Fill and Sign the Pooled Trust Form

Pooled Income Fund with Declaration of Trust by Charitable Organization (Revenue Procedure 88-53) On this the ___day of ______________, 20____, the board of directors of ____________________________ , a (name of state) non-profit corporation (the Charity ), hereby establishes a pooled income fund, within the meaning of Revenue Procedure, 1988-2 C.B. 712, Rev. Proc. 88-53, 1988 WL 494506 (1988) andInternal Revenue Code § 642(c)(5) (26 U.S.C.A. § 642(c)(5)) , as amended, or the corresponding provision of any successor law (the "Code"), named the _________________________ (the Fund ), and names _________________________________ of (street address, city, county, state, zip code) , as the initial trustee (the Trustee), to hold, manage, and distribute property to be transferred to and accepted by it as part of the Fund, under the terms and conditions of this instrument. 1. Gift of Remainder Interest Each donor transferring property to the Fund shall contribute an irrevocable remainder interest in such property to Charity. 2. Irrevocability and Amendments The Fund is irrevocable. However, Charity shall have the power, acting alone, to amend the Fund in any manner required for the sole purpose of ensuring that the Fund qualifies and continues to qualify as a pooled income fund within the meaning of § 642(c)(5) of the Code. 3. Retention of Life Income Interest A. Income interest. Each donor transferring property to the Fund shall retain an income interest in the property transferred, or create an income interest for the life of one or more named beneficiaries. Each income beneficiary must be a living person at the time of the transfer of property to the Fund by the donor. 1. If more than one beneficiary of the income interest is named, the beneficiaries may enjoy their shares concurrently (and/or) consecutively. 2.Charity may also be designated as one of the beneficiaries of the income interest. 3. The donor need not retain or create a life interest in all of the income from the property transferred to the Fund and any income not payable to an income beneficiary shall be contributed to and, within the taxable year of the Fund in which it is received, paid to Charity. B. Distribution to charity. Upon the termination of the income interest of the designated beneficiary (or, in the case of successive income beneficiaries, the survivor of the designated beneficiaries) entitled to receive income pursuant to the terms of a transfer to the Fund, the Trustee shall sever from the Fund an amount equal to the value of the remainder interest in the property upon which the income interest is based. The value of the remainder interest for severance purposes shall be its value as of the date on which the last regular payment was made before the death of the beneficiary. The amount so severed from the Fund shall be paid to Charity, to be used for its (description of purposes) . If Charity does not exist or is not an organization described in clauses (i) through (vi) of 26 U.S.C.A. § 170(b)(1)(A) at the time when any principal of the Fund is to be distributed to it, then the amount severed shall be paid by the Trustee to one or more organizations which, at that time, are described in 26 U.S.C.A. §§ 170(c), 2055(a), and2522(a) . 4. The Trustees A. Named trustees. ____________________________ is the initial Trustee. Charity shall always have the power to remove any Trustee or Trustees and to designate a new Trustee or Trustees; provided, however, that the Fund shall not have as a Trustee a donor to the Fund or a beneficiary (other than Charity) of an income interest in any property transferred to the Fund, and no donor or beneficiary (other than Charity) shall have, directly or indirectly, general responsibilities with respect to the Fund that are ordinarily exercised by a Trustee. B. Additional trustee. Subject to the limitations of Subparagraph A, the Trustee may appoint any individual or institution as a Co-Trustee to serve at the pleasure of the appointing Trustee. 1. No Trustee named in this instrument or by the Trustee shall be required to provide surety or other security on a bond. 2 . No Trustee shall be responsible for or need inquire into any acts or omissions of a prior Trustee. C. Delegation. Any Trustee may delegate any powers and authorities to another Trustee for any period that the delegating Trustee deems appropriate. A person dealing in good faith with any Trustee may rely without inquiry upon that Trustee's representation that a particular power or authority has been delegated and not rescinded. D. Resignation. Any Trustee may resign by giving written notice specifying the effective date of the resignation to Charity, which shall appoint a corporation authorized to provide trust services to fill any vacancy. E. Compensation. Each person who serves as a Trustee shall be entitled to receive reasonable compensation for services rendered. In the case of a corporate Trustee, reasonable compensation is based upon its published fee schedule in effect at the time its services are rendered, or as otherwise agreed, and its compensation may vary from time to time based on that schedule. F. Prohibited transactions. The income of the Fund for each taxable year shall be distributed at such time and in such manner as not to subject the Fund to tax under 26 U.S.C.A. § 4942. Except for making the required payments to the life income beneficiaries, the Trustee shall not engage in any act of self-dealing, as defined in 26 U.S.C.A. § 4941(d), and shall not make any taxable expenditures, as defined in 26 U.S.C.A. § 4945(d). The Trustee shall not make any investments that jeopardize the charitable purpose of the Fund, within the meaning of 26 U.S.C.A. § 4944, or retain any excess business holdings, within the meaning of 26 U.S.C.A. § 4943. G. Management powers. Charity grants the Trustee the powers described below, to be exercised in a fiduciary capacity. The Trustee may not exercise any discretion under this instrument in a manner reasonably likely to prejudice the continued qualification of the fund as a pooled income fund under § 642(c)(5) of the Code. 1.The Trustee may hold assets transferred to the Fund or invest and reinvest them (or leave them temporarily uninvested) in any type of property and every kind of investment, including (but not limited to) corporate obligations of every kind, preferred or common stocks, securities of any regulated investment trust, and partnership interests; provided, however, that the Trustee shall not hold or invest in any depreciable or depletable assets, or hold or invest in any securities the income from which is exempt from taxation under Subtitle A of the Code. Nothing in this instrument shall be construed to restrict the Trustee from investing the Fund assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of Fund assets. 2. The Trustee may sell or exchange any real or personal property contained in the trust, for cash or credit, at public or private sale, and with such warranties or indemnifications as the Trustee may deem advisable. 3. The Trustee may borrow money for the benefit of the trust and may secure these debts with assets of the trust. 4. The Trustee may grant security interests and execute all instruments creating such interests upon such terms as the Trustee may deem advisable. 5. The Trustee may compromise and adjust claims against or on behalf of the trust on such terms as the Trustee may deem advisable. 6.The Trustee may take title to any securities in the name of any custodian or nominee without disclosing this relationship. 7. The Trustee may determine whether receipts are to be allocated to income or principal and whether disbursements are to be charged against income or principal and whether disbursements are to be charged against income or principal to the extent not clearly established by state law. However, all capital gains shall be allocated to principal, except to the extent a contrary result is directed by state law. All determinations made by the Trustee in good faith shall not require equitable adjustments. 8. The Trustee may make all tax elections and allocations the Trustee may consider appropriate; however, this authority is exercisable only in a fiduciary capacity and may not be used to enlarge or shift any beneficial interest except as an incidental consequence of the discharge of fiduciary duties. All tax elections and allocations made by Trustee in good faith shall not require equitable adjustments. 9. The Trustee may employ such lawyers, accountants, and other advisers as the Trustee may deem useful and appropriate for the administration of the trust. The Trustee may employ a professional investment adviser and delegate to this adviser any discretionary investment authorities to manage the investments of the trust (including any investment in mutual funds, investment trusts, or managed accounts), and may rely on the adviser's investment recommendations without liability to any beneficiary. 10. The Trustee may divide and distribute the assets of the trust in kind or in cash, or partly in each, without regard to the income tax basis or any asset and without the consent of any beneficiary. The decision of the Trustee in dividing any portion of the trust between or among two or more beneficiaries shall be binding on all persons. 5. Mandatory Provisions A. Commingling of property. The property transferred to the Fund by each donor shall be commingled with, and invested or reinvested with, other property transferred to the Fund by other donors satisfying the requirements of this instrument and of § 642(c)(5) of the Code. The Fund shall not include property transferred under arrangements other than those specified in this instrument and satisfying the said provisions of the Code. All or any portion of the assets of the Fund may, however, be invested or reinvested jointly with other properties not a part of the Fund that are held by, or for the use of, Charity. When joint investment or reinvestment occurs, detailed accounting records shall be maintained by the Trustee specifically identifying the portion of the jointly invested property owned by the Fund and the income earned by, and attributable to such portion. B. Taxable year. The taxable year of the Fund shall be the calendar year. C. Beneficiary's income based on fund's rate of return. In any taxable year of the Fund, the Trustee shall pay income to each beneficiary entitled to the income in the amount determined by the rate of return earned by the Fund for the year with respect to the beneficiary's income interest. Payments must be made at least once in the year in which the income is earned. Until the Trustee determines that payments shall be made more or less frequently or at other times, the Trustee shall make income payments to the beneficiary or beneficiaries entitled to them in four quarterly payments on or about March 31, June 30, September 30, and December 31 of each year. An adjusting payment, if necessary, will be made during the taxable year or within the first 65 days following its close to bring the total payments to the actual income to which the beneficiary or beneficiaries are entitled for that year. D. Units of participation. On each transfer of property by a donor to the Fund, there shall be assigned to the beneficiary or beneficiaries of the income interest retained or created in the property the number of units of participation equal to the number obtained by dividing the fair market value of the property transferred by the fair market value of a unit in the Fund immediately before the transfer. The fair market value of a unit in the Fund immediately before the transfer shall be determined by dividing the fair market value of all property in the Fund at that time by the number of units then in the Fund. The initial fair market value of a unit in the Fund shall be the fair market value of the property transferred to the Fund divided by the number of units assigned to the beneficiaries of the income interest in that property. All units in the Fund shall always have equal value. E. Average fair market value. If a transfer of property to the Fund by a donor occurs on other than a determination date, the number of units of participation assigned to the beneficiary or beneficiaries of the income interest in the property shall be determined by using the average of the fair market values of the property in the Fund on the determination dates immediately preceding and succeeding the date of transfer. For the purpose of determining the average fair market value, the property transferred by the donor and any other property transferred to the Fund between the preceding and succeeding dates, or on each succeeding date, shall be excluded. The fair market value of a unit in the Fund immediately before the transfer shall be determined by dividing the average fair market value of the property in the Fund at that time by the number of units then in the Fund. Units of participation assigned with respect to property transferred on other than a determination date shall be deemed to be assigned as of the date of the transfer. F. Determination date. A determination date means each day within a taxable year of the Fund on which a valuation is made of the property in the Fund. The property of the Fund shall be valued on January 1, April 1, July 1, and October 1 of each year; provided however, that where such date falls on a Saturday, a Sunday, or a legal holiday (as defined in 26 U.S.C.A. § 7503 and the corresponding regulations), the valuation shall be made on the next succeeding day that is not a Saturday, a Sunday, or a legal holiday. G. Allocated income. The amount of income allocated to each unit of participation in the Fund shall be determined by dividing the income of the Fund for the taxable year by the outstanding number of units in the Fund at the end of the year, except that income shall be allocated to units outstanding during only part of the year by taking into consideration the period of time the units were outstanding during the year. H. Termination of income interest. The income interest of any beneficiary in the Fund shall terminate with the last regular payment of income that was made before the beneficiary's death. The Trustee of the Fund shall not be required to prorate any income payment to the date of the beneficiary's death. I. Maintenance by Charity. Charity shall always maintain the Fund or exercise control, directly or indirectly, over the Fund. 6. Incorporation by Reference The provisions of this instrument may be, and are intended to be, incorporated by reference in any will, trust, or other instrument by means of which any property is transferred to the Fund. Any property transferred to the Fund in a transfer under which an income interest is retained or created for the life of one or more named beneficiaries, where this instrument is not incorporated by reference, shall become part of the Fund and shall be held and managed under the terms and conditions of this instrument, unless the instrument of transfer is inconsistent with such terms and conditions, in which case the Trustee shall not accept the property. 7. Estate Taxes No estate, inheritance, or other death taxes with respect to the Fund shall be allocated to or recoverable from the Fund, notwithstanding any inconsistent statements in a donor's last will or in any other instrument. 8. Facility of Payment The Trustee may, at its discretion, do one or both of the following with respect to any payment that would be made to the donor at a time when the donor is legally disabled: (1) take any action necessary to have a legal guardian appointed for the donor, if none has already been appointed, and make the payment to such legal guardian, without having to see to the proper application of such payment; or (2) expend such payment for the donor's benefit. 9. Definitions and Miscellaneous A. Governing law. The operation of the Fund shall be governed by the laws of the state of __________________. However, the Trustee is prohibited from exercising any power or discretion granted under the laws of said state that would be inconsistent with the qualification of the Fund under § 642(c)(5) of the Code and the corresponding regulations. B. Income. For purposes of this instrument, the term "income" has the same meaning as it does under 26 U.S.C.A. § 643(b) and the corresponding regulations. C. Trustee. The "Trustee" shall include each Trustee, Co-Trustee, and any successor Trustee. D. Tax-related terms. All tax-related terms shall have the same meaning that they have in the Internal Revenue Code of 1986, as amended. E. Copies. Anyone may rely on a copy of this trust instrument certified by a notary public or similar official to be a true copy of the signed original (and of any amendments), as if that copy were the signed original. Anyone may rely upon any statement of fact certified by the person who appears from the original document or a certified coy to be a Trustee. F. Number. Whenever the context requires, the singular number includes the plural, and plural the singular. WITNESS our signatures as of the day and date first above stated. __________________, Trustee By:______________________________ By:________________________ (Name and Office in Bank) (Name and Office) Acknowledgments (form of acknowledgment may vary by state) Attach Schedule (if any)