Donor-Advised Fund Agreement Worksheet

Donor-Advised funds are a popular means for donors to create greater, longer-lasting impact in their charitable giving. A far more cost-effective and tax beneficial alternative to establishing a private foundation, donor-advised funds are often established through gifts of stock or other appreciated assets. Fundholders or their designated successors recommend grants to nonprofit organizations of their choice, while NCCF manages all aspects of administering the fund and overseeing the prudent investment of the fund’s assets.

This Worksheet is used to create the fund agreement establishing the fund with NCCF. Please fill out the information below.

General Information

NCCF does not share, sell, trade or exchange personal data or any information about its donors and fundholders unless expressly permitted to do so or if required by law.

Name of Fund * 🛈

Establishing Donor #1

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone *

Mobile Phone

Additional Address:

I/This donor has a work/seasonal/weekend home address?

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Seasonal Email Address

Seasonal Phone

Seasonal Phone *

When are you typically at your seasonal address? *

add a second Establishing Donor

Establishing Donor #2

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone

Mobile Phone *

This donor has a work or seasonal/weekend home address.

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Seasonal Email Address

Seasonal Phone

When is this donor typically at this seasonal address? *

Add a third Establishing Donor

Establishing Donor #3

Prefix *

If "Other," please explain *

First Name *

M.I.

Last Name *

Suffix

Primary (Home) Mailing Address *

Primary (Home) Mailing Address Line 2

City *

State *

Zip Code *

Email Address *

Home Phone *

Mobile Phone *

This Donor has a work or seasonal/weekend home address

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Seasonal Email Address

Seasonal Phone

When is this donor typically this seasonal address? *

Professional Advisor (optional)

Many people open donor-advised funds with advice from an attorney, accountant, financial advisor, or other professional. These individuals may also be involved in the transfer of assets into your fund. It is helpful for us to know who these advisors are. Contact information will not be shared outside of NCCF.

Advisor Information (optional):

Attorney

CPA

Financial Planner

Other

For "Other," please explain:

Name *

Name of Firm *

Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

add another Professional Advisor

Advisor Information (optional):

Attorney

CPA

Financial Planner

Other

For "Other," please explain:

Name *

Name of Firm *

Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Fund Type: Endowed or Non-Endowed

Endowments/Endowment funds are permanent funds established to carry out your philanthropic intentions in perpetuity. Assets are invested for growth, and the amount available for grants each year is based on a Community Distribution Policy with an objective of distributing up to 5% of the Fund's market value annually. This policy sets the annual grant limits. This fund is intended to make grants in perpetuity.

Non-Endowed funds permit grant distributions in any amount (minimum of $250 per grant) at any time. there are no grant distribution limits. If the fund balance is exhausted, the fund terminates. A non-endowed fund may be converted to an endowment (usually upon the death of the original donor/s), but an endowed fund may not become a non-endowed fund.

Pass-Through funds–because they are temporary and short in duration–are held in a Money Market account. These funds are for the short term, with the entire fund likely to be distributed within 12 months.

Select Fund Type: *

Endowed

Non-Endowed

Pass-Through

I/we wish the fund to become an endowment upon the death of the last establishing donor.

Recognition and Acknowledgements

Grant Acknowledgements Options:

1. I will let you know my recognition preferences on a case-by-case basis. (Note: You will have an opportunity to indicate your preferences each time you recommend a grant.)

2. I want my name and the name of the fund known to grant recipients and published in any public listings of grants, including ones published by NCCF and grantee organizations.

3. I do not want grant recipients to know grants are from me, but the name of the fund may be published in any public listings of grants. (This option is appropriate when the name of the fund does not include a family name-e.g., The Local Area Fund.)

4. I want to make all grants anonymously. I want to remain anonymous both to grant recipients and in any public listings of grants.

Please Select a Grant Acknowledgement Option: *

Option 1 (case-by-case basis)

Option 2 (my name and fund name)

Option 3 (fund name only)

Option 4 (completely anonymous)

Gift Acknowledgement Options: *

I would like my name to be included in the list of contributors to funds at NCCF. (Actual gift amounts are not listed.)

I prefer not to be recognized by NCCF for contributions to my fund(s) or for my support of other NCCF funds.

Mail:
The groups you support typically like to send a thank you letter to you, as well as put you on their mailing list for newsletters, annual reports and organizational updates etc. We ask them to send all correspondence directly to you unless otherwise specified.

Note: We do not sell, distribute or share donor contact information to third parties or other nonprofits.

Please select one of the mail options below: *

Please share my contact information with my grantees.

Please DO NOT share my contact information, or forward any correspondence from grantee organizations.

Please DO NOT share my contact information but DO forward thank you letters only to:

Please DO NOT share my contact information, but DO forward all fund mail from grantee organizations to:

*

Establishing Donor #1

Establishing Donor #2

Other (please contact NCCF)

Fund Statements

Fund Statements are posted to our online fund-advisor portal quarterly and all fund-advisors/donors receive email notification when statements are posted.

I would like an additional individual to receive quarterly statement notification

Please indicate the name, address and email of any individual other than the establishing donors whom you want to receive quarterly statement notification.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Grantmaking Support

Please indicate your preference: *

I will make grant recommendations for my fund based on my own research.

I would entertain (without obligation) grant opportunities passed along by NCCF staff through their general grant application invitations (open calls for proposals) to the local nonprofit community.

Do you have a preference for certain focus areas for your philanthropy? (e.g. social services, environment, health, arts and culture, animal welfare, children's causes, education etc.) *

General - no focus preference

Yes

Please describe your focus area preference(s): *

Succession Planning

How do you wish to set up Succession Planning? *

With Advisors

Without Advisors

As the Establishing Donor(s), you may name one or more Successor Advisors to the Fund who will assume the responsibility of making grant recommendations upon your death, resignation, refusal, or inability to continue to make grant recommendations.

If you choose to have multiple successor advisors, you are required to select a Lead Advisor who will transmit grant recommendations to NCCF on behalf of all the successor advisors.

PLEASE NOTE: Lead Advisor privileges will pass to the next advisor in the order listed below should the lead advisor be unable to perform this responsibility.

Alternatively, you may wish to provide an equal and independent share of the annual distributable fund balance to all successor advisors, so that each can recommend grants from their individual portion of total annual grant allowance. In this case you must designate all successor advisors as Peer Advisors.

It is understood that in the event that no Successor Advisor is able and/or willing to provide grant recommendations for a period of three years, the NCCF Board of Directors shall make grants from the fund according to the Fund Activity Policy.

This Advisor is a: *

Lead Successor Advisor

Successor Advisor

Peer Advisor

First Name *

Last Name *

Relationship *

Current Age *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

add another advisor

This Advisor is a: *

2nd Lead Successor Advisor

Successor Advisor

Peer Advisor

First Name *

Last Name *

Relationship *

Current Age *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

add another Advisor

This Advisor is a: *

3rd Lead Successor Advisor

Successor Advisor

Peer Advisor

First Name *

Last Name *

Relationship *

Current Age *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

add another Advisor

This Advisor is a: *

4th Lead Successor Advisor

Successor Advisor

Peer Advisor

First Name *

Last Name *

Relationship *

Current Age *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

I want grants from this fund to be made by NCCF as follows: *

As a Community Catalyst Fund: NCCF may make grants where the needs are greatest in the community.

As a Field of Interest Fund: I will provide a field of interest.

As a Designated Fund, a fund that benefits specific nonprofits: I will name specific nonprofits.

Please provide information on your area(s) of interest. (It can be in a focus area, like homeless children, food insecurity, after school enrichment, the environment and/or a geography, like greater Torrington, or the community of Norfolk.) This will guide NCCF in making sure your legacy is honored once you or the last Lead Successor Advisor is no longer recommending grants. You can be as general or specific as you like. *

Please designate nonprofits:

Organization Name *

Street Address *

Address Line 2 *

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

add another organization

Organization 2 Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

add another organization

Organization 3 Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this organization a 501(c)(3) public charity? *

Yes

No

Gift Information

Fund Creation

What type of gift(s) do you plan to make? Check all that apply. *

Current

Planned

Current

Type of Gift: *

Cash/Check

Securities/ Stock

IRA/Retirement plan assets

Other

For "Other", please explain: *

Planned

Type of Gift: *

For "Other," please explain: *

Gift Amount (approx.): *

Please make checks payable to The Northwest CT Community Foundation, Inc. with your fund name in the memo line. For the transfer of funds by wire, or for gifts of securities or complex assets, please visit Information for Current Donors.

Contributions are Irrevocable: All gift contributions made to The Northwest CT Community Foundation, Inc. become assets of the Northwest CT Community Foundation, Inc. and are irrevocable as tax deductible gifts. All gifts to the Northwest CT Community Foundation Inc. must further the charitable purpose and mission of the Northwest CT Community Foundation, Inc. The Northwest CT Community Foundation, Inc. reserves the right to review and approve all contributions.

Signatures

Name *

Signature *

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Name

Signature

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