Wealth Plan Worksheet RTQ

7/29/2019 Wealth Plan Worksheet RTQ

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A1A Wealth Management, Inc. 2011 Page 1 of 8 www.A1Awealthmanagement.com

Mark Dennis, CFPA1A Wealth Management, Inc.

1010 Atlantic Avenue, Suite E Fernandina Beach, FL 32034

(904) 491-1889

[email protected]

Wealth Plan

Worksheet
mailto:[email protected]:[email protected]:[email protected]


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PERSONAL INFORMATIONClient 1 Client 2

Name

Date of Birth

Social Security Number

Cell Phone

Email

REAL ESTATE INFORMATIONPrimary Residence Secondary Residence

Address

City, State, Zip

Phone

Purchase Price / Year / /

Current Value (as of )

Owner(s) (please list the name(s) & check

ownership type)

Years and months at this home

EMPLOYMENT INFORMATION

Client 1 Client 2

Occupation/Title

Employer

Employer Address

City, State, Zip

Phone

Fax

Annual Salary / Annual Bonus / /

CHILDREN & GRANDCHILDREN1st Child 2nd Child 3rd Child 4th Child 5th Child

First Name

Last Name

Birth Date

Prior Marriage Y / N Y / N Y / N Y / N Y / N

Dependent Y / N Y / N Y / N Y / N Y / N

Parent of Child BOTH/CLIENT1/CLIENT2 BOTH/CLIENT1/CLIENT2 BOTH/CLIENT1/CLIENT2 BOTH/CLIENT1/CLIENT2 BOTH/CLIENT1/CLIENT2

Spouse of Child

Birth DateGrandchild

Birth Date

Grandchild

Birth Date

Grandchild

Birth Date


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OTHER REAL ESTATE

Address Current Value Purchase Price Improvements Rental Income

PERSONAL PROPERTY

Description (make/model) Current Value Purchase Price Owner

Personal Property

Vehicle 1

Vehicle 2

Vehicle 3

Jewelry

Other

CASH ACCOUNTS

Institution Current Value Owner

Checking

Savings

Other

Other

TAXABLE INVESTMENT ACCOUNTS

Description (Institution) Current Value Owner

TAX-SHELTERED INVESTMENT ACCOUNTSOwner/Descrip.

(Institution)

Current

Value

Employee

Contribution

Employer

Contribution Primary Beneficiaries

Contingent

Beneficiaries

ATTACH STATEMENTS IF NOT PREVIOUSLY PROVIDED


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STOCK OPTIONS

Company Name

Grants: 1 2 3 4 5

Grant Date

Shares granted

Shares vested

Exercise Price

First Vest Date

Vest Frequency

Vesting Periods

Expiration Date

BUSINESS INTERESTS

Entity Name Owner/ Co-Owners

Fair Market

Value Tax Basis Ownership % Entity Type

1 year goal for business:

5 year goal for business:

Desire for business at retirement/death:

LIABILITIES

Description

Original Balance

Date of Loan

Interest Rate Monthly

PaymentCurrent Balance Term


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EXPENSESDescription Current Amount Retirement Changes Frequency Notes

ALIMONY MONTHLY / ANNUAL

ASSOCIATION DUES MONTHLY / ANNUAL

AUTOMOBILE FUEL MONTHLY / ANNUAL

AUTOMOBILE INSURANCE MONTHLY / ANNUAL

AUTOMOBILE MAINTENANCE MONTHLY / ANNUAL

AUTOMOBILE PAYMENTS MONTHLY / ANNUALCABLE MONTHLY / ANNUAL

CHARITY MONTHLY / ANNUAL

CHILD CARE MONTHLY / ANNUAL

CHILD SUPPORT MONTHLY / ANNUAL

DRY CLEANING MONTHLY / ANNUAL

CLOTHING PURCHASES MONTHLY / ANNUAL

CLUB/MEMBERSHIP MONTHLY / ANNUAL

ENTERTAINMENT MONTHLY / ANNUAL

FOOD/DINING MONTHLY / ANNUAL

FOOD/GROCERIES MONTHLY / ANNUAL

GIFTS MONTHLY / ANNUAL

HOBBIES MONTHLY / ANNUALHOME FURNISHINGS MONTHLY / ANNUAL

HOME IMPROVEMENTS MONTHLY / ANNUAL

HOUSE CLEANING MONTHLY / ANNUAL

INTERNET MONTHLY / ANNUAL

HOMEOWNER'S ASSOCIATION MONTHLY / ANNUAL

HOMEOWNER'S INSURANCE MONTHLY / ANNUAL

LAWN MAINTENANCE MONTHLY / ANNUAL

MEDICAL INSURANCE MONTHLY / ANNUAL

MEDICAL PRESCRIPTIONS MONTHLY / ANNUAL

MEDICAL VISITS MONTHLY / ANNUAL

MISCELLANEOUS MONTHLY / ANNUAL

PERSONAL CARE MONTHLY / ANNUALPET PRODUCTS MONTHLY / ANNUAL

PROFESSIONAL FEES MONTHLY / ANNUAL

PROPERTY TAX MONTHLY / ANNUAL

SECURITY SYSTEMS MONTHLY / ANNUAL

SUBSCRIPTIONS MONTHLY / ANNUAL

TELEPHONE MONTHLY / ANNUAL

TRASH MONTHLY / ANNUAL

TRAVEL MONTHLY / ANNUAL

UTILITIES MONTHLY / ANNUAL

VACATION MONTHLY / ANNUAL

OTHER MONTHLY / ANNUAL

OTHER MONTHLY / ANNUALOTHER MONTHLY / ANNUAL






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FINANCIAL GOALS

Please list any large purchases or expenditures anticipated in the next 10 yrs including amount &

date (for college expenses, please include specific details e.g. 75% in state public university tuition):

How much income is desired during retirement years?

Do you believe you will receive an inheritance in the future? If so, please explain.

Please list any specific concerns about your financial future:

Please list your other goals:

ADVISORS

Name Phone

Accountant

Attorney

Banker

Insurance Agent

Stock Broker

Other Advisor


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ADDITIONAL INFORMATION

A


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DDITIONAL INFORMATION

DOCUMENT REQUEST

Personal:

Wealth Management Worksheet Two (2) most recent federal and state income tax returns Most recent Social Security benefit statements Employment contracts Employee benefit statements and booklets Bonus plans Stock option and restricted stock statements Deferred compensation arrangements Pension documents and latest statement 401(k) statement and plan summary with investment alternatives Values of titled personal assets Most recent investment statements Cost basis of all assets Most recent mortgage statement, origination date, amount and interest rate Current wills, trust documents, powers of attorney and other legal documents Life, disability, liability and long-term care insurance policies, statements and illustrations (if available) Annuity statements Most recent pay stubs Deeds to real estate

Business:

Current financial statements: balance sheet, income statement Incorporation papers and bylaws Buy-sell agreements Two (2) most recent federal and state income tax returns Retirement plan document Insurance policies, statements and illustrations (if available)




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RISK TOLERANCE QUESTIONNAIRE

Fill out the questionnaire below based on your preferences. Questions 7 through 10 relate to the specific proposed account you

are considering. If you are considering more than one proposed account and the answers to those questions vary per proposed

account, you may specify different answers for each account.

1. What best describes your current situation? (select one) Answer: _______

A. Income and expenses are expected to rise and investable assets are accumulating (e.g., Early Career)

B. Income and expenses are relatively steady and savings are growing modestly (e.g., Mid/Late Career)

C. Income and expenses are relatively steady and savings are growing significantly (e.g., Mid/Late Career)

D. Income and expenses are declining and/or savings are being used to maintain desired lifestyle (e.g., Retirement)

2. What is your greatest concern? (select one) Answer: _______

A. Underperforming the market

B. Not growing my assets significantly over time; I am willing to assume higher risk for higher return potential

C. Losing money in a market downturn along the way

D. Losing more money than a certain amount within a given timeframe (e.g., retirement)

E. Not having certainty around achieving my wealth goal in the remaining time

3. Each year, the value of your portfolio fluctuates as markets change. If you invested $500,000, Answer: _______

which of the following portfolios below would you choose? (select one)

A. Portfolio 3

B. Portfolio 2

C. Portfolio 1

4. What describes you best? (select one) Answer: _______

A. I am a long-term investor focused on growing my assets

B. I am focused on preserving current wealth and have little tolerance for losses

C. I want to plan long-term but have a hard time shrugging off moderate to severe lossesD. I need stable cash flows to meet my living expenses

E. I am focused on preserving capital; I dont mind if this approach sacrifices return potential

5. If I look at my account statement and there is a moderate loss, my primary reaction is? (select one) Answer: _______

A. How did my portfolio compare with a market benchmark or other relative measures of success?

B. I lost money and am unhappy but am willing to stick with it until a recovery

C. I dont mind dips in portfolio value as long as I am still on track to meet my goal(s)

D. I worry about losses if they increase the risk that I wont be able to meet my living expenses

E. I can tolerate short-term losses as long as I have a specific amount of money at a specific time in the future

$500,00

ortfolio Portfolio

hese portfolios are strictly hypothetical and for illustrative purposes only.

Portfolio

$605,000

537,000

,

1.

.

- .

$703,000

,

,

22.4%

1 .

40.6%

539,000

522,000

500,000

.8%

.

.0%

his is where a $500,000

investment might be after

ne year of very good

market conditions



ne year of normal marketondition



ne year of poor market

on on

ONE YEAR RANGE OF POTENTIAL VALUES


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6. For the purpose of assessing your overall risk tolerance, which of the following investments Answer(s): _______

would you feel comfortable owning? Select all that apply:

A. Cash and Money Market

B. Government bonds, U.S. Corporate bonds and municipal bonds

C. U.S. Stocks

D. International securities (stocks and bonds)

E. Emerging markets (stocks and bonds)

F. Alternative investments (private equity, venture capital, hedge funds)

7. What is your primary objective for this proposed account? (select one)

A. Accumulation (means attempting to build up the value of a portfolio. Dividends and capital gains

are also reinvested during this process.)

B. Maintenance (means investments whose primary goal is to prevent the loss of an investments total value.)

C. Liquidity (means the conversion of assets to cash)

D. Distribution (means income generated from an investment is distributed to the investor or beneficiary through

periodic distributions.)

8. What percentage of your entire investable assets will this proposed account represent? (select one)

A. A modest percentage, and the rest of my assets are invested in conservatively (e.g., cash and

money markets, U.S. stocks and bonds)

B. A modest percentage, and the rest of my assets are invested aggressively (e.g., international securities,

emerging markets, alternative investments)

C. A significant percentage, and the rest of my assets are invested conservatively

D. A significant percentage, and the rest of my assets are invested aggressively

E. Substantially all of my assets

9. From what source was this proposed account obtained? (select one)

A. Investment activities, personally taking market risks

B. Entrepreneurial activities, personally taking business risks

C. Inheritance or other large, one-time payment

D. Accumulated savings over a long period of secure employment

10. If this proposed account suffered a temporary decline, could you cover your immediate cash flow

(i.e., expenses) needs from other sources of assets? (select one)

A. No. There are no other assets that I could use to cover my immediate cash flow needs

B. Yes. I have other assets that I could use to cover my immediate cash flow needs,

but it would be difficult to access them

C. Yes. I have other assets that I could use to cover my immediate cash flow needsD. This proposed account is not expected to fund any spending

Answer:

Account 1 _______

Account 2 _______

Account 3 _______

Answer:

Account 1 _______

Account 2 _______

Account 3 _______

Answer:

Account 1 _______Account 2 _______

Account 3 _______

Answer:

Account 1 _______

Account 2 _______

Account 3 _______

Wealth Plan Worksheet RTQ

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