Please visit our COVID-19 page for Community Fund Ohio’s response to the coronavirus including any adjustments to work hours, contact instructions, and procedures.
This page contains Community Fund Ohio’s forms. Please contact our Administrative Office if you need assistance.
Pooled Medicaid Payback Trust (Starting 10/01/19)
- The Pooled Medicaid Payback Trust Starter Kit (updated on 07/30/2020) contains all of the forms and instructions necessary to establish a new Pooled Medicaid Payback Trust. It includes:
- Attorney Instructions (UPDATED 07/30/2020)
- Pooled Medicaid Payback Trust Joinder Application
- NEW Investment Questionnaire (mandatory beginning September 1, 2020)
- Attorney Acknowledgment
- W-9
- Notice to Beneficiaries Age 65 or Older and Their Legal Counsel
- Opt-Out of Paper Statements for PMPTs (to be signed by Designated Advocate)
- Deposit Instructions
- Trust Comparison Fee Schedule
- About Trusts
- Tax Notice
- 13th Restatement of The Community Fund Management Foundation Pooled Medicaid Payback Trust Agreement (UPDATED 06/24/2020)
- Community Fund has partnerships with four Ohio nonprofits: Jewish Federation of Cleveland, Hattie Larlham, ADD, and The Arc of Ohio. One of the following Joinder Agreements should be used if the person establishing the Pooled Medicaid Payback Trust wishes for the named organization to receive trust funds at the death of the beneficiary:
Master Trust (Starting 10/01/19)
- The Master Trust Starter Kit contains all of the forms and instructions necessary to establish a new third-party discretionary Master Trust. It includes:
- Attorney Instructions
- Master Trust Joinder Application
- Attorney Acknowledgment
- W-9
- Opt-Out of Paper Statements for Revocable Master Trusts (to be signed by Grantor(s))
- Opt-Out of Paper Statements for Irrevocable Master Trusts (to be signed by Designated Advocate)
- Deposit Instructions
- Trust Comparison Fee Schedule
- About Trusts
- Tax Notice
- 4th Restatement of The Community Fund Management Foundation Master Trust Agreement
- Community Fund has partnerships with four Ohio nonprofits: Jewish Federation of Cleveland, Hattie Larlham, ADD, and The Arc of Ohio. One of the following Joinder Agreements should be used if the person establishing the Master Trust wishes for the named organization to receive trust funds at the death of the beneficiary:
- Jewish Federation of Cleveland Master Trust Joinder Application
- Hattie Larlham Master Trust Joinder Application
- ADD Master Trust Joinder Application
- The Arc of Ohio Master Trust Joinder Application
Notices Regarding the October 1, 2019 Change in Trustee
- Notice to Grantors of Revocable Master Trusts
- Notice to Designated Advocates of Irrevocable Master Trusts
- Notice to Designated Advocates of Pooled Medicaid Payback Trusts
- Notice to Designated Advocates of Roll-In Pooled Medicaid Payback Trusts
- Notice to Attorneys
About Community Fund Ohio
- Notice of Change of Address (Starting 10/15/2018)
- Contact List
- 2020 Holiday Schedule (Including 12/31/19 and 01/01/21)
Trust Distributions
- Common Distribution Requests
- Distribution Request Form
- Beneficiary Resource Record
- Instructions for Designated Advocates
- Receipt Log for Advances
- Distribution Packet for New Designated Advocates of Funded Trusts
Trust Distributions – Policy
Trust Administration
- About our Trust
- Authorization to Release Information
- Change of Address
- Changing the Designated Advocate by the Person who established the Trust
- Deposit Instructions
- Deposit Slip
- Frequently Asked Questions About Investments
- Trust Comparison Fee Schedule
- Opt-Out of Paper Statements For PMPTs and Irrevocable Master Trusts
- Opt-Out of Paper Statements for Revocable Master Trusts
- Tax Notice
Reference
- Annual Reports
- Special Needs Alliance’s Special Needs Trust Handbook
Grants
Please visit our Grants page for forms and other information about our grants for nonprofits and individuals with disabilities.