DONOR ADVISED FUND APPLICATION & AGREEMENT FOR INDIVIDUALS

Transcription

1 DONOR ADVISED FUND APPLICATION & AGREEMENT FOR INDIVIDUALS THIS DONOR ADVISED FUND APPLICATION AND AGREEMENT (this Agreement ) is entered into by and among (i) the Donor/Primary Adviser set forth below, (ii) as applicable, the Joint Adviser set forth in Section 1below, and (iii) the BNY Mellon Charitable Gift Fund (the Gift Fund ). The Gift Fund is exempt as a sponsoring organization described in sections 501(c)(3) and 4966 of the Internal Revenue Code of 1986 (the Code ) that administers donor advised funds. It is organized and operated exclusively for charitable and other purposes set forth in section 501(c) (3) of the Code. The terms and conditions of the Gift Fund s Policies and Guidelines, as amended from time to time (the Policies and Guidelines ), are hereby incorporated into this Agreement. Donor/Primary Adviser establishes the Account and makes the initial $10,000 contribution into the Account. Each Account will only have one Donor/Primary Adviser. As the Donor/Primary Adviser, you will have the privilege to recommend grants to charities, recommend investment alternatives for the Account, serve as the primary recipient for all Account correspondence, and receive all notifications for the Account. Joint Advisers must be appointed by the Donor/Primary Adviser and there can only be four (4) persons named to the role at any given time. A Joint Adviser has all the privileges accorded the Donor/Primary Adviser (see Policies and Guidelines). A Donor/Primary Adviser can appoint a Joint Adviser at the time an Account is established or subsequently. A Joint Adviser must agree to be bound by the terms and conditions applicable to Joint Advisers. Please refer to our website for additional Joint Adviser Applications if applicable. Authorized Representatives must be appointed by the Donor/Primary Adviser or Joint Adviser and there can be a total of five (5) people named to the role at any given time. An Authorized Representative may make additional contributions of $250 or more to the Account, and has the privilege to make grant recommendations. Please refer to our website for an Authorized Representative Application. Additional Donors must be approved by the Donor/Primary Adviser or Joint Adviser to make contributions of at least $250 into the Account once it has been established, and will receive an acknowledgment of any such contributions from the Gift Fund. Please refer to our website for an Additional Donor Application.

2 1. DONOR/PRIMARY ADVISER & JOINT ADVISER INFORMATION Donor/Primary Adviser Information: Mr. Mrs. Ms. Miss Dr. Other Name (First / Middle / Last) Social Security Number Date of Birth (mm/dd/yyyy) Home/Legal Street Address Joint Adviser Information (If Applicable): Mr. Mrs. Ms. Miss Dr. Other Name (First / Middle / Last) Social Security Number Date of Birth (mm/dd/yyyy) Home/Legal Street Address City, State, Zip Code Country (if not United States) City, State, Zip Code Country (if not United States) Mailing Address (if different from above) Mailing Address (if different from above) Home Telephone Number Cellular Telephone Number Home Telephone Number Cellular Telephone Number Address _ Address Country of Citizenship Country of Permanent Residency _ Country of Citizenship Country of Permanent Residency Method of delivery: Electronic correspondence: Tax Letter, Grant Confirmation Letters, Statements/Documents etc. Paper correspondence: Tax Letter, Grant Confirmation Letters, Statements/Documents, etc. Method of delivery: Electronic correspondence: Tax Letter, Grant Confirmation Letters, Statements/Documents, etc. Paper correspondence: Tax Letter, Grant Confirmation Letters, Statements/Documents, etc. If no selection is made, the default delivery method is set to Electronic correspondence 2

3 Donor/Primary Adviser: Occupation (See below for examples) Occupation Examples: Accounting/Auditing, Admin/Clerical, Attorney/Arbitrator/Paralegal, Banking Professional, Car/Boat/Airplane Dealer, Casino/Gaming, Construction/Skilled Trades, Creative/Design/Architectural, Defense/Military, Doctor/Medical/Health, Editorial/Writing/Publishing, Education, Engineering/Science/R & D, Entertainment/ Sports/Arts, Homemaker, Hospitality/Food, Independent Investor, Information Technology, Insurance, Manufacturing/Production Operations, Non-Bank Financial Professional (security broker/investment adviser/private equity or hedge fund professional), Not for Profit Executive, Public Service/ Elected Official/ Embassy, Real Estate /Leasing, Retail/Art Dealer/Antiques, Student, Transportation/Warehousing, Unemployed, Other (requires explanation) Source of Wealth (See below for examples) Source of Wealth Examples : Business Profits, Distribution from 401(k), Divorce, Inheritance/Gift, Insurance Settlement, Law Suit, Salary, Sale of Business, Wealth Accumulation Over Time, Other (requires explanation) Details of Source of Wealth (i. e. salary from management position at ABC business): Source of Income (See below for examples) Source of Income Examples: Employment Income, Household/Family Income, Inheritance, Investment Income, Retirement Income, Social Security, Trust Income, Unemployment Income, Other (requires explanation) A Politically Exposed Person ( PEP ) includes persons, immediate family members, and close associates who may have political exposure based on their occupation, relatives or associations. Please answer the following questions related to PEPs: Are you a Current or Former Senior Political Figure? YES NO Are you a Current or Former Head of State? YES NO Are you an Immediate Family Member or Close Associate of a Senior Political Figure? YES NO If YES, to any of the questions above: Reason for Senior Political Figure Status Date of Position Country of Position You may be requested to provide a copy of a current government issued photo ID such as a Driver s License or Passport for identity verification purposes. 3

4 Joint Adviser: (If applicable) Occupation (See below for examples) Occupation Examples: Accounting/Auditing, Admin/Clerical, Attorney/Arbitrator/Paralegal, Banking Professional, Car/Boat/Airplane Dealer, Casino/Gaming, Construction/Skilled Trades, Creative/Design/Architectural, Defense/Military, Doctor/Medical/Health, Editorial/Writing/Publishing, Education, Engineering/Science/R & D, Entertainment/ Sports/Arts, Homemaker, Hospitality/Food, Independent Investor, Information Technology, Insurance, Manufacturing/Production Operations, Non-Bank Financial Professional (security broker/investment adviser/private equity or hedge fund professional), Not for Profit Executive, Public Service/ Elected Official/ Embassy, Real Estate /Leasing, Retail/Art Dealer/Antiques, Student, Transportation/Warehousing, Unemployed, Other (requires explanation) Source of Wealth (See below for examples) Source of Wealth Examples : Business Profits, Distribution from 401(k), Divorce, Inheritance/Gift, Insurance Settlement, Law Suit, Salary, Sale of Business, Wealth Accumulation Over Time, Other (requires explanation) Details of Source of Wealth (i. e. salary from management position at ABC business) Source of Income (See below for examples) Source of Income Examples: Employment Income, Household/Family Income, Inheritance, Investment Income, Retirement Income, Social Security, Trust Income, Unemployment Income, Other (requires explanation) A Politically Exposed Person ( PEP ) includes persons, immediate family members, and close associates who may have political exposure based on their occupation, relatives or associations. Please answer the following questions related to PEPs: Are you a Current or Former Senior Political Figure YES NO Are you a Current or Former Head of State YES NO Are you an Immediate Family Member or Close Associate of a Senior Political Figure YES NO If YES, to any of the questions above: Reason for Senior Political Figure Status Date of Position Country of Position You may be requested to provide a copy of a current government issued photo ID such as a Driver s License or Passport for identity verification purposes. 4

5 2. ACCOUNT TITLE You have the option to name the Account you are establishing. You may select a name in honor of yourself, your family, relatives, friends, or a charitable purpose (e.g., Donor Family Fund ). The Gift Fund will review and must approve the name for an Account. The Gift Fund recommends using Fund in the name to signify the separate nature of the Account. To preclude certain legal implications, DO NOT use the words Foundation, Trust, or Endowment, to designate Accounts. Grants made by the Gift Fund to a charitable recipient are accompanied by an acknowledgment letter, which will reference the Account name, unless anonymity is specifically requested. Proposed Account Name: 5

6 3. RECOMMENDING INVESTMENTS The Gift Fund invests the proceeds of your contribution pursuant to the Gift Fund s Investment Policy outlined in the Policies and Guidelines. The Gift Fund has the sole responsibility and authority for investing the Account s assets. The Gift Fund reserves the right to review your recommended investment alternative and allocation and reserves the right to modify, in whole or in part, such recommendation. You have the option of recommending a portfolio allocation among the following: Investment Alternatives (+/- 10%) Investment % Cash Reserve 100% Cash Maximum Income 100% Fixed Income Income 30% Equity / 70% Fixed Income Growth and Income 60% Equity / 40% Fixed Income Growth 70% Equity / 30% Fixed Income Aggressive Growth 80% Equity / 20% Fixed Income *ESG Maximum Income 100% Fixed Income *ESG Income 30% Equity / 70% Fixed Income *ESG Growth and Income 60% Equity / 40% Fixed Income *ESG Growth 70% Equity / 30% Fixed Income *ESG Aggressive Growth 80% Equity / 20% Fixed Income Total Percentage Must Equal 100% *These pools invest in managers that consider environmental, social and governance issues (ESG) in their investment process. The Gift Fund reserves the right to modify the investment options available at any time. If no option is selected, the default will be Growth and Income. For Accounts with a market value of $5 million or more, individual stock and bond portfolios may be utilized. Please contact the Gift Fund for information. BNY Mellon, N.A. is the investment manager of the Gift Fund and makes available to the Gift Fund investment products that are sponsored, distributed, or provided by companies that are affiliates of BNY Mellon, N.A. 6

7 4. MAKING THE INITIAL CONTRIBUTION Initial contributions must be valued at $10,000 or more. No pooling of contributions among various donors will be accepted in establishing the Account. Contributions can include cash, cash equivalents, or publicly traded securities, including stocks, most mutual fund shares, and bonds. Contributions in the form of any other asset than those provided above may be accepted pursuant to the rules provided in the Policies and Guidelines on a case-by-case basis. Please see detailed delivery instructions at the end of this Application. Please do not send the contribution until you are notified that your Account has been approved. All contributions are irrevocable. Once assets are transferred to and accepted by the Gift Fund, they may not be returned. Please select the type of contribution(s) you are making and provide the requested information for such contribution(s): Securities (Stocks, Bonds, Mutual Funds, or other assets) Please check if held at BNY Mellon Please check if held at other institution Name of Security / Fund Ticker Symbol Number of Shares/Par Approximate Value Name of Financial Institution: Name on account where securities are being sent from: Name of Financial Adviser: Contribution of Cash (or cash equivalents) through Check and/or Wire Transfer Check (Make check payable to the BNY Mellon Charitable Gift Fund) Amount of Check: $ Name on account check is drawn on: Wire Amount of Wire: $ Financial institution/country wire being sent from: Name on account that wire is being sent from: If account is not held in the name of the Donor, then an explanation must be attached to this application along with authorization from the account holder Other Please Specify: 7

8 5. DESIGNATING A SUCCESSION PLAN You have the option of selecting one of the following succession plans upon your death, incapacity, refusal to serve, or any other event that would disqualify you as serving as the Donor/Primary Adviser: OPTION #1: Recommending a Successor (an individual that will succeed you as the Donor/Primary Adviser), OPTION #2: Recommending a charitable beneficiary (ies) to receive the proceeds of any remaining assets in the Account, or OPTION #3: Transferring the remaining Account balance to the general charitable Grant Fund. 1 All recommendations as to Successors or charitable beneficiaries are subject to the final review and approval of the Gift Fund, in its complete and absolute discretion, at the time the recommendation would otherwise take effect. If you fail to identify the desired plan of succession, then upon your death, incapacity, refusal to serve, or other disqualification as Donor/Primary Adviser, the Gift Fund will transfer the remaining Account balance to the general charitable Grant Fund. Please select the desired succession plan and provide the requested information: OPTION #1- Recommended Individual Successor 2 Named Successor for role of Donor/Primary Adviser Mr. Mrs. Ms. Miss Dr. Other Name: (First) (Middle) (Last) Date of Birth (mm/dd/yyyy) Home/Legal Street Address (no P.O. Boxes): City, State, Zip Code Country (if not United States) Home Telephone Number: Cellular Telephone Number: Address 1 The Grant Fund is the Gift Fund s unrestricted charitable account, which is established to make charitable grants. Donors may not recommend grants from this account. Donors may contribute any amount directly to the Grant Fund and may also recommend transfers to the Grant Fund from their Account. 2 Additional information will be required from the recommended Successor at the time of succession. Only after receipt of the information will the Gift Fund make a determination of acceptance regarding the recommended Successor. 8

9 Contingent Successor for role of Donor/Primary Adviser (In the event that the Named Successor refuses to serve, becomes incapacitated, dies, or otherwise is disqualified) Mr. Mrs. Ms. Miss Dr. Other Name: (First) (Middle) (Last) Date of Birth (mm/dd/yyyy) Home/Legal Street Address (no P.O. Boxes) City, State, Zip Code Country (if not United States) Home Telephone Number: Cellular Telephone Number: Address Contingent Charitable Beneficiary (In the event that the Named Successor and Contingent Successor (if applicable) refuses to serve, becomes incapacitated, dies, or otherwise is disqualified; the recommended Contingent Charitable Beneficiary organization listed below may receive the remaining balance of the Account, pending Gift Fund approval) Organization s Name Federal Tax ID Number _ Telephone Number Mailing Address City, State, Zip Code Country (if not United States) _ 9

10 OPTION #2- Recommended Charitable Beneficiary(ies) Charitable Beneficiary #1 Organization s Name Federal Tax ID Number Telephone Number Mailing Address City, State, Zip Code Country (if not United States) _% Recommended Percentage of remaining Assets the Charitable Beneficiary is to receive Charitable Beneficiary #2 Organization s Name Federal Tax ID Number Telephone Number Mailing Address City, State, Zip Code Country (if not United States) _% Recommended Percentage of remaining Assets the Charitable Beneficiary is to receive If additional space is needed with respect to recommended charitable beneficiaries, please attach a sheet including any additional recommended charitable beneficiaries, the beneficiaries required contact information, and the recommended percentage of assets the beneficiary is to receive. OPTION #3- Grant Fund Transfer the remaining Account balance to the general charitable Grant Fund upon death, incapacity, refusal to serve, or other disqualification as Donor/Primary Adviser. 10

11 6. FUND AGREEMENT FOR INDIVIDUALS INTENDING TO BE LEGALLY BOUND, THE DONOR/PRIMARY ADVISER ( DONOR ), THE JOINT ADVISER (AS APPLICABLE), AND THE GIFT FUND AGREE THAT THE FOLLOWING TERMS AND CONDITIONS SHALL APPLY TO THE ACCOUNT ESTABLISHED BY THE DONOR: 1. Creation of the Account. An Account shall be established on the books and records of the Gift Fund and, upon review and approval of the Gift Fund, shall be known by the name designated above or such other name as approved by the Gift Fund. The Account shall include the Initial Contribution set forth herein and any other assets that are subsequently contributed to the Account and any investment earnings with respect to the Account less any applicable investment and administrative fees as set forth in the Policies and Guidelines. 2. Irrevocable Transfer. The transfer of the Initial Contribution and all subsequent transfers to the Gift Fund are irrevocable and such assets will not be refunded to the Donor and/or the Joint Adviser in any manner. Upon transfer, the Gift Fund shall acquire all right, title and interest in the Initial Contribution and all subsequent contributions to the Account. Any assets in the Account, including any investment returns, are exclusively owned and controlled by the Gift Fund. The underlying assets contributed and any future investment returns are exclusively owned by the Gift Fund. As owner of the assets in the Account, the Gift Fund is not and will not be under any obligation to redeem, sell, or otherwise transfer any assets in the Account. The Donor and/or the Joint Adviser has not and may not impose any restriction or condition that prevents the Gift Fund from freely and effectively using the Initial Contribution or any subsequent contributions to further charitable or other purposes set forth in section 501(c)(3) of the Code. 3. Minimum Contributions. The minimum initial contribution required to establish the Account is $10,000 as set forth in Section 4 above. Donors may make subsequent contributions of at least $250 or more after the Account has been established. The Gift Fund reserves the right to revise the minimum contribution levels, and such revised amounts shall be set forth in the Policies and Guidelines. 4. Distributions for Charitable Purposes. All distributions from the Account shall be for purposes described in section 501(c) (3) of the Code and in compliance with any requirements set forth in sections 4966 and 4967 of the Code with respect to donor advised funds. The Donor and/or the Joint Adviser may, and is encouraged to, make distribution recommendations for grants for the benefit of organizations that are recognized as exempt public charities described in sections 501(c)(3) and 509(a)(1), 509(a)(2) or, as appropriate, 509(a)(3) of the Code, subject to any terms on permissible recipients and purposes set forth in the Policies and Guidelines. The Gift Fund reserves the right to review any grant recommendations and the right to reject any such recommendation. Charitable distributions from the Account shall be made at such times, in such amounts, in such ways, and for such purposes as the Gift Fund shall determine, in its sole and independent discretion, within the charitable purposes of the Gift Fund. 5. Variance Powers. The Donor and/or Joint Adviser acknowledges and confirms that, in accordance with the governing documents of the Gift Fund, the Gift Fund has the ultimate authority, discretion, and control over all the assets in the Account, including any income and appreciation, including the authority to exercise its variance powers as set forth in the governing documents and the Policies and Guidelines to modify the terms and purposes of the Account, including as required under Treas. Reg A-9(f) (11) (v) (B). 6. Component Part. It is intended that the Account shall be a component part of the Gift Fund and not a separate entity for tax purposes, and that nothing in this Agreement shall affect the status of the Gift Fund as a charitable organization described in section 501(c) (3) of the Code, and as an organization that is not a private foundation within the meaning of Section 509(a) of the Code. In particular, the Gift Fund is intended to qualify as a sponsoring organization of donor advised funds satisfying all requirements under Treas. Reg A-9(f) (10) and (11). This Agreement shall be interpreted to conform to the requirements of the foregoing provisions of the federal tax laws and any applicable regulations. The Gift Fund is authorized to amend this Agreement to conform to the provisions of any applicable law or government regulation in order to carry out the purposes of the Gift Fund. 11

12 7. Investment of the Assets. The Gift Fund shall have the right, but not the obligation, to sell the Initial Contribution and any subsequent contributions and invest the proceeds of any sale in accordance with the Policies and Guidelines and this Agreement. 8. Recommendation of Investment Strategy. The Donor and/or Joint Adviser may recommend the investment strategy and the allocation of the Account assets among a variety of investment alternatives offered by the Gift Fund as set forth in Section 3 above. The Gift Fund reserves the right to review any investment recommendation and the right to modify, in whole or in part, such recommendation. The Gift Fund has the sole responsibility and authority for investing the Account s assets and no recommendation provided by the Donor and/or Joint Adviser shall be binding on the Gift Fund. The Donor and the Joint Adviser acknowledge that the Gift Fund shall have sole and independent discretion to determine the investments of the Account. The Donor and Joint Adviser understand that despite the exercise of reasonable care, there can be no assurances with respect to performance or the amount that will be available for charitable distributions. 9. Reliance by Donor. The Gift Fund is not providing any legal or tax advice with respect to contributions to the Account. The Donor and/or the Joint Adviser are advised to consult their legal and/or tax advisor regarding the contribution, deductibility, and any applicable appraisal requirements. The Donor and the Joint Adviser may not rely on any statements made by representatives of the Gift Fund with respect to legal or tax matters. 10. Joint Adviser/Successor. The Donor may recommend an individual(s) to act as Joint Adviser, Authorized Representative and/or Additional Donor in accord with the Policies and Guidelines. The Donor and the Joint Adviser acknowledge that the Joint Adviser has all the privileges accorded the Donor but must be appointed by the Donor. There can only be four (4) people named to the role of Joint Adviser at any given time. The Donor may also recommend Successors to the various roles in accord with the Policies and Guidelines. The Joint Adviser may name a successor to the Joint Adviser role and may select Authorized Representatives and Additional Donors. Restrictions with respect to each selected role are set forth in the Policies and Guidelines. The Gift Fund reserves the right to review any selection(s) and the right to reject any such selection(s). 11. Certification. The Donor and the Joint Adviser hereby certify that all information represented in this Agreement is accurate, true, and complete. The Donor and the Joint Adviser will notify the Gift Fund in writing of any changes to the information represented therein and herein. 12. Governing Law. The validity, effect, and construction of this Agreement and any obligation undertaken pursuant hereto shall be determined in accordance with the laws of the State of Delaware. 13. Binding Effect. The Donor and Joint Adviser have received, reviewed and agree to the terms and conditions applicable to the Initial Contribution and any subsequent contribution set forth in (i) the Policies and Guidelines (an additional copy of which can be obtained upon request) and (ii) this Agreement. The Donor and Joint Adviser acknowledge that all contributions to the Account will be subject to the terms provided in the Policies and Guidelines and this Agreement. The provisions of this Agreement shall be deemed to bind, obligate and extend to, and inure to the benefit of, the Parties hereto, and the successors, administrators, affiliates, officers, directors, agents, servants, employees, and representatives of each Party hereto, including those who may assume any or all of the above-described capacities subsequent to the execution of this Agreement. [Signature Page Follows] 12

13 IN WITNESS WHEREOF, this Agreement has been executed by the Parties hereto. DONOR/PRIMARY ADVISER: Printed Name: Signature: Date: JOINT ADVISER: Printed Name: Signature: Date: BNY MELLON CHARITABLE GIFT FUND: Printed Name: Signature: Title: Date: When your form is complete, please review it, sign it, and send it via mail, overnight delivery, or fax to: BNY Mellon Charitable Gift Fund 201 Washington Street Suite Boston, MA Fax: (866) BNY MELLON CHARITABLE GIFT FUND is a service mark of The Bank of New York Mellon Corporation BNY MELLON CHARITABLE GIFT FUND. All rights reserved. 13

14 BNY Mellon Charitable Gift Fund Delivery Instructions Check and Wire Instructions Check: Fed Wire: Payable to: BNY Mellon Charitable Gift Fund Mail to: BNY Mellon Wealth Management Attn: BNY Mellon Charitable Gift Fund 201 Washington Street, AIM Boston, MA ABA: / The Bank of New York Mellon DDA: (General) FFC Account Name: BNY Mellon Charitable Gift Fund FFC Account Number: Marketable Securities: DTC Eligible (e.g., Stocks, Corporate Bonds, etc.): DTC Participant #: 0443 DTC Participant Name: Pershing, LLC. FFC Account Name: BNY Mellon Charitable Gift Fund FFC Account Number: N7M FED Book Entry Securities (e.g., Treasuries): ABA: / Bank of NY/Pershing FFC Account Name: BNY Mellon Charitable Gift Fund FFC Account Number: N7M Mutual Funds and Foreign Securities: Please contact BNY Mellon Capital Markets at or at bnymcmgiftprocessing@bnymellon.com Physical Security Deliveries: Please contact BNY Mellon Capital Markets at or at bnymcmgiftprocessing@bnymellon.com Other Assets: Please contact the BNY Mellon Charitable Gift Fund at bnymcharitable@bnymellon.com or at (888) to discuss. BNY MELLON CHARITABLE GIFT FUND is a service mark of The Bank of New York Mellon Corporation BNY MELLON CHARITABLE GIFT FUND. All rights reserved.