisa, which includes certain ongoing and one-time expenses. A copy of the said Report of LCM, is attached hereto as Exhibit "F."11. Because the terms of the Special Needs Trust require the Trustee to obtain prior Court approval to use Trust principal for Lisa's special needs, Petitioner hereby seeks authorization to make certain annual and one-time expenditures for Lisa's special needs, as described in the LCM report and as summarized in Schedules A and B attached as Exhibit "G." As set forth in the comprehensive list of expenses set forth in Schedule A, Lisa's annual cash needs are estimated to be $35,624 per year; her one-time needs total $53,800.12. Lisa qualifies for and relies upon Medicaid for her medical care. Thus, an allowance for the cost of basic medical care covered by insurance is not included in this petition.13. Lisa's presumptive intestate heirs are as follows: | Mary Jones 617 Alcott Street Philadelphia, PA 19120 | Mother (consent attached) |
| James Black whereabouts unknown | Father |
Lisa's mother and father were never married but lived together for some time. Lisa's father left when she was seven years old. He does not participate in Lisa's life or her care and his whereabouts are currently unknown. Lisa also has a sister, Jennifer Jones, who is 18 years old.
By letter dated January 14, 2000, a copy of which is attached, Petitioner provided notice of the filing (as well as a copy) of this Petition to the following:
Andrew Coates, Esquire
Department of Public Welfare, Legal
302 State Office Building
1400 Spring Garden Street
Philadelphia PA 19130
SSI Program Support Team
Attention: Team Leader
Mid Atlantic Program Service Center
3rd and Spring Garden Streets
Philadelphia PA 19101
Wherefore, Petitioner respectfully requests that this Court enter the proposed Decree attached hereto, which provides that ABC Bank, Trustee of the Special Needs Disability Trust for the benefit of Lisa Jones, is authorized to use Trust principal for Lisa's special needs, to the extent not covered by insurance or payable from any other source and to the extent that Trust income is insufficient, as follows:
| A. | For Lisa's ongoing annual special needs for the next three years (a new Petition for Allowances to be filed upon the expiration of three years), as follows: | |
| Gas/Oil for specially modified van | $ 1,680/yr |
| Insurance on specially modified van | 1,944/yr |
| Supplemental Home Nursing Care (LPNs, RNs) | 30,000/yr |
| Private Care Management Services | 2,000/yr |
| B. | For Lisa's one-time special needs as follows: | |
| Wheelchair accessible van w/ lift | $42,000 |
| Construction of wheelchair ramps for home | 6,000 |
| Specially Adapted Computer with Printer and Accessories | 1,800 |
| Computer desk and special bed | 4,000 |
John K. Trustworthy, Esquire
Attorney for Petitioner
[SEE AFFIDAVIT AT 1.4.1 OR VERIFICATION AT 1.4.3 ]