Build a legacy with CHS Membership Trust Account, achieve immediate tax saving and bring hope to the world through your CHS membership

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1 Welcome to CHS TRUST Build a legacy with CHS Membership Trust Account, achieve immediate tax saving and bring hope to the world through your CHS membership Our Charitable giving plan is a member-advised program it is a program that is maintained and operated by a section 501(c) (3) organization, which is called a sponsoring organization. Each membership is funded by an individual or business donor who receives an immediate tax deduction for their contribution. While the organization has legal control over the contribution, the member can make investments for the befit of their trust and grant recommendations to support his or her favorite charities. The Church for the Healthy Self (CHS) Program for Charitable Giving is a national, donor advised program that was founded in Dallas, Texas in The program provides an efficient and effective means for initiating, growing and distributing charitable gifts to the world. Through the Program, individuals and corporations can actively engage in philanthropy and support qualified charitable organizations throughout the United States and World. CHS Program s offers to its members Personalized Services to help them learn and grow in all intelligences, Charitable giving with tax advantages, low operating fees to maximize our giving and programs and your member remainder benefit (MRM). Member can feel confident they have made the right choice for aligning their financial resources with their passion for charity. The CHS Program for Charitable Giving is a public charity as described under section 170(b)(1)(a)(c) and is tax exempt under section 501(c)(3) of the Internal Revenue Code. The Program is governed by members and staff who bring a variety of expertise to the oversight of the Program and its activities. CHS s tax identification number is Terms and conditions of the Trust Agreement By signing this application, we/i, the donor(s) declare that we/i now establish a charitable remainder unitrust within the meaning of Rev. Proc and 664(d)(2) of the Internal Revenue Code (hereinafter the Code ), and enter into this trust agreement with The Church for the Healthy Self, a Texas church, as the initial trustee (hereinafter the Trustee ). This trust shall be known as the Charitable Fund. 1. Funding of Trust. The Donor(s) hereby transfers and irrevocably assigns, on the above date, to the Trustee the property described in Schedule A, and the Trustee accepts the property and agrees to hold, manage and distribute the property, and any property subsequently transferred, under the terms set forth in this trust instrument. 2. Payment of Unitrust Amount. In each taxable year of the trust during the unitrust period, the Trustee shall pay to Beneficiary #1 (hereinafter the Initial Recipient ) until the Initial Recipient's death, next to Beneficiary #2 and thereafter to Contingent Beneficiary (hereinafter "the Successor Recipient"), a unitrust amount equal to 5 percent of the net fair market value of the assets of the trust valued as of the first day of each taxable year of the trust (hereinafter the valuation date ). The first day of the unitrust period shall be the date property is first transferred to the trust and the last day of the unitrust period shall be the date of the death of the survivor of the Initial Recipient and the Successor Recipient. The unitrust amount shall be paid in equal monthly installments at the end of each calendar month from income and, to the extent income is not sufficient, from principal. Any income of the trust for a taxable year in excess of the unitrust amount shall be added to principal. If, for any year, the net fair market value of the trust assets is incorrectly determined then, within a reasonable period after the correct value is finally determined, the Trustee shall pay to the Initial Recipient and/or the Successor Recipient (in the case of an undervaluation) or receive from the Initial Recipient (in the case of an overvaluation) an amount equal to the difference between the unitrust amount(s) properly payable and the unitrust amount(s) actually paid. 3. Proration of Unitrust Amount. For a short taxable year and for the taxable year during which the unitrust period ends, the Trustee shall prorate on a daily basis the unitrust amount described in paragraph 2 or, if an additional contribution is made to the trust, the unitrust amount described in paragraph Distribution to Charity. At the termination of the unitrust period, the Trustee shall distribute all of the then principal and income of the trust (other than any amount due the Recipient under the terms of this trust) to The Church for the Healthy Self (hereinafter the Charitable Organization ). If the Charitable Organization is not an organization described in 170(b)(1)(A), 170(c), 2055(a) and 2522(a) of the Code at the time when any principal or income of the trust is to be distributed to it, then the Trustee sh all distribute the then principal and income to one or more organizations described in 170(b)(1)(A), 170(c), 2055(a) and 2522(a) of the Code as the Trustee shall select, and in the proportions as the Trustee shall decide, in the Trustee s sole discretion. 5. Additional Contributions. If any additional contributions are made to the trust after the initial contribution, the unitrust amount for the year in which any additional contribution is made shall be [same percentage used in paragraph 2] percent of the sum of (a) the net fair market value of the trust assets as of the valuation date (excluding the assets so added and any post-contribution income from, and appreciation on, such assets during that year) and (b) for each additional contribution during the year, the fair market value of the assets so added as of the valuation date (including any post-contribution income from, and appreciation on, such assets through the valuation date) multiplied by a fraction the numerator of which is the number of days in the period t hat begins with the date of contribution and ends with the earlier of the last day of the taxable year or the last day of the unitrust period and the denominator of which is the number of days in the period that begins with the first day of such taxable year a nd ends with the earlier of the last day in such taxable year or the last day of the unitrust period. In a taxable year in which an additional contribution is made on or after the valuation date, the assets so added shall be valued as of the date of contribution, without regard to any post-contribution income or appreciation, rather than as of the valuation date. 6. Deferral of the Unitrust Payment Allocable to Testamentary Transfer. All property passing to the trust by reason of the de ath of the Donor (hereinafter the testamentary transfer ) shall be considered to be a single contribution that is made on the date of the Donor s death. Notwithstanding the provisions of paragraphs 2 and 5 above, the obligation to pay the unitrust amount with respect to the testamentary transfer shall commence with the date of the Donor s death. Nevertheless, payment of the unitrust amount with respect to the testamentary transfer may be deferred from the date of the Donor s death until the end of the taxable year in which the funding of the testamentary transfer is completed. Within a reasonable time after the end of the taxable year in

2 which the testamentary transfer is completed, the Trustee must pay to the Recipient (in the case of an underpayment) or receive from the Recipient (in the case of an overpayment) the difference between any unitrust amounts allocable to the testamentary transfer that were actually paid, plus interest, and the unitrust amounts allocable to the testamentary transfer that were pa yable, plus interest. The interest shall be computed for any period at the rate of interest, compounded annually, that the federal income tax regulations under 664 of the Code prescribe for this computation. 7. Unmarketable Assets. Whenever the value of a trust asset must be determined, the Trustee shall determine the value of any assets that are not cash, cash equivalents or other assets that can be readily sold or exchanged for cash or cash equivalents (hereinafter unmarketable assets ), by either (a) obtaining a current qualified appraisal from a qualified appraiser, as defined in 1.170A-13(c)(3) and 1.170A-13(c)(5) of the Income Tax Regulations, respectively, or (b) ensuring the valuation of these unmarketable assets is performed exclusively by an independent trustee, within the meaning of (a)(7)(iii) of the Income Tax Regulations. 8. Prohibited Transactions. The Trustee shall not engage in any act of self-dealing within the meaning of 4941(d) of the Code, as modified by 4947(a)(2)(A) of the Code and shall not make any taxable expenditures within the meaning of 4945(d) of the Code, as modified by 4947(a)(2)(A) of the Code. 9. Taxable Year. The taxable year of the trust shall be the calendar year. 10. Governing Law. The operation of the trust shall be governed by the laws of the State of Texas. However, the Trustee is prohibited from exercising any power or discretion granted under said laws that would be inconsistent with the qualification of the trust as a charitable remainder unitrust under 664(d)(2) of the Code and the corresponding regulations. 11. Limited Power of Amendment. This trust is irrevocable. However, the Trustee shall have the power, acting alone, to amend the trust from time to time in any manner required for the sole purpose of ensuring that the trust qualifies and continues to qualify as a charitable remainder unitrust within the meaning of 664(d)(2) of the Code. 12. Investment of Trust Assets. Nothing in this trust instrument shall be construed to restrict the Trustee from investing the trust assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of trust assets. 13. Definition of Recipient. References to the Recipient in this trust instrument shall be deemed to include the estate of th e Recipient with regard to all provisions in this trust instrument that describe amounts payable to and/or due from the Recipient. The prior sentence shall not apply to the determination of the last day of the unitrust period. 14. The trust hereunder shall be a Net Income with Makeup Charitable Remainder Trust or NIMCRUT, a type of trust that requires that a fixed percentage (minimum of 5) of the annual value of trust assets be credited to the income beneficiary, or if less, the net income of the trust for that year, with any deficiencies to be made up in later years when trust income exceeds the required set percentage amounts for such years. If a deferred annuity contract is used to fund a NIMCRUT, the trustee has discretion as to the timing of distribution of income, to allow for the buildup of income. This NIMCRUT shall not allow invasion of principal for the payout of income. If there is insufficient income to meet the payout, the income beneficiary must wait until sufficient income exists. Until such time however, the income beneficiary's "make-up account" will continue to build. Once income is sufficient, the income beneficiary will be entitled to the entire buildup in the "make-up account." About this Application This is a CHS Membership Trust Account Application. Please read it carefully, as you will select products and services, tell us how you want to communicate with us, and agree to certain provisions that will govern our relationship. When we accept it, this Application and all accompanying or supplemental documents form the entire Agreement between us for this account. Unless otherwise indicated in this Application, the words you, your, yourself, and yours mean the applicant(s). The words we, us, and our mean {CHS, 3131 McKinney Ave, Suite 600, Dallas, TX } and our Staff All moneys or hard assets placed in your member charitable trust is a donation, you will receive a 100 tax deduction for the full value of your contribution up to 50 of your gross income per year. We offer you flexibility in the direction of the investments fund, and donor advised investment options charitable program(s) of your choice that your member trust account makes. 5 from this account will go to fund charitable programs, in which you may give your input on the funding of a program. Any Hard Assets returned to you will be at $0.00 value and any moneys return to you will be as new income to you. Getting Started Please complete and sign this Application, along with any required supplemental forms identified through this application process. To complete this Application, you may need some or all the following information: Identification information, such as a driver s license, passport, or another type of government-issued identification Federal tax information Information about your annual income, debt, expenses, and net worth Back-up contact information [Firms can include other relevant documents or information] Please remember to notify us if you experience a significant life change, such as the birth of a child, marriage, divorce, death of a spouse, loss of a job, change in financial situation, etc.

3 Use this form to establish a CHS Trust account. Please review our Program Policies prior to opening an Account. 1. Create an Account Name When granting to charity, the donor will have the option to include this Account name in the letter that accompanies the check. Please use the word Fund or Account in the name (i.e., ABC Family Charitable Fund). Account Name (maximum 75 characters) 2. Provide Account Holder Information Primary and Secondary Account Holders have full and equal Account access and privileges, including the ability to: Access CHS Trust Client Center (Existing CHS Trust clients have access by logging into CHSTrust.org and using their CHS Trust ID and password. Non-CHS Trust clients can call Donor Relations at for access.) Recommend grants to eligible charities Recommend a portfolio allocation among the Investments of your choice Add new Account Holders or Additional Account Users and recommend Successors or Charitable Beneficiaries Maintain Account Holder privileges in the event of death/incapacity, refusal to serve, or other disqualifications of other Account Holders Primary Account Holder Title (Default recipient for all Account correspondence) Name (First) (Middle) (Last) / / Home Address: Must NOT Contain a P.O. Box City, State, Zip Code if Different from Above Home Telephone Number Business Telephone Number Mobile Telephone Number Address The Primary Account Holder will receive electronic copies of grant and contribution correspondence. Check here if the Primary Account Holder would prefer to receive paper letters and statements Church For The Healthy Self. All rights reserved. Page 1 of 8

4 2. Provide Account Holder Information Continued To add up to five Secondary Account Holders, please make copies of this page and include them with the completed application. Secondary Account Holder #1 Title Name (First) (Middle) (Last) / / Home Address: Must NOT Contain a P.O. Box City, State, Zip Code if Different from Above Home Telephone Number Mobile Telephone Number Business Telephone Number Address Check here for this Secondary Account Holder #1 to receive paper letters and statements Church For The Healthy Self. All rights reserved. Page 2 of 8

5 3. Authorize Additional Account Users (Optional) Account Holders may authorize up to four individuals (such as family members or assistants) who may: Access CHS Trust Client Center Recommend grants to eligible charities Recommend investments To add up to four individuals as Additional Account Users, please make copies of this page and include them with the completed application. Note that Additional Account Users will not succeed Account Holders on the Account unless they are added separately as successors in section 4 by an Account Holder. Additional Account User #1 Title Name (First) (Middle) (Last) / / Home Address: Must NOT Contain a P.O. Box City, State, Zip Code if Different from Above Home Telephone Number Business Telephone Number Address Check here for this additional Account User to receive paper letters and statements Church For The Healthy Self. All rights reserved. Page 3 of 8

6 4. Choose Succession Planning Options Continued A. Name Individuals as Successors and/or an Individual as Contingent Successor A new Account will be opened for each designated Successor. Total of Account Designated for Successors To add up to four Successors, please make copies of this page and include them with the completed application. Successor #1 Title Name (First) (Middle) (Last) Allocation Percentage / / Relationship to Account Holder Successor #2 Title Name (First) (Middle) (Last) Allocation Percentage / / Relationship to Account Holder Contingent Successor A Contingent Successor will succeed to the Account only upon the death, incapacity, refusal to serve or other disqualification of all Successors with full privileges. (Only one Contingent Successor per account.) Title Name (First) (Middle) (Last) / / Relationship to Account Holder 2018 Church For The Healthy Self. All rights reserved. Page 4 of 8

7 4. Choose Succession Planning Options Continued B. Name Individuals as Beneficiaries and/or an Individual as Contingent Beneficiaries Total of Account Designated for Beneficiaries To add up to six Beneficiaries, please make copies of this page and include them with the completed application. Beneficiary #1 Organization Name Federal Tax ID Number (if known) Allocation Percentage Beneficiary #2 Organization Name Federal Tax ID Number (if known) Allocation Percentage Contingent Beneficiary If, at the time of death, no named Beneficiaries are eligible grant recipients, the Contingent Beneficiary will become the recipient. The Contingent Beneficiary will also succeed to the account in the event that a recommended Successor or Contingent Successor is unable to fulfill the duties of an Account Holder. (Only one Contingent Beneficiary per account.) Organization Name Federal Tax ID Number (if known) Allocation Percentage 2018 Church For The Healthy Self. All rights reserved. Page 5 of 8

8 4. Choose Succession Planning Options Continued C. Recommend the CHS Trust Program Total of Account Designated for the CHS Trust Program The CHS Trust Program requires a minimum account balance of $10,000. New Account Name Select a new Account name that will go into effect at the time of activation. Please use the word Fund or Account in the name (i.e., ABC Family Charitable Fund). Distribution Options: years TERM: Issue grants for a term of (minimum of 5 years) TOTAL Annual Distribution Percentage: (minimum 5) Beneficiary Charitable Organization #1 To add up to six Beneficiary Charitable Organizations, please make copies of this page and include them with the completed application. Organization Name Federal Tax ID Number (if known) (No P.O. Boxes) Telephone Number Home Business Mobile of Total Annual Distribution for Charitable Organization #1 Beneficiary Charitable Organization #2 Organization Name Federal Tax ID Number (if known) (No P.O. Boxes) Telephone Number Home Business Mobile of Total Annual Distribution for Charitable Organization #2 D. Recommend the CHS Trust Charitable Programs Allocations Total Allocations for all selected options must total Church For The Healthy Self. All rights reserved. Page 6 of 8

9 5. Contribute to Account Contributions to an Account can include marketable securities such as equities, mutual funds, fixed income, and assets that are not publicly traded. To contribute restricted or non-cash assets, call Donor Relations at or us at Initial contributions must be in the amount of $10,000 or more, with subsequent contributions at a minimum of $500. All contributions are irrevocable and are eligible for a tax deduction. Donating shares held less than a year may impact your deduction. Consult with your tax advisor. If you are an executor or personal representative of an estate, or a trustee of a trust, please consult your tax or legal professional for advice as to the timing and/or your authority to make the contribution. 1. Source of Funds (REQUIREDPlease select all that apply.) Please select all of the original sources of assets that would fund your Account. Salary/Wages/Savings Social Security Benefits Sale of Property or Business Family/Relatives/Inheritance Investment Capital Gains Gifts Gambling/Lottery Other (please specify) 2. Contributions to Your Account A. Assets From Your CHS Trust Account Assets to be transferred may be noted in a spreadsheet which must be signed, dated and returned with this application. Brokerage Account Number Name(s) on Account 1. Stocks, Bonds, Mutual Funds or Other Assets Description of Assets/Name of Security Symbol (if applicable) Number of Shares (mandatory) Approximate $ Value (mandatory) Cost Basis Include both price and date information if available. Purchase Date Price per Share Total 2. Cash Contribution: $ 2018 Church For The Healthy Self. All rights reserved. Page 7 of 8

10 6. Contribute to Account Continued A. Check or Wire Transfer Check Enclosed: $ Wire Transfer: $ (Make payable to Church For The Healthy Self. Addresses are in Section 7.) (Wire instructions are in Section 7.) B. Security Certificates Held in Personal Possession Please have all registered owners of the donated assets endorse each certificate by writing Church For The Healthy Self between the words appoint and attorney in the space provided on the back of the certificate. All registered owners must sign and date each certificate exactly as their name appears on the face of the certificate. Specify Securities Name of Security Symbol (if applicable) Number of Shares Approximate $ Value If you are sending security certificates, send them with this form via registered, certified or overnight mail and request a return receipt. Note: Securities must be marketable and in most cases penny stock certificates are not accepted. Total 7. Signatures (Mandatory) All Account holders must sign. To add additional Account Holders signatures, please make copies of this page and include them with the completed application. Primary Account Holder Signature Additional Account Holder Signature Additional Account Holder Signature / / Date (mm/dd/yyyy) / / Date (mm/dd/yyyy) / / Date (mm/dd/yyyy) CHS is the name used for the combined programs and services of Church For The Healthy Self, an independent nonprofit organization. CHS has entered into service agreements with certain affiliates of CHS. CHS Trust Locations Magnolia Street, Suite #206 Westminster, CA McKinney Ave, Suite #600 Dallas, TX E. Ninth Street Brooklyn, NY Senter Road, Suite #11 San Jose, CA W. Jackson Blvd., Suite #400 Chicago, IL Phone: info@chstrust.org Church For The Healthy Self. All rights reserved. Page 8 of 8