Fill and Sign the Title 4 Civil Division Department of Justice Form

JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 1 of 12 ❑ District Court ❑ Denver Probate Court ___________________ County, Colorado Court 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 Order PART A: CONTACT INFORMATION Protected Person’s Information: ❑ Check if Updated Information from last Report Name: __________________________________________________ Age : _________________ Street Address: (Include Name of Living Center or Nursing Home) City: State: Zip Code: Mailing Address, if different: _______________________________________________________________ Primary Phone : Alternate Phone : _____________________ Conservator’s Information: ❑Check if U pdated Information from last Report Name: ____________________________________________________ Age : ________ __ ______ Occupation: _____________________ Your Relationship to Protected Person: ____________ ____ _________ _ Street Address: ______________ _________ ____ _________________________________ City: ___________________ State: ______ Zip Code: _________ Mailing Address, if different: __________________________________________________________________ City: _________________ State: __________ Zip Code: _________ __________________________ Primary Phone : Alternate Phone: _____________________ Email Address: __________________________________________________________ Have you had any criminal charges filed against you or convictions entered since the last report? ❑ Yes ❑ No If Yes, explain: _____________________________________________________________________________ Co -Conservator’s Information: (if applicable) ❑Check if Updated Information from last Report JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 2 of 12 Name: _____________ _____ ___ __ _____ ___ ___ __________________ Age : _____ __________ Occupation: _____________________ Your Relationship to Protected Person: __ _______ _______________ _ Street Address: ___________ ___________________________________ ____ _______ City: ______________________ State: ____ Zip Code: ________ Mailing Address, if different: ______________________________________________________________ City: ___________________ State: __________ Zip Code: _________________________ Primary Phone : Alternate Phone: _____________________ Email Address: ________________________________________________________________________ Have you had any criminal charges filed against you or convictions entered since the last report? ❑ Yes ❑ No If Yes, explain: ____________________________________________________________________________ __ *** Notice to Interested Person s: 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 ISSUES 1. 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 sh ould 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 COMP LETE 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 accountin g 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. JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 3 of 12 Steps 2 and 3 summarize the income a nd 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 amount s from the prior period or the Financial Plan. Step 4 reports a dditional 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 peri od 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 Inv entory, provide specific detail regarding any asset purchases or sales. Step 7 is a summary. T ransfer 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. Part C: FINANCIAL INFORMATION Step 1: Detail Listing of Receipts/Income and Disbursements/Expenses Complete this Detail f or all bank account s. Make additional copies of this form as necessary. Alternatively, Check Regist er form JDF 871, a spreadsheet, or a report from personal accounting software m ay be attached . Please l ist all transactions , includ ing 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): __________ Date Check or I.D. No. Description of item Received or Disbursed, include Name of Payee (if Disbursement) Amount Received Amount Disbursed Page ____________ of _______ May continue entries on Check Register Form JDF 871 $ $ JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 4 of 12 ❑ Check here if additional detailed spreadsheets are attached to this report . Individual Bank Account Summary Beginning Cash Balanc e $ _____________ (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) Step 2: Receipts and Income Column 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 Col umn 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 Category List 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 Period Column C Change in Amount of Receipt/ Income Indicate +/- Asset Not Previously Reported Business Income Court Order Repayment Disability /Unemployment /Worker’s Comp Distribution - Annuity Distribution – Pension s/Retirement Plan Distribution – Trust Farm/Ranch Income Gifts from Others Inheritance Insurance Settlement/Benefit Interest/Dividends Loan Repayment Oil/Gas /Mineral Royalties Other Public Assistance Other Receipts/Income Proceeds from Sale of Assets JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 5 of 12 Rental Income Reverse Mortgage Payment Social Security Tax Refunds VA Benefits Wages 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 ❑ No If 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. Step 3: Disbursements/Expenses Column 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 Category List 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 B Total Amount of Disbursement / Expense for Current Reporting Period Column C Change in amount of Disbursement/ Expense Indicate +/- Assisted Living/Care Facility Bank/Investment Account Fees Caregiver/In -Home Provider Charitable Contributions Clothing Collectibles Debt Repayment (excluding CC) Debt Repayment (Credit Card) Distributions - Protected Person Education/Tuition/Student Loan Entertainment/Movies Equipment Farm/Ranch Expense Fees – Accountant/CPA JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 6 of 12 Fees – Conservator – Non -Prof Fees – Conservator -Prof Fees – Court Visitor Fees – Guardian – Non -Prof Fees – Guardian - Prof Fees – Guardian Ad Litem (GAL) Fees -Investment Acct Management Fees – Legal for Conservator Fees – Legal for Guardian Fees – Legal for GAL Fees – Legal for Protected Person Fees –Other Professional Funeral Gifts Groceries/Hygiene/Household Supplies HOA Fees Hobbies Home Furnishings Insurance – Home/Renter Insurance – Life Insurance – Long Term Care Insurance – Other Jewelry Livestock Loan Interest Loans Medical -Doctor/Prof/Hospital Medical Furnishings/Supplies Medical -Insurance Medical -Medicab/Transportation Medical -Medications Medical -Other Mortgage Motor Vehicle – Insurance Motor Vehicle – Loan Payments Motor Vehicle – Registration/Other Motor Vehicle – Repairs/Maint/Fuel Moving Expenses Other Disbursement/Expense Other Transportation Pet Care Property Repairs/Maintenance Rent Restaurants/Dining Out School Supplies Services – Cleaning Services – Personal Care JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 7 of 12 Subscriptions/Dues Taxes – FICA and Medicare Taxes – Income Taxes – Property and Assessments Travel/Vacations Utilities (Including Phone/Cell) TOTALS (Move these totals to Step 7) Step 4: Conservator, Guardian, and Professional Fees Detail List all conservators, guardians, and professionals paid. Include the hourly r ate, number of hours worked, fees and costs , as well a description of the services provided and the benefit to the estate . Name of Conservator, Guardian, and Professional Hourly Rate (Range) No. of Hours Worked Total Hourly Fees Other Costs Charged Brief Description of Services Provided and Benefit to the Estate Account Management – Professional Accountant/CPA Conservator –Non -Professional Conservator - Professional Court Visitor Guardian – Non -Professional Guardian - Professional Guardian Ad Litem (GAL) Legal Fees -Conservator Legal Fees -Guardian Legal Fees -GAL Legal Fees - Protected Person Other Professional Fees TOTAL ( Fees and Costs ) ( Move these totals to Step 3) Ha ve 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 t he Inventory and Financial Plan. JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 8 of 12 Step 5: Assets Column 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 pri or Conservator’s Report filed, to complete C olumn 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 A Account Number (last 4 digit s) Column B Name of Financial Institution or Description of Asset Column C * Fair Market Value ❑as of Last Day of Prior Reporting Period or ❑Inventory Column D Fair Market Value (as of Last Day of Current Reporting Period) Column E Change in Value of Asset Indicate +/- Checking Accounts Balance from Step 1 Savings Accounts Balance from Step 1 Certificate of Deposit Money Market Pre -Paid Debit Card Cash On Hand Stocks Bonds Mutual Fund Oth er Financial Investments Life Insurance (Cash Value) Pension /Retirement (Vested) IRA / 401(k) Annuities Loans from Estate JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 9 of 12 Motor Vehicle Real Estate Home Furnishings Collect ibles (e.g., stamps or coins) Jewelry Livestock Equipment Oil/Gas/Mineral Interest Other Personal Property List Other Assets TOTALS (Move these totals to Step 7) 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 Price Purchase 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 anothe r asset, etc. ). Description of Asset Sale Price Sale Date Use of Proceeds JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 10 of 12 Please include a description of any other changes to the value of estate assets . 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 A Account Number (last 4 -digits only) Column B Name of Financial Institution Column C *Balance Due on Last day of ❑ Prior Reporting Period or ❑ Inventory Column D Balance Due on Last Day of Current Reporting Period Column E Change in Amount of Liability Indicate +/- Mortgage (princ ipal due only) Motor Vehicle Loan 2nd Mortgage/ Home Improvement Student Loan /Tuition Reverse Mortgage HELOC Credit Card Federal Taxes State / Local Taxes Other Loan/ Liabilit y/Debt TOTALS (Move these totals to Step 7) JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 11 of 12 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 P lan. Step 7: Summary Summary of Financial Activity *Prior Reporting Perio d 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. *** ***** REPORT MUST BE SIGNED AND DATED BY ALL CONSERVATORS AND SERVED ON TH E PROTECTED PERSON AND ALL INTERESTED PARTIES AS INDIC ATED BY THE ATTACHED CERTIFICATE OF SERVICE ******** JDF 885 SC R6/19 CONSERVATOR’S ANNUAL/FINAL REPORT Page 12 of 12 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. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of Executed on the ______ day of (date) (date) _______________________, _________, _______________________, _________, (month) (year) (month) (year) at ______________________________________ at ______________________________________ (city or other location, and state OR country) (city or other location, and state OR country) _______________________________ _______________________________ (printed name) (printed name) _______________________________ _______________________________ (Signature of Conservator/Successor) (Signature of Co -Conservator/Successor , if any) ________________________________________ __________________ Attorney Signature, (if any) Date CERTIFICATE OF SERVICE I certify that on ___________________ (date), a copy of this _______________ (name of document) was served as follow s on each of the following: Name and Address Relationship to Decedent, Ward, or Protected Person Manner of Service* *Insert one of the following: hand delivery, first -class mail, certified mail, e -service , or fax. ___________________________________ ___ ___ ________ Signature