Stein Wealth Advisors, LLC Financial Services o!ered ... · Stein Wealth Advisors, LLC Lake View Square 4000 Washington Rd., Ste. 101 McMurray, PA 15317-2534 Phone: 724.260.0491 Fax:

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Stein Wealth Advisors, LLCLake View Square

4000 Washington Rd., Ste. 101McMurray, PA 15317-2534

Phone: 724.260.0491Fax: 724.260.0674

[email protected] Services o!ered through Mid Atlantic Financial Management, Inc.

Financial Fact FinderPlease bring the following to each meeting:� Pension estimate or projection statement

� Employer retirement statements (401(k), 403(b), 457 plan, etc. Please include all investment options available)

� Social Security statement

� Stock option statement

� Deferred compensation statement

� Form 1040 of last year’s tax return

� Monthly budget

� Current paystubs

� Education account statements (529 plans, custodial accounts, UGMA/UTMA accounts)

� Personal brokerage account statements (IRA, Roth IRA, Annuity or any miscellaneous investment statements)

� Bank account statements: checking, savings, money market, certificate of deposit

� Liability statements: mortgage, credit cards, car loans, student loans, any debt statements

� Updated life insurance statement and original policy

� Disability insurance statements and original policy

� Long Term Care statements and original policy

� Will(s), trusts & other estate planning documents

� Employee Benefit Handbook(s)

Questions for your advisor

Securities offered through Mid Atlantic Capital Corporation (MACC), member FINRA/SIPC.Advisory services offered through Mid Atlantic Financial Management, Inc. (MAFM), a registered investment adviser.Trust services offered through Mid Atlantic Trust Company (MATC), a non-depository trust company.Stein Wealth Advisors, LLC is not a registered entity or a subsidiary or control affiliate of MACC, MAFM or MATC.

Financial Fact Finder PAGE 2

What Keeps You Up At Night?Please take a minute to review the topics and related questions below. Check off any concerns you have right now.

Retirement

� Will my money last through retirement?

� Do I need long-term care insurance?

� What are my retirement investment options?

� How do I manage all my retirement plans?

� What should I do with my employer retirement plan?

� Since I am retiring soon, what do I need to do now?

� Should I retire to a different state?

� When should I take Social Security?

� How much will healthcare cost?

Estate Planning

� What should I know about estate planning?

� How do I protect my estate from taxes?

� Will my family be secure if something happens to me?

� How do I create a legacy for my children?

� Can I provide for my favorite charity when I am gone?

� What will my survivors need to know?

Education Planning

� How much should I save for college? When should I start planning?

� Will I qualify for financial aid? Where do I start?

� What are my college savings options?

Life Events

� How do we manage our finances after getting married?

� What happens to my 401(k) when I change jobs?

� What are my options if I am laid off?

� I am getting divorced. What happens to my assets?

� How do I help my recent college grad transition intothe workforce?

� What do I do when a loved one dies?

Eldercare

� How does Medicare work?

� What should I look for in a nursing home?

� How do I cope with Alzheimer’s disease?

� What happens if I have to care for my parents?

Financial Basics

� How do I keep my records safe and organized?

� How do I do a better job budgeting?How do I reduce my debt?

� How do I teach my children about money?

� How do I help a young adult establish a financial strategy?

� How do I have financial discussions with family?

Comments


Personal DataPlease complete both columns, unless you are single, widowed, or divorced.

Client A - Personal Information

First Name Middle Last

Nickname Date of Birth

Social Security Number � Male � Female

� U.S. Citizen � Resident Alien � Non-Resident AlienCitizenship

Birth State Mother’s Maiden Name

Driver’s License Number State

Issue Date Expiration date

Home Street Address

City State Zip Code

Personal Email

Home Telephone Cell Phone

� Single � Married � Domestic Partner

Marital Status:

� Widowed � Divorced

Anniversary Date (if married):

Client A - Employment Information

Job Title Employer

Employer Street Address

City State Zip Code

Work Email

Work Telephone Work Cell

Client B - Personal Information

First Name Middle Last

Nickname Date of Birth

Social Security Number � Male � Female

� U.S. Citizen � Resident Alien � Non-Resident AlienCitizenship

Birth State Mother’s Maiden Name

Driver’s License Number State

Issue Date Expiration date

Home Street Address

City State Zip Code

Personal Email

Home Telephone Cell Phone

Client B - Employment Information

Job Title Employer

Employer Street Address

City State Zip Code

Work Email

Work Telephone Work Cell

� Same Address as Client A

If different please fill out:


Interview Questions

Have you worked with a financial professional in the past?

If yes, please provide their name:

How was the experience?

What are your expectations from us?

What fears or potential pitfalls would you like to avoid?

� Yes � No

Dependent Personal Data

First Name Middle Last Date of Birth Social Security Number






Do you plan on having additional children?

Are there any immediate or long term financial obligations for supporting parents or dependents?

If yes, please explain (ie: special needs, etc.)

� Yes � No

� Yes � No

Who prepares your tax forms?

Are you obligated to do business with anyone else?


General Questions

AffiliationsAre you (or a member of your immediate family) a director, 10% shareholder or policymaking officer of a publiclytraded company?

� Yes � No If yes, Company Name:

� Yes � No If yes, specify Firm Name:

Are you (or a member of your immediate family) a registered representative of a broker-dealer?

Are you (or a member of your immediate family) employed by or otherwise affiliated with FINRA or any broker-dealer?

� Yes � No If yes, specify Firm Name:

Are you (or a member of your immediate family) a politically exposed person in non-U.S. country?

� Yes � No If yes, specify:

Education Objectives

Child 1

Name of Child

University, College or School of Choice

Expected Annual Tuition andLiving Expenses Per Year

Expected Year to Enter College

Number of Years ofEducaton:

Undergraduate

Graduate

Do you plan to send yourchild(ren) to private schoolbefore college?

� Yes � No

If yes, please provide the annual tuition amount?

Child 2

Name of Child





Undergraduate

Graduate


� Yes � No


Child 3

Name of Child





Undergraduate

Graduate


� Yes � No


Child 4

Name of Child





Undergraduate

Graduate


� Yes � No


Instructions: Please use the section below to estimate the amount of education expenses you may want to fund for your children. The average annual cost of all schools in the United States is approximately $32,000 (Including room, board & tuition) as of 2016. School costs can vary dramatically so it is important to identify the type of school as well as the amount of education you want to fund (i.e. 100% vs 50%).


Retirement ObjectivesClient A Client B

Target Retirement Age (what age do you want to retire?) Target Retirement Age (what age do you want to retire?)

What milestones do you see in the future for your Retirement or Financial Independence (i.e., purchase a new home, relocate,remodel the kitchen, travel more, enjoy a comfortable retirement, etc.)

Where do you dream of going/do you plan to move out of state in retirement? (Did you know that the 2010 average U.S. vacation cost per day for food and lodging for two people was $244?)

How do you want to make a difference to family, community, an organization or friends? Sometimes dreams and goalscan include helping others. Think about the people, communities and organizations that matter to you. How do youwant to support them now and in the future? Think BIG!

What are your anticipated annual expenses in retirement? (after tax)


Do you have a will and/or a trust? If yes, when was it last updated?

Are you expecting to receive money or property from an inheritance, a gift, judgment or lawsuit orother? If yes, please explain:

Do you have any children or grandchildren with special needs or for whom you would like to makespecial provisions?

Do you make any charitable donations? If so, to whom?

Have you or your spouse been married before? If yes, are there children by a previous marriage?

Have you entered into a prenuptial agreement? If yes, please provide a copy.

Are both of you U.S. citizens? If no, please specify:

Have you and/or your spouse made any gifts to any one individual in a calendar year in excess of$14,000 or $28 ,000 jointly? If so, please explain and list the years:

� Yes � No

� Yes � No

� Yes � No

� Yes � No

� Yes � No

� Yes � No

� Yes � No

Estate Planning

� Yes � No

Income Type Amount (Pretax)Age income begins:

� Client A � Client B

Sample:

Salary $20,000

Income Type � Client A � Client B







Ownership: Details:

Income InformationInstructions: Please include all current and future income sources including but not limited to: Salary, Estimated Annual Bonuses, Deferred Compensation, Royalties, Social Security, Pensions, Rental Income, Annuity Payments, Business Income, Other Income.

Amount (Pretax)Age income begins:







Currently Collecting?

Does it Inflate?

� Yes � No

� Yes � No%3


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%


Does it Inflate?

� Yes � No

� Yes � No%

60


Asset InformationBanking: Checking, Savings, Money Market, CDs

Asset Type Institution Name Current Balance Monthly Savings Amount(Your contributions per month)

� Client A � Client B � Joint

Sample:

Checking PNC Bank $5,000 $100















Ownership:

Investments: 529 Plans, Savings Bonds, 401(k), 403(b), SEP IRA’s, 457 Plans, Retirement Saving Plans, Roth IRA’s, Traditional/Rollover IRA’s, Annuities, UGMA/UTMA, Stock Options, Restricted Stocks, SAR’s, Non-Retirement Investment Accounts, etc.

Asset Type Institution Name Current Balance Monthly Savings Amount(Your contributions, amount or% salary per month)


Sample 1:

Roth IRA Vanguard $5,000 $50Employer Contributions

N/A

Asset Type Institution Name Current Balance � Client A � Client B � JointEmployer Contributions





Ownership:

Monthly Savings Amount(Your contributions, amount or% salary per month)






Real Property: Real Estate, Cars, Jewelry, Boats, etc.

Asset Type Current Value � Client A � Client B � Joint

Sample:

Home Residence $350,000






Asset Information (Continued)

Liabilities

Loans and Liabilities: Mortgage, Home Equity Loan, Car Loan, Student Loan, Credit Cards, etc.

Liability Name Institution Name Minimum Monthly Payment Interest Rate %


Sample 1:

Mortgage Wells Fargo $1,547 4.5%Current Balance

$205,547



Current Balance



Current Balance



Current Balance



Current Balance

Liability Name Institution Name Minimum Monthly Payment Interest Rate % Current Balance

Additional Monthly Payment

$547







Protection Planning

Life Insurance

Insurance Company Insured’s Name

� Term � Whole Life � Universal Life

Cash ValueAnnual PremiumDeath Benefit













Disability Insurance

Insurance Company Insured’s Name Monthly BenefitBenefit Period Annual Premium Waiting Period



Long Term Care Insurance





Health Status

Client A

Are you a Smoker?

Please rate you overall health status.

Are your parents living?

If not please provide age at time of death.

Mother ______ Father ______

Do you take medications?If so, please list.

� Yes � No

� Excellent � Good � Fair � Poor

Have you had any major surgeries orhospitalizations in the last 15 years?

Client B

Have you had any major surgeries orhospitalizations in the last 15 years?

� Yes � No

Are you a Smoker?

Please rate you overall health status.

Are your parents living?

If not please provide age at time of death.

Mother ______ Father ______

Do you take medications?If so, please list.

� Yes � No

� Excellent � Good � Fair � Poor

� Yes � No

Documents

Stein Wealth Advisors, LLC Financial Services o!ered ... · Stein Wealth Advisors, LLC Lake View Square 4000 Washington Rd., Ste. 101 McMurray, PA 15317-2534 Phone: 724.260.0491 Fax: