Table of Contents Financial Planning Packet Direc ons...page 1 What to Expect...Page 2 Documenta on to Gather...Page 3 Investor Personality Profile...Pages 4-5 Personal Data Organizer... Pages 6-11 Privacy Policy... Page 12 Financial Planning Agreement...Pages 13-14 Exhibit I...Page 14 Directions 1. Cypress Wealth Management, LLC Form ADV Part II In compliance with the Investment Advisors Act of 1940 you will receive a copy of Form ADV Part II along with this packet. This is a disclosure document which provides you with important informa on about Cypress Wealth Management, LLC. Please read it and retain a copy for your records. If you have not received a copy of Form ADV Part II, please no fy your Advisor immediately. 2. Read and Complete the Documenta on (Listed Above) Complete all requested informa on, then return the originals to your Advisor or mail them to: Cypress Wealth Management, LLC 9873 Farmyard Drive Cordova, TN 38016 3. If you have any ques ons: Please call: 901-292-3596 or Email: john@cypresswm.com
Page 2 of 14 What to Expect The Financial Planning Process consists of the following six steps: 1. Ini al Mee ng. The ini al mee ng will be free of charge. The purpose of the mee ng is to understand your goals and what you hope to achieve from the financial planning process. You and your advisor will 1) define what type of financial planning you require 2) agree upon the roles and responsibili es throughout the process 3) go over the fees, es ma on and payment process, and 4) discuss the length of the rela onship and how and when decisions will be made. 2. Gathering client data, including goals. During the first mee ng, your advisor will ask for informa on about your current financial situa on. This includes the informa on in this packet and any other per nent informa on you may have. You and your advisor will mutually define your personal and financial goals, understand your me frame for results and discuss, if relevant, how you feel about risk. Please be prepared to provide your advisor with copies of necessary documenta on. Documents you may need to provide are listed in the Documenta on Checklist on the following page. 3. Analyzing and evalua ng your financial status. Your advisor team will analyze the informa on and goals you provided. They will assess your current situa on and prepare a plan to help you reach your goals. Depending on what services you need or are interested in, this could include analyzing your assets, liabili es and cash flow, current insurance coverage, investments or tax strategies. 4. Presen ng financial planning recommenda ons and/or alterna ves. Your advisor will meet with you to present the financial planning recommenda ons. The advisor will go over the recommenda ons with you to help you understand them so that you can make informed decisions. You will have an opportunity to ask ques ons and voice any concerns. If needed, you and your advisor team will make revisions to the recommenda ons as appropriate. 5. Implemen ng the financial planning recommenda ons. Once the plan is complete, you and your advisor will come to an agreement on how the recommenda- ons will be carried out. The advisor may carry out a por on of the recommenda ons or serve as your coach, coordina ng the whole process with you and other professionals such as a orneys. 6. Monitoring the financial planning recommenda ons. The most important part of any plan is successful execu on. During this final step, you will decide who will monitor progress towards your goals. If Cypress Wealth Management, LLC is charged with monitoring the process, then your advisor will report to you periodically to review your situa on and adjust the recommenda ons, if needed, as your life changes.
Page 3 of 14 Documentation Checklist It will be beneficial for you to bring copies of the following types of documents. These documents, along with the Investor Personality Profile and the Personal Data Organizer will be used to tailor a financial plan to meet your life goals. Re rement Planning Documents Recent IRA, 401(k), 403(b), TSA, Keogh statements Employee benefits program Deferred compensa on and stock op on agreements Pension and profit sharing statements Tax Planning Documents Tax returns for last year W-2 and a recent pay stub Es mated taxes Financial Documents Savings account statements Mutual fund statements Brokerage account statements Investment documents Loan documents List of stocks held outside of brokerages Partnership agreements Asset Protec on Documents Life insurance policies and statements Medical, homeowners and auto insurance policies and statements Disability, umbrella, and long term care insurance policies Annuity policies and statements Estate Planning Documents Summary of your will, living will, durable powers of a orney and health care powers Living trusts
Page 4 of 14 Investor Personality Profile Please enter the number value of your choice in the boxes provided. This will create an Investor Personality Profile that will help determine the investments most appropriate for helping achieve the financial goals that are important to you. 1. What type of returns are you seeking? 2 Income 3 Growth > Infla on 4 Maximum Growth Poten al 2. Keeping in mind your primary financial goals, in approximately how many years would you expect to need this money? 2 1-3 years 3 3-7 years 4 7+ years 3. Which one of the following describes your expected future earnings over the next five years? 4 I expect my earnings increases will far outpace infla on (due to promo ons, new job, etc.) 3 I expect my earnings increases to stay somewhat ahead of infla on. 2 I expect my earnings to keep pace with infla on. 1 I expect my earnings to decrease (re rement, part- me work, economically-depressed industry, etc.) 4. How concerned are you that your savings and investment dollars outpace infla on? 2 Not very concerned 3 Moderately concerned 4 Highly concerned 5 Very highly concerned 5. If you are looking for your investments to grow, approximately what annual rate of return would you want/need to meet your goals? 2 Less than 5% 3 5% - 10% 4 Greater than 10% 6. How would you react if the value of your long-term investments declined by 10% in one year? 1 I understand there may be market fluctua ons, but I would be very concerned if the value of my investments declined by 10%. 2 I accept some market fluctua ons, but I would be somewhat concerned if the value of my investments declined this much. 3 I generally invest for the long term and I would not be concerned with this decline. 4 I invest for the long term and would accept a 10% decline. IPP Score (Sum of Ques ons #1-9) 7. How would you react if the value of your long-term investments declined by 20% in one year? 1 I understand there may be market fluctua ons, but I would be very concerned if the value of my investments declined 20%. 2 I accept some market fluctua ons, but I would be somewhat concerned if the value of my investments declined this much. 3 I generally invest for the long term and I would not be concerned with this decline. 4 I invest for the long term and would accept a 20% decline. 8. Have you ever invested in individual bonds/stocks or bond/stock mutual funds. 1 No, but if I had, the fluctua ons would make me uncomfortable. 2 No, but if I had, I would be comfortable with the fluctua ons in order to receive the poten al for higher returns. 3 Yes I have, but I was uncomfortable at mes with the fluctua ons, despite the poten al for higher returns. 4 Yes I have, and I felt comfortable with the fluctua ons in order to receive the poten al for higher returns. 9. Which of the following statements best describes your feelings toward choosing your investments? 2 I would select investments that have a low degree of risk associated with them. 4 I prefer to diversify with a mix of investments, placing an emphasis on those with a low degree of risk and a small por on in others that have a higher degree of risk that may yield a greater return. 6 I prefer to diversify with a balanced mix of investments. 8 I prefer to diversify with an aggressive mix of investments including some that have a low degree of risk, but emphasizing those that may yield greater returns and have a higher degree of risk. 12 I would only select investments that have a higher degree of risk and a greater poten al for higher returns. Client Name Address (May NOT be a PO Box) City, State Zip Home Phone Cell Phone
Page 5 of 14 Investor Personality Profile Please validate your IPP Score by selec ng the appropriate Category (select one). IPP Score: 14-20 Category: Conserva ve Your Investment Personality Score of 14-20 is a Conserva ve Profile, indica ng you are very conserva ve in nature and would not be comfortable with por olio risk and market vola lity of more than (-3 to -5%) downside in any given year. Safety of principal is very important, but you may accept minimal risk and vola lity in pursuit of enhanced returns. You are open to other alterna ves that may enhance monthly returns or income. Your goal is to preserve your capital while producing an income of 2-3% over infla on over an investment period of 1-3 years with a Vola lity Risk Budget of (-3 to -5%) in any given year. IPP Score: 21-25 Category: Moderate Conserva ve Your Investment Personality Score of 21-25 is a Moderate Conserva ve Profile, indica ng you are generally conserva ve in nature and would not be comfortable with por olio risk and market vola lity of more than (-5 to -10%) downside in any given year. Safety of principal is important, but you may accept some risk and vola lity in pursuit of enhanced returns. You are open to other alterna ves that may enhance monthly returns or income. Your goal is to produce income of 4-5% over infla on while maintaining stability of principal over an investment period of 3-5 years with a Vola lity Risk Budget of (-5 to -10%) in any given year. IPP Score: 26-30 Category: Moderate Your Investment Personality Score of 26-30 is a Moderate Profile, indica ng that you are comfortable with por olio risk and market vola lity of (-10 to -15%) downside in any given year. You are a racted to higher returns, and are willing to accept some addi onal risk in order to achieve them. Your goal is to achieve a total annual rate of return of 6-7% over infla on over an investment period of 5-7 years with a Vola lity Risk Budget of (-10 to -15%) in any given year. IPP Score: 31-35 Category: Moderate Aggressive Your Investment Personality Score of 31-35 is a Moderate Aggressive Profile, indica ng that you are comfortable with por olio risk and market vola lity of (-15 to -20%) downside in any given year. Your focus is directed toward long-term financial goals. You are comfortable with higher degrees of risk and market fluctua ons. Your goal is to maximize returns on all your investments with the target of achieving a total annual rate of return of 8-9% over infla on over an investment period of 7-10 years or more with a Vola lity Risk Budget of (-15 to -20%) in any given year. IPP Score: 36+ Category: Aggressive Your Investment Personality Score of 36+ is an Aggressive Profile, indica ng that you are comfortable with por olio risk and market vola lity of (-20 to -30%) downside in any given year. Your focus is directed toward long-term financial goals. You are comfortable with higher degrees of risk and market fluctua ons. Your goal is to maximize returns on all your investments with the target of achieving a total annual rate of return of 10-12% or more over infla on over an investment period of 10 years or more with a Vola lity Risk Budget of (-20 to -30%) in any given year. Client Ini als
CLIENT INFORMATION CO-CLIENT INFORMATION Page 6 of 14 Personal Data Organizer Client Name Client Name Address (May NOT be a P.O. Box) Address (May NOT be a P.O. Box) City, State ZIP Date of Birth Gender City, State ZIP Date of Birth Gender Home Phone Cell Phone Work Phone Home Phone Cell Phone Work Phone Email Address Email Address Employer Name Employer Name Occupa on Occupa on Your Children Name: Age: Name: Age: Name: Age: Name: Age: Your Parents Financial Status: Health Status: Are you expec ng to receive any inheritance? Yes No If yes, when and how much do you expect to receive?:
Page 7 of 14 Personal Data Organizer Why do you want to create a financial plan? Goals and Re rement Planning What are your financial concerns? What do you want to accomplish in the next 10 years? Do you have any goals you want to accomplish when you achieve financial independence? In the next couple years, do you an cipate any of the following to change? Your lifestyle (re rement, job change) Yes No Your expenditures Yes No Your responsibility for children Yes No Your responsibility for parents Yes No
Page 8 of 14 Personal Data Organizer Is it possible you will win or lose a legal judgment in the next 2-4 years? Yes No Do you plan on making a significant purchase or sale? Yes No At what age would you like to be able to re re? At what age do you expect to re re? What amount of monthly income do you expect to need when you re re? Addi onal comments on your goals: Financial Informa on Income Salary per year, including any bonuses: Number of pay periods per year: Other Sources of Income Rental Income: Social Security: Dividends And Interest: Pension: Trust Funds: Self Employed: Capital Gains: Annuity:
Page 9 of 14 Personal Data Organizer Contribu ons 401(k): 403(b): IRA: Roth IRA: Other Re rement Plans: Net Worth What is your approximate net worth? Assets And Liabili es Liquid Assets (cash, money market, CDs): Taxable Investments (mutual funds, stocks, bonds): Tax Sheltered Investments (401(k)s, IRAs, annui es): Stock Op ons: Real Estate: Personal Residence: Vehicles: Property: Cash Reserves, Debt Management and Savings Do you carry credit card balances from month to month? Yes No Do you have a savings plan? Yes No Do you have cash reserves in case of an emergency? Yes No Do you have any assets you wish you did not own? Yes No Addi onal comments on cash reserves, debt and savings:
Page 10 of 14 Personal Data Organizer Asset Protec on Do you have any health problems? Yes No Heath insurance coverage/type: Disability insurance coverage/type: Personal liability insurance coverage/type: Life insurance - how much and type: Do you have long-term care insurance? Yes No Addi onal comments on asset protec on: Do you plan to pay some/all of your child s educa on costs? Yes No Addi onal comments on educa on: Educa on
Page 11 of 14 Personal Data Organizer Estate Planning Do you have an estate plan? Yes No Do you have a will? Yes No - When was it last updated Do you have a living will? Yes No Do you have any children who are minors? Yes No - What are their ages - Have you made guardianship arrangements? Yes No Do you have any trusts? Yes No - Have you tled assets in the name of your trust? Yes No Are you the beneficiary of any trusts or estates? Do you an cipate receiving an inheritance? Have you included charitable giving? Do you wish to provide an inheritance to your children? Will your estate avoid probate? Have you provided adequate estate liquidity for your heirs? Addi onal comments on estate planning: Yes Yes Yes Yes Yes Yes No No No No No No
Privacy Policy Page 12 of 14 PRIVACY POLICY - We Care About Your Privacy! In compliance with the Gramm-Leach-Bliley (GLBA) Act, the United States Securi es and Exchange Commission (SEC), and the Na onal Associa on of Security Dealers (NASD), this no ce describes the privacy policy and prac ces followed by Cypress Wealth Management, LLC. (CWM) and their affiliated companies. Your privacy is a high priority for us and it will be treated with the highest degree of confiden ality. In order for us to be able to provide you with products and services, we need to collect certain informa on from you. However, we want to emphasize that we are commi ed to maintaining the privacy of this informa on in accordance with law. All individuals with access to personal informa on about our customers are required to follow this policy. Non-public Informa on Collected. 1. Informa on we receive from you on applica ons or other forms such as your name, address, date and loca on of birth, marital status, sex, social security number, medical informa on, beneficiary informa on, etc., and 2. Informa on about your transac ons with us, our affiliates or others such as premium payment history, tax informa on, investment informa on, and accoun ng informa on. Non-public Informa on Disclosed. 1. We may provide the non-public informa on that we collect to affiliated or nonaffiliated persons or en es involved in the underwri ng, processing, and servicing of your accounts with Cypress Wealth Management, LLC. We will not provide this informa on to any other nonaffiliated third party unless we have a wri en agreement that requires such third party to protect the confiden ality of this informa on. 2. We may have to provide the above described non-public informa on that we collect to authorized persons or en es to comply with a subpoena or summons by federal, state or local authori es and to respond to judicial process or regulatory authori es having jurisdic on over our company for examina on, compliance or other purposes as required by law. 3. We do not disclose any non-public personal informa on about our customers to anyone except as permitted or required by law. Confiden ality and Security of Your Non-public Personal Informa on. 1. We restrict access of non-public personal informa on about you to only those persons who need to know about the informa on to process and service your accounts with Cypress Wealth Management, LLC. 2. We maintain physical, electronic, and procedural safeguards that comply with state and federal standards to guard your non-public personal informa on. 3. If we become aware at any me that personal informa on may be materially inaccurate, we will make a reasonable effort to re-verify its accuracy and correct any error as appropriate. Informa on about Former Customers. Non-public informa on about our former customers is maintained by Cypress Wealth Management, LLC. on a confiden al and secure basis. If any such disclosure is made, it would be for reasons and under the condi ons described in this no ce. We do not disclose any non-public personal informa on about our former customers to any except as permi ed of required by law. Further Informa on and/or Customer Complaints. If you have any ques ons or comments, you can contact us at: Cypress Wealth Management, LLC., 9873 Farmyard Drive Cordova, TN 38017. Phone 901-292-3596.
Page 13 of 14 Planning Agreement Financial Planning Service Agreement The undersigned ( Client ), being duly authorized, has established a Rela- onship (the Rela onship ), and hereby agrees to engage Cypress Wealth Management, LLC ( Advisor ) on the following terms and condi ons. 1. Appointment of Cypress Wealth Management, LLC The Client hereby appoints Advisor as investment advisor/financial planner for this Rela onship. 2. Services by Advisor. By execu on of this Agreement, Advisor hereby accepts the appointment as investment advisor for the Rela onship and agrees from and a er the effec- ve date, as referred to in the Schedule of Fees a ached hereto as Exhibit I, (a) to create a financial plan for Client, which will outline Client s risks and tolerance levels; (b) It is understood and agreed that Advisor, in the maintenance of records for its own purposes, or in making such records or the informa on contained therein available to Client or any other person at the direc on of Client, does not assume responsibility for the accuracy of informa on furnished by Client or any other person, firm or corpora on. 3. Fees. The compensa on of Advisor for its services rendered hereunder shall be calculated in accordance with the Schedule of Fees a ached hereto as Exhibit I. 4. Representa ons by Client. The execu on and delivery of this Agreement by Client shall cons tute the representa ons by Client that the terms hereof do not violate any obliga- on by which Client is bound, whether arising by contract, opera on of law or otherwise. Client will indemnify Advisor from any liability or expense resul ng from a breach of Client s representa ons. 5. Representa ons by Advisor. By execu on of this Agreement, Advisor represents and confirms that it is registered as an investment adviser in the State of Tennessee. 6. Assignment and Termina ons. This Agreement may not be assigned or transferred in any manner by any party without the prior wri en consent of all par es receiving or rendering services hereunder. The Services and recommenda ons developed for Client pursuant to this Agreement are developed specifically for Client, and therefore, may not be suitable for and are not intended to be followed by any other par es. Agreement may be terminated by any party upon wri en no ce to the other. In the event of termina on by Client, Advisor shall s ll be en tled to be paid for the me spent in developing the Services prior to such termina- on. The amount due Advisor in the event of termina on shall be a pro-rata amount based upon the degree of comple ng of the Services, at the me no ce of termina on is received by Advisor. 7. No ces. All no ces and other communica ons contemplated by this Agreement shall be deemed duly given if transmi ed to Advisor at: 9873 Farmyard Drive, Cordova, Tennessee, 38016 to the a en on of its President, and to Client at the address appearing below, or at such other address or addresses as shall be specified, in each case, in a wri en no ce similarly given. 8. Governing Law. The validity of this Agreement and the rights and liabili es of the par es hereunder shall be determined in accordance with the laws of the State of Tennessee except to the extent preempted by ERISA. 9. Exhibits. The following Exhibits are a ached, and are part of this Agreement: Exhibit I - Schedule of Fees 10. Receipt. Client acknowledges receipt of either a copy of Part II of Advisors Form ADV as required by Rule 204-3 under the Advisers Act. Client acknowledges receipt of Part II of Form ADV. 11. Confiden al Rela onship. All informa on and advice furnished by either party to the other shall be treated as confiden al and shall not be disclosed to third par es except as required by law. 12. Arbitra on It is agreed that any controversy between us arising out of your business or this agreement, shall be submi ed to arbitra on conducted before the Na onal Associa on of Securi es Dealers, Inc. and in accordance with its rules. Arbitra on must be commenced by service upon the other party of a wri en demand for arbitra on or a wri en no ce of inten on to arbitrate. No person shall bring a puta ve or cer fied class ac on to arbitra on, nor seek to enforce any predispute arbitra on agreement against any person who has ini ated in court a puta ve class ac on; or who has not opted out of the class with respect to any claims encompassed by the puta ve class ac on un l: (i) the class cer fica on is denied; or (ii) the class is decer fied; or (iii) the customer is excluded from the class by the court. Such forbearance to enforce an agreement to arbitrate shall not cons tute a waiver of any rights under this agreement except to the extent stated herein. This agreement contains a predispute arbitra on clause. By signing an arbitra on agreement the par es agree as follows: 1) All par es to this agreement are giving up the right to sue each other in court, including the right to a trial by jury, except as provided by the rules of the arbitra on forum in which a claim is filed. 2) Arbitra on awards are generally final and binding; a party s ability to have a court reverse or modify an arbitra on award is very limited. 3) The ability of the par es to obtain documents, witness statements and other discovery is generally more limited in arbitra on than in court proceedings. 4) The arbitrators do not have to explain the reason(s) for their award. 5) The panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securi es industry. 6) The rules of some arbitra on forums may impose me limits for bringing a claim in arbitra on. In some cases, a claim that is ineligible for arbitra on may be brought in court. 7) The rules of the arbitra on forum in which the claim is filed, and any amendments thereto, shall be incorporated into this agreement. 13. Investment Risk Client understands that any investment plan involves certain risks. Advisor does not make any representa on or provide any warranty as to any investment return, profit or other financial result which may be realized by Client as a consequence of following the recommenda ons developed for Client. 14. Miscellaneous Provisions This Agreement represents the en re Agreement between the par es with respect to the subject ma er contained herein and may be modified only by wri en agreement signed by all par es. Paragraph headings are for convenience only and are not of substan ve effect.
Financial Planning Service Agreement (Con nued) Page 14 of 14 Planning Agreement IN WITNESS THEREOF, the par es have executed this Agreement on the date stated below. ACCEPTED BY: Client Cypress Wealth Management, LLC Client Signature Date Signature Date Client Signature Date Title Exhibit I Fee Schedule The following are the fees charged by Investment Advisory Firm (Advisor) for services provided: FINANCIAL PLANNING Financial plans and financial planning may include, but are not limited to: investment planning, life insurance; tax concerns; re rement planning; investment planning; college planning; and debt/credit planning. HOURLY FEES Depending upon the complexity of the situa on and the needs of the client, the hourly fee for these services is $150. Fees are paid in arrears upon comple on. Because fees are charged in arrears, no refund is necessary. Advisory clients may receive a discount on financial planning services at the sole discre on of Cypress Wealth Management, LLC. Clients may terminate their contracts without penalty within five business days of signing the financial planning contract. The es mated rate is: