Self Funded Trust

New Forms (for submissions beginning Jan. 1, 2023)

Wispact Trust I Self-Funded

• Master Trust I – Restatement (Fully Executed 12-08-2022)

Beneficiary-Funded Trust I Creation Documents

• Attorney Checklist (2023)
• Contribution Agreement to Establish Sub-Account – Trust I (2023)
• Wispact Retained Fund Grant Policy Acknowledgement (2023)
• Individual Spending Plan (2023)
• IRS Form W9 for Beneficiary (link to external irs.gov)
• SSA Release of Information BPQY (2018)
• Medicaid/DHS Release of Information
• Contact and Planning Information (2021)
• Heirs at Law (2023)
• Loan Agreement (2020)
• Creation Grant Application (2023)

Retained Fund Sub-Account Creation Documents

• Attorney Checklist (2023)
• Contribution Agreement to Establish Retained Fund Sub-Account-Trust I (2023)
• Wispact Retained Fund Grant Policy Acknowledgement (2023)
• Contact and Planning Information (2021)
• Loan Agreement (2020)