Dear Client,
The following worksheets are designed to provide you with a method of self tracking your financial position,
and to allow you to easily update our records.
Please fill in all yellow highlighted cells as are appropriate for your financial situation.
In the many of the worksheets please enter both the amount and frequency for an income/expense item
Example: bi-weekly pacheck is a frequency of 26 (26 bi-weekly periods in a year of 52 weeks)
semi annual auto insurance is a frequency of 2 (2 pay periods per year)
Non Highlighted cells should not be modified so as to preserve the calculation integrity of the worksheet.
Please complete and return this work book along with the following forms/statements.
You may do so by secure email, fax or mail.
- All non-Commonwealth Investment account statements
- All retirement account statements (inc. a list of all investment options in the plan if a 401k)
- Most recent Employer Benefits Election Statement and coverages
- Personal Insurance policy statements & Reprojections
- Pay Check Stub of the last normal pay period
- All ava. loan statements displaying payment duration and terms
- Estate Plan documents: Trust, Power of Att'y(s) or amendments in past 12 months
- Employer Retirement Plans Beneficiary Designation
- Employer Retirement Plans Summary Plan Document
- Non-Commonwealth account Beneficiary designation statements
- Prior year Federal Tax return and attachments (inc. 1120, Sch. A, C, D, etc.)
Please note any special issues and financial items on this or a separate page.
Thank you for your effort in providing critical information for our assessment and review.
Mark Phillips
Items of Special Note:
Gross Asset Statement as of:
ASSETS Institution Current $ Value
Personal Assets
Primary Residence $0
Secondary Residence $0
Home Furnishings $0
Auto #1 $0
Auto #2 $0
Auto #3 $0
Collectibles $0
Other $0
Other $0
Total Personal Use Assets $0
Business Assets
Cash & Cash Equivelants @ $0
Receivables less payables $0
Real Estate $0
Equipment $0
Goodwill $0
Other $0
Total Funding in Place for Buy-out $0
Total Business Assets $0
Cash Savings
Svg./Ckg:____________Bank $0
Svg./Ckg:____________Bank $0
Svg./Ckg:____________Bank $0
Money Mkt:___________ $0
Money Mkt:___________ $0
CDs:_______________Bank $0
CDs:_______________Bank $0
EE/I Bonds $0
Total Cash & Cash Equivelants $0
Taxed Investments
Brokerage* (ex cash) @__________ $0
Brokerage* (ex cash) @__________ $0
Brokerage* (ex cash) @__________ $0
Mutual Funds* @:_____________ $0
Mutual Funds* @:_____________ $0
Mutual Funds* @:_____________ $0
Mutual Funds* @:_____________ $0
Mutual Funds* @:_____________ $0
Stock (direct/certificate) of________ $0
Stock (direct/certificate) of________ $0
Rental Property @______________ $0
Raw Land @________________ $0
Personal Loan made to:____________ $0
Irrevocable Trust Benificiaried to Client(s) $0
Client 1 Future Inheritance $0
Client 2 Future Inheritance $0
Total Taxed Investments $0
Tax Deferred Investments
Client 1 401(k)s* $0
Client 1 401(k)s* $0
Client 1 DB Retirement Plan* $0
Client 2 DB Retirement Plan* $0
Client 1 IRAs (inc. SEP & Simple)* $0
Client 2 IRAs (inc. SEP & Simple)* $0
Client 1 Roth IRAs* $0
Client 2 Roth IRAs* $0
Client 1 TSAs (403b)* $0
Client 2 TSAs (403b)* $0
529/ESA* acct. for:______________ $0
529/ESA* acct. for:______________ $0
529/ESA* acct. for:______________ $0
529/ESA* acct. for:______________ $0
HAS acct. @:_____________ $0
Non-Qualified Deferred Annuity* $0
Non-Qualified Deferred Annuity* $0
Non-Qualified Deferred Life Ins. Value* $0
Non-Qualified Deferred Life Ins. Value* $0
Total Tax Deferred Investments $0
Debts & Debt Service Current Period
Debt Service
Interest Original
Rate Start Date Balance Duration*
Residence First Mortgage 0.00% 1/0/00 $0 360
Residence Second Mortgage 0.00% 1/0/00 $0 360
Residence Home Equity Line of Credit 0.00% 1/0/00 $0 120
2nd home First Mortgage 0.00% 1/0/00 $0 360
2nd home Second Mortgage 0.00% 1/0/00 $0 360
2nd home Home Equity Line of Credit 0.00% 1/0/00 $0 360
Auto Loan:________________ 0.00% 1/0/00 $0 72
Auto Loan:_________________ 0.00% 1/0/00 $0 360
Credit Card:____________________ 0.00% 1/0/00 $0 360
Credit Card:____________________ 0.00% 1/0/00 $0 360
Credit Card:____________________ 0.00% 1/0/00 $0 360
Credit Card:____________________ 0.00% 1/0/00 $0 360
Credit Card:____________________ 0.00% 1/0/00 $0 360
Business Loan 0.00% 1/0/00 $0 360
Business Loan 0.00% 1/0/00 $0 360
Business Loan 0.00% 1/0/00 $0 360
Other Debt Payments 0.00% 1/0/00 $0 360
Total Monthly Debt Payments
Total Annual Debt Payments
* note: Original Duration (mo.) (100,000 for int. only)
t Period
Current Monthly
Balance Payment
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0 $0.00
$0.00
Income and Income Tax Current Reporting Period
Income (forward looking 12 months)
Annual Annual
Amount Frequency Amount
Client 1 Gross wages $0 12 $0
Client 1 Est Annual Bonus $0 0 $0
Client 2 Gross wages $0 26 $0
Client 2 Est Annual Bonus $0 0 $0
Client 1 Social Security (Current) $0 12 $0
Client 2 Social Security (current) $0 0 $0
Pension Income (current) $0 0 $0
Pension Income (current) $0 0 $0
Business Profit Income (xxx) $0 0 $0
Other Income ________________ $0 0 $0
Other Income ________________ $0 0 $0
Total Income $0
Income Tax Expenses (Est.)
Client 1 Federal Income Taxes $0 26 $0
Client 2 Federal Income Taxes $0 26 $0
Quarterly Fed. Tax Payments $0 0 $0
Client 1 State & Local Taxes $0 26 $0
Client 2 State & Local Taxes $0 26 $0
Quarterly State Tax Payments $0 0 $0
Total Income Tax Expenses $0
Payroll Taxes (Est.)
Client 1 OASDI Taxes self emp. ? $0
Client 2 OASDI Taxes self emp. ? $0
Client 1 Medicaid Taxes $0
Client 2 Medicaid Taxes $0
Total Payrol Tax Expenses $0
Total Income & Payrol Tax Expenses $0
Savings Current Period
Asset Additions (Savings)
% of total $ per payrol annual payrol Annual
Comp (alt. to % election) periods amount
Client 1 401(k)/SRA deferral 0.00% 0.00 26 $0
Client 1 Employer Match 0.00% 0.00 1 $0
Client 2 401(k)/SRA deferral 0.00% 0.00 26 $0
Client 2 Employer Match 0.00% 0.00 1 $0
Total Client(s) Income Deferral $0
Preiods per Annual
$ per period year amount
Client 1 IRA Contribution $0 0 $0
Client 2 IRA Contribution $0 0 $0
Client 1 Roth IRA contribution $0 0 $0
Client 2 Roth IRA contribution $0 0 $0
529/ESA:________________ $0 0 $0
529/ESA:________________ $0 0 $0
529/ESA:________________ $0 0 $0
529/ESA:________________ $0 0 $0
Systematic Savings Program $0 0 $0
Installment Certificates $0 0 $0
Other_____________________ $0 0 $0
Other_____________________ $0 0 $0
Other_____________________ $0 0 $0
Other_____________________ $0 0 $0
Total non-deductable savings $0 0 $0
Total Asset Additions $0
A
Spending: Next 12 Months n Budget
Annual Annual Monthly
Amount Frequency Amount Ave. Oct-11
Discretionary Expenses
Cable TV/Internet $25 12 $300 2 2
Entertainment/Dining $420 12 $5,040 1 1
Cash Charitable Contributions $0 12 $0 1 1
Gifts (Birthdays, Holiday) $300 12 $3,600 1 1
Hobbies/Pets $100 12 $1,200 1 1
Home Improvements $100 12 $1,200 1 1
Subscriptions $0 12 $0 1 1
Recreation/Travel $1,500 1 $1,500 1 1
Kid's Recreation $500 12 $6,000 1 1
Other: $0 12 $0 1 1
Total Discretionary $18,840 $11 $11
Other Committed Expenses
Bank $0 12 $0 #DIV/0!
Child Support $0 0 $0 #DIV/0!
FSA Dependent Care $0 12 $0 #DIV/0!
Dependent Care Out of Pocket $800 12 $9,600 #DIV/0!
Education/Continuing Ed. $0 12 $0 #DIV/0!
Home Repairs $0 1 $0 #DIV/0!
FSA/HSA Health Care $0 12 $0 #DIV/0!
Medical/Dental (Out of Pocket) $200 4 $800 #DIV/0!
Prescription Drugs $30 12 $360 #DIV/0!
Personal Care $200 12 $2,400 #DIV/0!
Medical Insurance $0 26 $0 #DIV/0!
Umbrella Insurance $0 1 $0 #DIV/0!
Other Health Ins. (Dental, Vission) $0 1 $0 #DIV/0!
Telephone $50 12 $600 #DIV/0!
Business Meals/Travel $0 0 $0 #DIV/0!
Dues $0 1 $0 #DIV/0!
Other: $0 4 $0 #DIV/0!
Other: $0 12 $0 #DIV/0!
Other Committed $13,760 #DIV/0! $0
Household Expenses
Rent $2,000 12 $24,000 #DIV/0!
Homeowners/Renter Insurance $250 1 $250 #DIV/0!
Real Estate Taxes (Residence #1) $0 2 $0 #DIV/0!
Real Estate Tax (other) $0 0 $0 #DIV/0!
Utilities (electric/gas/water/trash) $75 12 $900 #DIV/0!
Lawn Care $0 12 $0 #DIV/0!
House Cleaning $0 12 $0 #DIV/0!
Association Dues $0 12 $0 #DIV/0!
Other: $0 12 $0 #DIV/0!
Total Household $25,150 #DIV/0! $0
Food/Clothing/Transportation
Groceries/Food $800 12 $9,600 #DIV/0!
Clothing/Dry Cleaning $200 1 $200 #DIV/0!
Auto Insurance Payments $100 12 $1,200 #DIV/0!
Auto Gas $250 12 $3,000 #DIV/0!
Auto Maintenance & Repairs $125 12 $1,500 #DIV/0!
Vehicle Registration Tax $300 1 $300 #DIV/0!
Other: $0 0 $0 #DIV/0!
Other: $0 0 $0 #DIV/0!
Total Food/Clothing/Trans. $15,800 #DIV/0! $0
Total Discretionary Expenses $1,570 12 $18,840 0.611111 $11
Total Committed Expenses $4,559 12 $54,710 0 $0
Total Expenses $6,129 12 $73,550 0.611111 $11
Actual
Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
Cash Flow Statement Analysis
Cash Flow Summary
Proportional Spending, Savings, & Tax
Current Current Current Period $
Period $ Period %
Total Income $0
Total Tax Expenses
Total Tax Expenses $0 #DIV/0!
Total Debt Expenses $0 #DIV/0!
Total Committed Expenses $54,710 #DIV/0! Total Debt Expenses
Total Discretionary Expenses $18,840 #DIV/0!
Total Savings $0 #DIV/0! Total Committed
Unused Cash Flow (+ or -) ($73,550) #DIV/0! Expenses
Total Discretionary
Expenses
Mark Phillips MBA CFP
Total Savings
Financial Advisor
Certified Financial Planner Professional
(949) 333-6394 Business Unused Cash Flow (+
(949) 333-6392 Fax or -)
Cash Flow Comparison: Annual
$60,000
$40,000
$20,000
$0
($20,000)
($40,000)
($60,000)
($80,000)
Total Income
A
Spending: Next 12 Months n Budget
Annual Annual Monthly
Amount Frequency Amount Ave. Oct-11
Discretionary Expenses
Cable TV/Internet $25 12 $300 #DIV/0!
Entertainment/Dining $420 12 $5,040 #DIV/0!
Cash Charitable Contributions $0 12 $0 #DIV/0!
Gifts (Birthdays, Holiday) $100 12 $1,200 #DIV/0!
Hobbies/Pets $100 12 $1,200 #DIV/0!
Home Improvements $100 12 $1,200 #DIV/0!
Subscriptions $0 12 $0 #DIV/0!
Recreation/Travel $1,500 1 $1,500 #DIV/0!
Kid's Recreation $0 12 $0 #DIV/0!
Other: $0 12 $0 #DIV/0!
Total Discretionary $10,440 #DIV/0! $0
Other Committed Expenses
Bank $0 12 $0 #DIV/0!
Child Support $0 0 $0 #DIV/0!
FSA Dependent Care $0 12 $0 #DIV/0!
Dependent Care Out of Pocket $0 12 $0 #DIV/0!
Education/Continuing Ed. $0 12 $0 #DIV/0!
Home Repairs $200 1 $200 #DIV/0!
FSA/HSA Health Care $0 12 $0 #DIV/0!
Medical/Dental (Out of Pocket) $200 12 $2,400 #DIV/0!
Prescription Drugs $60 12 $720 #DIV/0!
Personal Care $200 12 $2,400 #DIV/0!
Medical Insurance $115 12 $1,380 #DIV/0!
Umbrella Insurance $350 1 $350 #DIV/0!
Other Health Ins. (Dental, Vission) $150 12 $1,800 #DIV/0!
Telephone $50 12 $600 #DIV/0!
Business Meals/Travel $0 0 $0 #DIV/0!
Dues $0 1 $0 #DIV/0!
Other: $0 4 $0 #DIV/0!
Other: $0 12 $0 #DIV/0!
Other Committed $9,850 #DIV/0! $0
Household Expenses
Rent/Mortgage $1,800 12 $21,600 #DIV/0!
Homeowners/Renter Insurance $1,000 1 $1,000 #DIV/0!
Real Estate Taxes (Residence #1) $1,750 2 $3,500 #DIV/0!
Real Estate Tax (other) $0 0 $0 #DIV/0!
Utilities (electric/gas/water/trash) $75 12 $900 #DIV/0!
Lawn Care $120 12 $1,440 #DIV/0!
House Cleaning $0 12 $0 #DIV/0!
Association Dues $0 12 $0 #DIV/0!
Other: $0 12 $0 #DIV/0!
Total Household $28,440 #DIV/0! $0
Food/Clothing/Transportation
Groceries/Food $350 12 $4,200 #DIV/0!
Clothing/Dry Cleaning $100 1 $100 #DIV/0!
Auto Insurance Payments $100 12 $1,200 #DIV/0!
Auto Gas $250 12 $3,000 #DIV/0!
Auto Maintenance & Repairs $125 12 $1,500 #DIV/0!
Vehicle Registration Tax $300 1 $300 #DIV/0!
Other: $0 0 $0 #DIV/0!
Other: $0 0 $0 #DIV/0!
Total Food/Clothing/Trans. $10,300 #DIV/0! $0
Total Discretionary Expenses $870 12 $10,440 0 $0
Total Committed Expenses $4,049 12 $48,590 0 $0
Total Expenses $4,919 12 $59,030 0 $0
Actual
Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
$0 $0 $0 $0 $0 $0 $0 $0 $0
Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0