STUDENT LOAN AND FINANCIAL BEST PRACTICES FOR OSTEOPATHIC STUDENTS AND GRADUATES. Presented by Jason DiLorenzo Founder & Executive Director

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STUDENT LOAN AND FINANCIAL BEST PRACTICES FOR OSTEOPATHIC STUDENTS AND GRADUATES Presented by Jason DiLorenzo Founder & Executive Director

Agenda Resident and Fellow Economics Responsible Borrowing Choosing from Today s Many Options Loan Forgiveness and Legislation Update Case Studies The Refinancing Marketplace Taxes & Other Financial Considerations Available Resources, Q&A

Federal Loans: (Stafford, Grad PLUS) Federal Stafford: Fixed Rate 6% (since July 1st 2006) Unsubsidized: all interest accrues Direct Graduate PLUS: Fixed Rate 7% (all interest accrues) Private Loans: Sometimes needed for Externships, Internships, or Residencies Interest rates vary Margins have decreased but minimum credit requirements have tightened High Rate Private Grad PLUS Unsubsidized Stafford Subsidized Stafford Perkins Low Rate Private Grants/Scholarships High Cost To Borrower Low Cost To Borrower

Responsible Borrowing Federal loans are unique as unlike in the private marketplace, underwriting is limited and funds are available up to your COA Limit your borrowing! Every additional $10k you borrow results in roughly $120 per month over 10-year payment plan Develop a budget and hold yourself accountable to it Understand repayment and forgiveness options now, as they can improve the economic value of some career paths Don t put your head in the sand! Review your federal loans at www.nslds.ed.gov

Changes in Student Debt Levels Debt levels have quadrupled in the last 20 years ~$220k $300k ~$50k ~$89k 1993 2000 2017

Starting Physician Salaries by Specialty Anesthesia: $250k Emergency: : $280k Family Medicine: $183k IM, General: $185k OBGYN: $219k Pediatrics: $167k Psychiatry: $208k Surgery, General: $328k Surgery, Neuro: $680k Your future salary and sector of employment should inform your action plan NOW

REPAYMENT TIMELINE AFTER GRADUATION Winter/Spring 2017: Graduation, File 2016 Taxes By Fall 2017: End of Grace Period on Stafford/Grad PLUS Training Exit Analysis ( Fork ) PSLF / Standard / Refinance July 2017: Begin Residency IDR Renewal every 12 Months / Review Profile and Legislative Changes

A Physician s Fork In The Road FORGIVENESS PSLF Taxable Loan Forgiveness Payment Relief in Training Average Savings over $150k ACCELERATED PAYMENT/ REFINANCING Private Sector High Household Income Federal Benefits not Needed Doctors can save over $60k out-ofpocket today

Repayment Options During Residency Standard or Extended Term Forbearance Refinancing IBR PAYE / New IBR REPAYE Most Housestaff need payment relief during training MOST COSTLY! MPH/other students CAN waive deferment if in residency Available with attractive underwriting profile May be appropriate for some residents 15% of discretionary income, 25 year taxable forgiveness 10% of discretionary income, 20 year taxable forgiveness Only available if no loans outstanding on Oct 1, 2007 10% of discretionary income, 25 year taxable forgiveness for grads 50% of accruing interest not charged, no borrowing restriction

Budgeting For Loan Repayment Salary: 10-Year Standard Payment: Monthly Interest in Forbearance $ 55,000 $56,650 $58,350 $60,000 $3,354 = $40k annual = $160k over 4 years $1,538 = $18,500 annual = $74k in accrued interest PAYE / REPAYE / NEW IBR Payment: $ 0 $76 $301 $303 $33k in interest savings Liquidity during training Payments count toward PSLF

What is Public Service Loan Forgiveness? Eligible Loans: Direct Stafford, Direct Grad PLUS, Direct Consolidation Non-Direct, Perkins, Health Professions (HPSL) and Loans for Disadvantages Students (LDS) can be consolidated for eligibility Eligible Payments: Borrower must use an IDR or standard 10 year payment plan Make 120 on-time payments (10 year minimum) Eligible Employment: Borrower must be directly employed by a federal, state, or local government entity, or 501(c)3 non-profit Employment must be full-time and 30hrs+ per week

Impact of Stark Law and Specialty Stark Law bans the practice of physician self-referral, there are loopholes Some states have more restrictive interpretation than others Specialties with higher likelihood of for-profit employment after training: Emergency Medicine Anesthesia Radiology Paths with higher non-profit opportunity: Family Medicine Psychiatry Pediatrics Academic

Marketplace and Legislative Change Servicer mismanagement of PSLF, Navient allegations Media coverage of PSLF fears (current class action) All Reauthorization bills could get on fast track with Republican majority Proposed single repayment plan for borrowers after July 2017, but existing borrowers will still have access to current programs Elimination of PSLF proposed, grandfathering suggested for borrowers before July 2018 Trump had commented on a 12.5% income cap, consolidate to single IDR plan Potential for private lenders to participate again (but current lending marketplace values cash flow)

PSLF Case Study Profile: 2017 Graduate Debt - $300k Specialty OBGYN PSLF Eligible during training Future expected income - $250k Directly employed by a 501c3 hospital after training

Sample PSLF Case Study ($300k debt) FEDERAL LOAN OVERVIEW Current Federal Loan Amount $ 300,000.00 Federal Loan Blended Average Interest Rate 6.1525% Standard 10 year total payment $ 402,436.32 Extended 25 year total payment $ 588,289.94 PUBLIC SERVICE LOAN FORGIVENESS PROJECTION YEAR 1 2 3 4 5 6 7 8 9 10 Monthly Repayment Options Standard 10 Year Repayment 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 Extended 25 Year Repayment 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 Income Driven Repayment - 76.21 300.79 302.94 312.03 1,245.73 1,942.47 2,000.75 2,060.77 2,122.59 Income Driven Repayment Type REPAYE REPAYE REPAYE REPAYE REPAYE REPAYE REPAYE REPAYE REPAYE REPAYE Demographics Information Est. Adjusted Gross Income - 27,500.00 55,000.00 55,825.00 57,499.75 170,145.63 254,375.00 262,006.25 269,866.44 277,962.43 Household Size 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Partial Financial Hardship? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes PSLF Eligible Employment? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes ESTIMATED OUT OF POCKET COST: USD 124,371.42 ESTIMATED LOAN BALANCE FORGIVEN: USD 318,257.25 EFFECTIVE INTEREST RATE DURING TRAINING: 3.41622%

PSLF Case Study Profile: 2017 Graduate Debt - $300k Specialty OBGYN PSLF Eligible during training Future expected income - $250k Directly employed by a 501c3 hospital after training Gets married in fall of PGY2, spouse makes $200k, no debt

Sample PSLF Case Study ($300k debt) FEDERAL LOAN OVERVIEW Current Federal Loan Amount $ 300,000.00 Federal Loan Blended Average Interest Rate 6.1525% Standard 10 year total payment $ 402,436.32 Extended 25 year total payment $ 588,289.94 PUBLIC SERVICE LOAN FORGIVENESS PROJECTION YEAR 1 2 3 4 5 6 7 8 9 10 Monthly Repayment Options Standard 10 Year Repayment 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 3,353.64 Extended 25 Year Repayment 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 1,960.97 Income Driven Repayment - 76.21 300.79 302.94 312.03 1,245.73 1,942.47 2,000.75 2,060.77 2,122.59 Income Driven Repayment Type REPAYE REPAYE REPAYE PAYE PAYE PAYE PAYE PAYE PAYE PAYE Demographics Information Est. Adjusted Gross Income - 27,500.00 55,000.00 55,825.00 57,499.75 170,145.63 254,375.00 262,006.25 269,866.44 277,962.43 Household Size 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Partial Financial Hardship? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes PSLF Eligible Employment? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes ESTIMATED OUT OF POCKET COST: USD 124,371.42 ESTIMATED LOAN BALANCE FORGIVEN: USD 345,819.90 EFFECTIVE INTEREST RATE DURING TRAINING: 3.79087%

Private Refinancing Opportunity Lending marketplace increasingly crowded and highly competitive Rates typically lower than Federal rates, fixed as low as 3.5% Payment terms from 5 to 20 years For graduates with $75k or less in federal debt, IDR s and PSLF holds little value Rarely available for residents without a cosigner Considerations Loss of Federal benefits Liquidity, can you afford the payments? Fees may erode savings Fixed vs. variable rate loan types You CAN refinance an already refinanced loan in the future

Recommended Refinancing Process 1. Identify if refinancing is suitable! 2. Review existing financial and credit profile to determine if refinancing is available Debt-to-income ratio considered No negative credit history, min 680 score Adding co-signer can improve results 3. Approach marketplace 4. Once terms and rates are quoted, select option in the context of your liquidity needs Work with an Advisor Deferment/Low payments in residency available Better rates available for shorter terms, but can you afford higher payment right after training?

EXIT STRATEGY CASE STUDY

Exit Case Study After 4 years of training, a graduating resident contemplates the next step in her career. How does loan forgiveness impact the economics of working for a non-profit? Original Debt: $250,000 (6%) Debt after training: $303,000 PAYE / $276,500 REPAYE Non-profit salary offer: $175,000 For-profit salary offer: $200,000

Exit Case Study Costs and Benefits of Career Opportunities $800,000.00 $600,000.00 $613,608.25 $701,266.57 $400,000.00 $200,000.00 $- $(200,000.00) $(74,203.64) $(400,000.00) $(311,407.13) PSLF For-Profit (Standard 10 Year Payoff Amount)

Salary Equivalent 300,000.00 250,000.00 200,000.00 Annual economic benefit of PSLF 73,050.70 Refi to 5 year term saves $60k 150,000.00 100,000.00 175,000.00 200,000.00 50,000.00-1 2 Base Salary Series2

OTHER FINANCIAL CONSIDERATIONS

Sample Budget: Fail to Plan, Plan to Fail!

COMPONENTS OF A CREDIT SCORE Credit History and Credit Mix (15%): Length of credit and types of credit Credit Inquiries (10%): Checks on a borrowers credit Other (7%): Amount Owed (33%): Ratio of debt to total credit Payment History (35%): Late Payments Standardized credit scores provide lenders of all types with valuable criteria used to determine how appropriate you are for a certain loan.

Investing During Residency Accumulate 3 to 6 months of living expenses in savings for the unexpected If you are able to do ANY long-term investing, maximize: 401(k) / 403(b) Max-out the employer match Roth IRA contributions Max contribution - $5,500 per person. able to contribute for the prior year up to tax filing deadline

Income Protection for YOUR Occupation Why do I need DI? Disability I nsurance prot ects your ability to earn an income This helps hedge risk against losing all t hat educat ion and t raining t hat a doctor has spent learning over t he past 10 years Residents are eligible for up to $5k/ mont h in coverage Doesn t my employer provide t his? Taxable benef it Not specif ic to your OWN occupat ion St arts over wit h each j ob change Considerat ions Guarant eed I nsurability OWN occupat ion coverage Price is based on when you purchase coverage

Financing a Home Purchase Renting versus buying during training $165,000 mortgage 30 year fixed interest @ 4.5% = $836/month (+H/O ins +Taxes) After 3 years = $8,850 in principal paid down After 5 years = $15,135 in principal paid down Estimated transaction costs = 10% = $16,500 - $15,135 equity = $1,365 loss Consider how a home purchase will impact long term planning

Budgeting For Success: A Case Study Salary: $ 55,000 $56,650 $58,350 $60,000 PAYE / REPAYE Payment: Savings / Interest Accrual Fund / Roth IRA: Occupation-specific Income Protection (DI): $ 0 $76 $301 $303 $ 400 $400 $400 $400 $ 125 $125 $125 $125 Total Monthly Allocation to Strategy: $525 $601 $826 $828 Savings Account / Roth IRA Value in 2021: $20k+

DWOQ Consultations: AOA MEMBERS GET 20% OFF Individual Loan Consultations with Annual Support $295 then $60 quarterly ($475/$90 for couples with debt) Complete review of federal and private loan portfolio Annual repayment options overview, including Income-Driven options and loan forgiveness opportunities Overview and/or completion of consolidation and repayment application Review loans for refinancing opportunities Develop strategy to allocate income towards savings, retirement, home purchase and income protection Develop a timeline of action items Annual access to your DWOQ advisor FREE REFINANCING SUITABILITY ANALYSIS AND SUPPORT

Jason DiLorenzo Jason@dwoq.com WWW.DWOQ.COM 314.787.7399