; Charitable Gift Annuity Agreemen
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Charitable Gift Annuity Agreemen


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									                                                                                   Monday, May 31, 2010

                             INSTRUMENT OF TRANSFER
                            Charitable Gift Annuity Agreement

Truman Heartland Community Foundation
North Office
c/o Commerce Bank
300 North Osage
Independence, Missouri 64050

This Agreement is made this ______day of (month) ______________, 2010, between
(donors)__________________________ of (city & state)____________________________, hereafter
called the “Donors,” and The Truman Heartland Community Foundation, a Missouri non-profit
corporation, hereafter called “THCF.”

       Transfer of Property. The Donors hereby transfer to THCF, and THCF hereby acknowledges
       receipt of, the property described in Exhibit B attached hereto. It is agreed by the Donors and
       THCF that the property described in Exhibit B altogether has a fair market value of (written
       dollar amount) _______________________ ($_____________.)

       Payment of Annuity. In consideration of the property transferred by the Donors, THCF agrees
       to pay to (donors)_____________________________, for their joint lives and to the survivor of
       them for his or her life, an annuity or annual sum of $________, which is to be paid in equal
       quarterly installments of $____________ as of the last day of March, June, September and
       December. The first installment shall be paid on December 31, 2008, in the amount of

       Non-assignability of Annuity. The annuity specified in the above paragraphs shall be non-
       assignable, except in the case of a voluntary transfer of part or all of such annuity to THCF.

       Termination of Annuity. The obligation of THCF to make annuity payments under the
       agreement shall terminate with the regular payment next preceding the death of the survivor of
       (donor) ____________________________________, at which date it is agreed that THCF shall
       be released from all obligations provided all quarterly payments which were previously due
       have been paid.

       Disclosure Statement. A qualified charitable gift annuity is not insurance under the laws of the
       state of Missouri and is not subject to regulation by the Department of Insurance or protected
       by a guaranty association. The THCF’s disclosure statement is attached as Exhibit A.

       The birthday of (donor) _______________________ is (date) ___________________, and the
       birthday of (joint donor) _______________________________ is (date) __________________.

       The charitable proceeds of the annuity shall be used by the THCF to add to the
       _____________________________________Fund of the Truman Heartland Community

IN WITNESS WHEREOF, both the Donors and THCF have executed this instrument on the day and date
first set out above.

_________________________________              ___________________________________
Donor name                                     Joint Donor name

SS#: ___________________________ SS#: _____________________________

                                                            Truman Heartland Community Foundation

                                                           By: Phillip J. Hanson, MPA, President & CEO

                                                                                 Monday, May 31, 2010

                                           EXHIBIT A
                                      Disclosure Statement

Per the Charitable Gift Annuity Agreement, guaranteed payments of the amount indicated will be made
to the annuitant for life.

With a gift annuity, you simultaneously make a charitable gift and provide guaranteed payments for life
to yourself and/or another person. The fact that you are making a charitable gift may entitle you to
income, gift and estate tax deductions.

Because a charitable gift is involved, the annuity rates offered by the THCF are lower than those
available through commercial annuities offered by insurance companies and other financial institutions.

These annuity payments are a general obligation of the Truman Heartland Community Foundation
(THCF), and they are backed by all of its assets. As of December 31, 2005 the fair market value of the
THCF’s assets exceeded $24 million. These assets are invested primarily in publicly traded stocks, bonds
and mutual funds.

The THCF was established in 1994. Responsibility for governing the organization is vested in a Board of
Directors comprised of not less than nine persons, who are elected by the current Board of Directors
and serve with no compensation.

Common investment funds managed by the THCF are exempt from registration requirements of the
federal securities laws, pursuant to the exemption for collective investment funds and similar funds
maintained by charitable organizations under the Philanthropy Protection Act of 1995 (P.L. 104-62).
Information in this statement is provided to you in accordance with the requirements of that Act.

                                      Monday, May 31, 2010

                   EXHIBIT B
               Property Description


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