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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:
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1.
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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.
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2.
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On September 1, 1994, Lisa was struck by a car
while crossing Oak Street in Philadelphia.
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3.
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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.
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4.
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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.
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5.
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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:
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a. |
Cash payment of $500,000, and |
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b. |
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.
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6.
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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."
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7.
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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."
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8.
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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.
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9.
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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.
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10.
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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."
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11.
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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.
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12.
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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.
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13.
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Lisa's presumptive intestate heirs are as follows:
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Mary Jones
617 Alcott Street
Philadelphia, PA 19120 |
Mother
(consent attached) |
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James Black
whereabouts unknown |
Father |
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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.
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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:
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Andrew Coates, Esquire
Department of Public Welfare, Legal
302 State Office Building
1400 Spring Garden Street
Philadelphia PA 19130 |
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SSI Program Support Team
Attention: Team Leader
Mid Atlantic Program Service Center
3rd and Spring Garden Streets
Philadelphia PA 19101
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