Fill and Sign the Interim Report Due on Final Report Form

JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 1 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado District Court Denver Probate Court___________________ County, ColoradoCourt Address:In the Interest of:Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address):Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division ____ Courtroom CONSERVATOR’S REPORT  ADULT  MINOR ANNUAL REPORT AMENDED REPORT CURRENT REPORTING PERIOD FROM ________________TO __________________ (MM/DD/YYYY) (MM/DD/YYYY) INTERIM REPORT DUE ON _________________________FINAL REPORT If Final Report, indicate why: Protected Person deceased Minor turned 21 Judicial OrderPART A: CONTACT INFORMATIONProtected Person’s Information:  Check if Updated Information from last ReportName:__________________________________________________ Date of Birth: _____________________Address: (Include Name of Living Center or Nursing Home)City: State: Zip Code: Telephone Number: Last 4 digits of Social Security # __________________Conservator’s Information:  Check if Updated Information from last ReportName: ____________________________________________________Date of Birth: ____________________ Last 4 digits of Social Security #_____________________________NOTE: Agency designees and professional fiduciaries need not provide their DOB or last 4 digits of their SSN.Occupation: _____________________ Your Relationship to Protected Person: __________________________Address: __________________________________________________________________ Apt. # ___________ City: ___________________ State: ______ Zip Code: _________ E-Mail Address: _______________________Telephone Numbers: Home ___________________ Work ____________________ Cell ___________________Have you had any criminal charges filed against you or convictions entered since the last report? Yes  NoIf Yes, explain: _____________________________________________________________________________Co-Conservator’s Information: (if applicable) Check if Updated Information from last ReportName: ____________________________________________________Date of Birth: ____________________ Last 4 digits of Social Security #_____________________________Occupation: _____________________ Your Relationship to Protected Person: _________________________Address: __________________________________________________________________ Apt. # ___________ City: ______________________ State: ____ Zip Code: ________ E-Mail Address: _______________________Telephone Numbers: Home ___________________ Work ____________________ Cell ___________________Have you had any criminal charges filed against you or convictions entered since the last report? Yes  No JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 2 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado If Yes, explain: ______________________________________________________________________________*** Notice to Interested Persons: Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code, including the appropriateness of disbursements, the compensation of fiduciaries, attorneys, and others, and the distribution of estate assets. Interested persons may file an objection with the Court. The Court will not review or adjudicate these or other matters unless specifically requested to do so by an interested person.PART B: CONSERVATORSHIP ISSUES1.Is there a continued need for the Conservatorship? Yes No If No, describe why and what steps should be taken. If you would like the Court to take action, you must file a motion with the Court.2. Are the remaining assets in the estate sufficient to provide for the present and future care of the protected person? Yes No If No, describe why and what steps should be taken. If you would like the Court to take action, you must file a motion with the Court. 3. Should there be a change in scope of the Conservatorship? Yes No If Yes, describe why and what steps should be taken. If you would like the Court to take action, you must file a motion with the Court. 4. Attach a copy of the Bond to this Report, unless the Bond was waived or not required by the Court. What is the amount of the Bond? $ ________________. Is the amount of the Bond sufficient to cover all unrestricted assets? Yes No If No , describe why and what steps should be taken. If you are requesting a change to the Bond, you must file a motion with the Court. INSTRUCTIONS ON HOW TO COMPLETE THIS FORM The Conservator’s Report must be filed annually pursuant to §15-14-420, C.R.S. Part C of this report concerns the information necessary to satisfy the court that the Conservator has maintained a complete accounting of all financial transactions and managed the Protected Person’s estate responsibly. Step 1 is a financial transaction detail and should be completed for each bank or investment account. A spreadsheet or report from personal accounting software may also be submitted in lieu of completing the transaction detail. Steps 2 and 3 summarize the income and expense for the reporting period and compare those amounts to the previous period or the Financial Plan. Explain the cause for any changes between the current period amounts and amounts from the prior period or the Financial Plan. Step 4 reports additional detail for fees paid to professionals including the hourly rate, number of hour worked, and description of services provided. Steps 5 and 6 summarize assets and liabilities as of the reporting date and compare those amounts to the previous period or the Inventory. In addition to explaining the cause for any changes between the current period amounts and amounts from the prior period or the Inventory, provide specific detail regarding any asset purchases or sales. Step 7 is a summary. Transfer the respective income and expense totals from Steps 2 and 3 as well as the asset and liability totals in steps 5 and 6 to the appropriate lines in Step 7 to calculate the net income and net worth. JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 3 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Part C:FINANCIAL INFORMATION Step 1: Detail Listing of Receipts/Income and Disbursements/ExpensesComplete this Detail for all bank accounts . Make additional copies of this form as necessary. Alternatively, Check Register form JDF 871, a spreadsheet, or a report from personal accounting software may be attached. Please list all transactions, including Income (deposits) and Expenses (withdrawals), for the entire reporting period. Each Receipt/Income item should be listed in the Amount Received column and each Disbursement/Expense item should be listed in the Amount Disbursed column. ** Note: This report should resemble a check register for each bank account. Name of Bank: __________________________________ Account Number (last 4-digits only): __________ DateCheck or I.D. No.Description of item Received or Disbursed, include Name of Payee (if Disbursement) Amount ReceivedAmount Disbursed Page ____________ of _______May continue entries on Check Register Form JDF 871$$ Check here if additional detailed spreadsheets are attached to this report. Individual Bank Account SummaryBeginning Cash Balance $ _____________ (Balance from prior year Report or Inventory)Add: Total Amount of Income + $ _____________ (Total Income received from detail above)Add: Total Amount Received as Transfer + $ _____________ (Total transferred from other bank accounts)Less: Total Amount Disbursed - $ _____________ (Total disbursements from detail above)Less: Total Amount Transferred out - $ _____________ (Total transfers moved to other accounts)Ending Cash Balance = $ _____________ (Transfer this account balance to Step 5.) (This will be the beginning balance on next year’s report) JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 4 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 2: Receipts and IncomeColumn A: Is this the first annual Conservator’s Report filed? Yes No If Yes, use the amounts from the Inventory with Financial Plan (JDF 882) to complete Column A that is marked with an asterisk (*) below. If No, use the amounts from the prior Conservator’s Report filed to complete Column A that is marked with an asterisk (*) below.Column B: Transfer all individual income category totals from completed Detail Listing in Step 1 or attached spread sheet. Column C: Calculate and record the difference between Column A and Column B. Description of Receipt/Income CategoryList Total Receipts/Income from Detail Listing (From Step 1 or Separate Spreadsheet) Column A *Total Amount of Receipts / Income from Prior Reporting Period or Financial Plan Column B Total Amount of Receipts / Income for Current Reporting PeriodColumn CChange in Amount of Receipt/IncomeIndicate +/- Wages Social Security Interest / Dividends Pensions / Retirement Plan Distributions Tax Refunds Proceeds from Sales of Assets Rental Income Gifts from Others Disability, Unemployment or Worker’s Compensation Other Public Assistance Other Receipts / Income (Please list) TOTALS (Move to Step 7) Have Total Receipts/Income in Column B changed from the Prior Reporting Period or Financial Plan totals in Column A ?  Yes NoIf Yes, explain the changes below. Please include a description of any changes or unanticipated transactions. If income and expenses are anticipated to differ going forward, it may be necessary to file an Amended Inventory with Financial Plan and Motion for Approval (JDF 882) or a separate petition for approval with the court. JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 5 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 3: Disbursements/ExpensesColumn A:Use the amounts from the Inventory with Financial Plan (JDF 882) or from the prior Conservator’s Report filed to complete Column A that is marked with an asterisk (*) below. Column B:Transfer all individual expense category “totals” from completed Detail Listing in Step 1 or attached spread sheet. Column C: Calculate and record the difference between Column A and Column B. Description of Disbursement / Expense CategoryList Total Disbursements/Expenses from Detail Listing (From Step 1 or Separate Spreadsheet) Column A *Total Amount of Disbursement / Expense from Prior Reporting Period or Financial Plan Column BTotal Amount of Disbursement / Expense for Current Reporting PeriodColumn C Change in amount of Disbursement/ ExpenseIndicate +/- Total Professional Fees and Costs Paid (From Step 4)Distributions to Protected Person Income Taxes FICA and Medicare Taxes Health Care (include insurance & medication) Other Insurance Rent or Mortgage Property Taxes and Assessments Repairs and Maintenance Utilities, including phones Home Furnishings Food and Household Supplies Clothing Personal Care Auto Expenses Education Entertainment, Vacations and Travel Gifts Other Disbursements/Expenses (Please list)TOTALS (Move these totals to Step 7) JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 6 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 4: Professional Fees Detail List all professionals paid. Include the hourly rate, number of hours worked, fees and costs, as well a description of the services provided and the benefit to the estate.Name of ProfessionalHourly Rate (Range)No. of Hours Worked Total Hourly Fees Other Costs ChargedBrief Description of Services Provided and Benefit to the EstateConservator feesGuardian feesGuardian ad litemLegal Fees for Protected PartyLegal Fees for ConservatorLegal Fees for GuardianLegal Fees for GALAccountant / CPAOther: TOTAL (Fees and Costs) (Move these totals to Step 3)Have Total Disbursements/Expenses in Step 3, Column B  Increased or  Decreased from the Prior Reporting Period or Financial Plan in Step 3, Column A? Explain the changes below. Please include a description of any changes or unanticipated transactions. A separate petition for approval may need to be filed with the court for significant changes outside the amounts allowed in the Inventory and Financial Plan. JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 7 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 5: AssetsColumn A:List the last 4 digits of all bank, investment or other financial accounts.Column B:List name of the bank or financial institution in which accounts are being held, or describe specific asset.Column C:Use amounts from the original Inventory with Financial Plan (JDF 882) or from the prior Conservator’s Report filed, to complete Column C marked with an asterisk (*) below. Column D:List all cash and investment account balances. These should coincide and be transferred from the Ending Cash Balances on the Detail Listing in Step 1. Column E:Calculate and record the difference between Column C and Column D. Vehicles, real estate, and all other assets should be valued at what the asset could be sold for in its current condition (i.e. Fair Market Value). Description of Asset(Identify all accounts) Column AAccount Number(last 4 digits) Column B Name of Financial Institution orDescription of AssetColumn C* Fair Market Valueas of Last Day of Prior Reporting Period or Inventory Column DFair Market Value (as of Last Day of Current Reporting Period)Column EChange in Value of AssetIndicate +/- Checking AccountsBalance from Step 1 Savings AccountsBalance from Step 1 Other Cash Accounts, Money Markets & CD’s Stocks Bonds Mutual Funds Other Financial Investments Life Insurance (Cash Value) Pension & Retirement (vested portion) IRA’s / 401(k)’s Annuities Motor Vehicles Real Estate Home Furnishings Collections (e.g., stamps or coins) List Other Assets List Other AssetsList Other AssetsTOTALS (Move these totals to Step 7) JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 8 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Have Total Assets in Step 5, Column D changed from the last day of the Prior Reporting Period or Inventory in Step 5, Column C? Yes No Provide additional detail for any assets on the preceding schedule that were purchased during the reporting period. Include a description of the asset purchased, the purchase price, purchase date, and source of funding for the purchase (e.g. cash, loan, sale of another other asset, etc.). Description of Asset Purchase PricePurchase Date Purchase method Provide detail for any assets on the preceding schedule that were sold during the reporting period. Include a description of the asset sold, the sale price, sale date, and use of funds proceeds from the sale (e.g. living expenses, extinguish debt, purchase of another asset, etc.). Description of Asset Sale PriceSale Date Use of Proceeds Please include a description of any other changes to the value of estate assets. JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 9 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 6: Liabilities/Debts Column A: List the last 4 digits of all account or loan numbers.Column B: List the name of the bank or financial institution to which loans or debts are being paid. Column C: Use amounts from the original Inventory with Financial Plan (JDF 882) or from the prior Conservator’s Report filed, to complete Column C marked with an asterisk (*) below. Column D: List all current balances due on loans and debts. Column E: Calculate and record the difference between Column C and Column D. Description of Liability/Debt(Identify all accounts)Column AAccount Number(last 4-digits only) Column B Name of Financial InstitutionColumn C*Balance Due on Last day of  Prior Reporting Period or Inventory Column DBalance Due on Last Day of Current Reporting PeriodColumn EChange in Amount of LiabilityIndicate +/- Mortgages(principal due only) Car Loans Home Improvement Loans Student Loans/Tuition Credit Card Debt Federal Taxes Owed State and Local Taxes Owed Other Liabilities/Debts TOTALS (Move these totals to Step 7) Have Total Liabilities/Debts changed from the last day of the Prior Reporting Period or Inventory? Yes No If Yes, explain the changes below. Please include a description of any changes or unanticipated transactions. A separate petition for approval may need to be filed with the court for significant changes outside the amounts allowed in the Inventory and Financial Plan. JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 10 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado Step 7: Summary Summary of Financial Activity *Prior Reporting Period Current (or Financial Plan) Reporting Period (A) Total Receipts/Income from Step 2 $ _____________ $ _____________(B) Total Disbursements/Expenses from Step 3 $ _____________ $ _____________(A) minus (B) = Net Income $ _____________ $ _____________ Summary of Net Worth Fair Market Value of Assets Minus Liabilities/Debts *Last Day of Last Day of Prior Reporting Period Current Reporting Period(or Inventory) (A) Total Assets from Step 5 $ _____________ $ _____________(B) Total Liabilities/Debts from Step 6 $ _____________ $ _____________(A) minus (B) = Net Worth $ _____________ $ _____________ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form.(Checking this box requires you to remove JDF number and copyright at the bottom of the form.) VERIFICATION I state under penalty of perjury that this is a true and complete report of the administration of this estate, during the period shown, both dates inclusive, to the best of my knowledge, information and belief. I understand that this report is subject to audit and verification.I understand that I am required to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional. The Court or any Interested Persons as identified in the Order Appointing Conservator may request copies at any time.Date: _____________________________ _____________________________________________ Signature of Conservator Date: ____________________________ ____________________________________________Signature of Co-Conservator (if applicable) ******** REPORT MUST BE SIGNED AND DATED BY ALL CONSERVATORS AND SERVED ON THE PROTECTED PERSON AND ALL INTERESTED PARTIES AS INDICATED BY THE ATTACHED CERTIFICATE OF SERVICE ******** JDF 885 R8-17 CONSERVATOR’S ANNUAL/FINAL REPORT Page 11 of 11 © 2017 Colorado Judicial Department for use in the Courts of Colorado IMPORTANT THIS SECTION MUST BE COMPLETED CORRECTLY AND SIGNED OR THE REPORT MAY BE REJECTED. Colorado Law REQUIRES that the Conservator’s Report be served on the PROTECTED PERSON AND INTERESTED PERSONS pursuant to Order Appointing Conservator, including minors 12 years of age or older (§15-14-404(4), C.R.S.). In the space below, list the names, addresses, and method of delivery for each party listed on the Order Appointing Conservator and provide each party with a copy of this Report. Certificate of Service I certify that on _______________________ (date) the original was e-filed/filed with the Court and a copy of this Conservator’s Report was served on each of the following: Name of person receiving this document (Interested Persons)Relationship to Protected Person Address Manner of Service**Protected Person**Insert hand delivery, first class U.S. Mail, certified U.S. Mail, e-filed, fax or other method allowed under Colorado law. X_________________________________________________ Signature