Form CAFC502B – Parenting Plan Part B – Support Mother: Case Information 1. Children’s Information Case Number Father: County Exhibit Number Part B of this parenting plan applies to ____________ child(ren). They are: 1. _______________________________ 4. _______________________________ 2. _______________________________ 5. _______________________________ 3. _______________________________ 6. _______________________________ 2. Medical Insurance Neither party is required to maintain medical insurance for the benefit of the children. A medical benefit plan is not available at reasonable cost through either parent’s employer or union. No support rights have been assigned to the state of Missouri and the Family Support Division is not providing support enforcement services to either party. Father shall maintain and pay the cost of medical insurance for the benefit of the children. The cost of medical insurance to be paid by Father is _____________ per month. Mother shall maintain and pay the cost of medical insurance for the benefit of the children. The cost of medical insurance to be paid by Mother is _____________ per month. 3. Dental Insurance Neither party is required to maintain dental insurance for the benefit of the children. A dental benefit plan is not available at reasonable cost through either parent’s employer or union. No support rights have been assigned to the state of Missouri and the Family Support Division is not providing support enforcement services to either party. Father shall maintain and pay the cost of dental insurance for the benefit of the children. The cost of dental insurance to be paid by Father is _____________ per month. Mother shall maintain and pay the cost of dental insurance for the benefit of the children. The cost of dental insurance to be paid by Mother is _____________ per month. 4. Cost of Medical and Dental Insurance In the event either parent is required to maintain medical or dental insurance, the parent providing the health benefit plan shall provide to the other parent an insurance identification card. If support rights have been assigned to the state of Missouri or the Family Support Division is providing support enforcement services to either party, the person paying support shall notify the Family Support Division regarding the availability of medical insurance coverage through an employer or a group plan, provide the name of the insurance provider when coverage is available, and inform the division of any change in access to such insurance coverage. 5. Medical and Dental Expenses As used herein, medical and dental expenses include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. This includes orthodontic and vision care, eyeglasses, contact lenses, and prescription drugs. It does not include cosmetic surgery that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. It does include expenses to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease. Expenses for counseling for the minor children shall be included as medical and dental expenses if the counseling is provided by a licensed social worker, licensed professional counselor, licensed psychologist or licensed psychiatrist. Parenting Plan Part B – Support of Children – Page 1 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com 6. Payment of Medical and Dental Expenses not Covered by Insurance 7. Payment of Extraordinary Medical Costs to be included on Form 14 The person receiving support will pay all reasonable and necessary medical and dental expenses of the children not covered by insurance and the person paying support will reimburse the person receiving support for _______ percent of all such expenses that are actually paid by the person receiving support and are in excess of $250 per year per child. This does not include the uninsured extraordinary costs set forth in paragraph 7 below. No reimbursement of uncovered medical and dental expenses of the children will be allowed unless the person receiving support submits proof of such expenses to the person paying support in writing within 120 days of the date said expenses were incurred. The person paying support does not have the financial resources to contribute to the payment of medical or dental expenses of the children not covered by insurance. The person receiving support will be responsible for all reasonable and necessary medical or dental expenses of the children not covered by insurance. This does not apply to the medical costs listed in Paragraph 7 below. All reasonable and necessary medical or dental expenses of the children are covered by insurance. The person receiving support has not substantially complied with the terms of the health benefit coverage. The person receiving support will be responsible for all reasonable and necessary medical or dental expenses of the children not covered by insurance. This does not apply to the medical costs listed in Paragraph 7 below. Extraordinary medical costs are predictable and recurring, such as expenses for dental treatment, orthodontic treatment, asthma treatment and physical therapy. These expenses MAY be included in the Form 14 calculation. Uncovered Extraordinary Medical Costs to be Paid by Father INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Uncovered Extraordinary Medical Costs to be Paid by Mother INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ 8. Payment of Work-Related Child Care Costs Total Amount of Expense $___________ per month Total Amount of Expense $___________ per month There are no reasonable work-related child care expenses incurred by the parties. The reasonable work-related child care costs of the children to be paid by Father are $___________ per month. The reasonable work-related child care costs of the children to be paid by Mother are $___________ per month. These amounts have been included in the child support calculation pursuant to Form 14. Mother will pay all reasonable work-related child care expenses. The cost of reasonable workrelated child care expenses has NOT been included in the child support calculation pursuant to Form 14. Father will reimburse Mother for _______ percent of all reasonable work-related child care expenses actually paid by Mother. Mother will not be entitled to reimbursement from Father unless said payments are appropriately reported to the Internal Revenue Service. No reimbursement of reasonable work-related child care expenses will be allowed unless Mother submits proof of such expense to Father in writing within 120 days of the date said expenses were incurred. Father will pay all reasonable work-related child care expenses. The cost of reasonable workrelated child care expenses has NOT been included in the child support calculation pursuant to Form 14. Mother will reimburse Father for _______ percent of all reasonable work-related child care expenses actually paid by Father. Father will not be entitled to reimbursement from Mother unless said payments are appropriately reported to the Internal Revenue Service. No reimbursement of reasonable work-related child care expenses will be allowed unless Father submits proof of such expense to Mother in writing within 120 days of the date said expenses were incurred. Each parent will pay his or her own reasonable work-related child care expenses related to his or her employment. The cost of reasonable work-related child care expenses has NOT been included in the child support calculation pursuant to Form 14. Neither parent will reimburse the other parent for any portion of the child care expenses. Parenting Plan Part B – Support of Children – Page 2 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com 9. Child Care Expenses Unrelated to Employment Incidental child care costs not related to employment are to be paid by the party with physical custody at the time the child care costs are incurred. 10. College Expenses College expenses of the children may be addressed in this parenting plan as extraordinary childrearing costs in Paragraph 11. As used herein, educational expenses for college or post-secondary education (also referred to as college expenses) include tuition, fees, books, dormitory cost for room and board. It does not include room and board while residing with either parent. This term shall be the actual cost to the child. In the event the child receives a scholarship or other aid which reduces the tuition, fees, books, or dormitory costs for room and board, then the educational expenses for college or postsecondary education does not include the amount of such scholarship or aid. For this purpose, loans to the student shall not be considered ‘scholarship or other aid’. The maximum educational expenses for college or post-secondary education, as defined herein, shall not exceed the cost for tuition, fees, books, and dormitory costs for room and board at the University of Missouri at Columbia, regardless of what institution the child attends. College expenses shall be considered due and payable at the beginning of each semester for purposes of determining the parent’s obligation to pay for an entire semester. 11. Payment of Extraordinary Child-Rearing Costs of the Children Extraordinary child-rearing costs incurred by the parents may be included on Form 14, or the parents may agree to divide these costs on some percentage basis. The costs to be addressed are to be paid as follows: a. Extraordinary Child-Rearing Costs INCLUDED on Form 14 Extraordinary Child-Rearing Costs Paid by Father INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Extraordinary Child-Rearing Costs Paid by Mother INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Total Amount of Expense $___________ per month Total Amount of Expense $___________ per month b. Extraordinary Child-Rearing Costs NOT INCLUDED on Form 14 Extraordinary Child-Rearing Costs Paid by Father NOT INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Percentage to be Paid by Mother to Father __________ % __________ % Mother will reimburse Father for the percentage amount of each of these extraordinary childrearing costs of the children so long as they are actually paid by Father. No reimbursement of extraordinary child-rearing costs of the children will be allowed unless Father submits proof of such expense to Mother in writing within 120 days of the date said expenses were incurred. Extraordinary Child-Rearing Costs Paid by Mother NOT INCLUDED on Form 14 _______________________________________________________ _______________________________________________________ Percentage to be Paid by Father to Mother __________ % __________ % Father will reimburse Mother for the percentage amount of each of these extraordinary child-rearing costs of the children so long as they are actually paid by Mother. No reimbursement of extraordinary child-rearing costs of the children will be allowed unless Mother submits proof of such expense to Father in writing within 120 days of the date said expenses were incurred. Parenting Plan Part B – Support of Children – Page 3 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com 12. Method of Payment of Child Support A wage assignment will not issue because a written agreement has been reached between the parties that provides for an alternative arrangement. Child support shall be paid directly to the person receiving support. A wage assignment will not issue because there is good cause not to require immediate income withholding for the reason that implementation of an immediate wage withholding would not be in the best interest of the child and the person paying support has made timely payments of all previously ordered support. Child support shall be paid directly to the person receiving support. A wage assignment will not issue because a written agreement has been reached between the parties that provides for an alternative arrangement. Child support shall be paid directly to the Family Support Payment Center, PO Box 109001, Jefferson City, Missouri, 65110-9001. A wage assignment will not issue because there is good cause not to require immediate income withholding for the reason that implementation of an immediate wage withholding would not be in the best interest of the child and the person paying support has made timely payments of all previously ordered support. Child support shall be paid directly to the Family Support Payment Center, PO Box 109001, Jefferson City, Missouri, 65110-9001. A wage assignment will be prepared by the person receiving support and issued by the Circuit Clerk upon the effective date of this judgment. Child support is ordered to be paid to the Family Support Payment Center, PO Box 109001, Jefferson City, Missouri, 65110-9001. 13. Is Child Support pursuant to Form 14? Yes. The court-ordered child support is the same as the presumed children support amount. The presumed child support amount as calculated herein is not rebutted as being unjust and inappropriate. No. The court-ordered child support is different than the presumed children support amount. After consideration of all relevant factors pursuant to RSMo. §452.340.8 and Form 14, the child support as calculated herein is rebutted as being unjust and inappropriate. 14. Designation of Parties Mother is the petitioner/plaintiff. Father is the respondent/defendant. Father is the petitioner/plaintiff. Mother is the respondent/defendant. 15. Designation of Parent Paying Support Mother is the “parent paying support”. Father is referred to as the “person receiving support”. Father is the “parent paying support”. Mother is referred to as the “person receiving support”. If no regular monthly child support is to be paid by either parent, then you must still check one of the two boxes in this paragraph, but you should enter “0.00” in the appropriate blanks in Paragraph 16. 16. CourtOrdered Child Support Six or More Children - The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for six or more children covered by this parenting plan. Five Children - The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for five children covered by this parenting plan. Four Children – The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for four children covered by this parenting plan. Three Children - The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for three children covered by this parenting plan. Two Children - The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for two children covered by this parenting plan. One Child - The person paying support is to pay to the person receiving support ____________ per month when the person receiving support is entitled to support for one child covered by this parenting plan. Parenting Plan Part B – Support of Children – Page 4 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com 17. Starting Date for Child Support 18. Income Tax Exemptions The first child support payment is due on the date of the entry of the judgment. The first child support payment is due on _______________________. The parties shall be entitled to claim the minor children as dependents for income tax purposes as follows: (Person paying support must be current with all support obligations as of December 31 of the tax year in which the child is to be claimed. Each parent will sign any appropriate documents to allow the other parent to make such claims.) If the person claiming the children is not listed below, then the person receiving support shall be entitled to claim the omitted children as dependents in all years. Name of Child 19. Additional Provisions Pertaining to Support of the Children In odd numbered tax years, this parent will claim this child as a dependent In even numbered tax years, this parent will claim this child as a dependent ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________ Mother ____________________________ Father ____________________________ Attorney for Mother ____________________________ Guardian ad Litem ____________________________ Attorney For Father Parenting Plan Part B – Support of Children – Page 5 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com Form 14 Child Support Calculation PARENT RECEIVING SUPPORT Total Number of Children: ______ PARENT PAYING SUPPORT COMBINED 1. MONTHLY GROSS INCOME 1a. Monthly court ordered maintenance being received 2a. ADJUSTMENT - Other monthly court or administratively ordered child support being paid 2b. ADJUSTMENT – Monthly court ordered maintenance being paid 2c (1). How many children other than the children that are the subject of this proceeding primarily reside with each parent? 2c (2). Each parent‘s support obligation from support schedule using his or her Line 1 monthly gross income 2c (3). Monthly amount of child support received pursuant to a court or administrative order for unemancipated children not the subject of this proceeding that primarily reside with each parent 2c. ADJUSTMENT - Support obligation for other children who primarily reside with each parent (Line 2c (2) minus Line2c (3)) 3. ADJUSTED MONTHLY GROSS INCOME (Sum of lines 1 and 1a, minus lines 2a, 2b and 2c) 4. PROPORTIONATE SHARE OF COMBINED ADJUSTED MONTHLY GROSS INCOME (Each parent's line 3 income divided by combined line 3 income) 5. BASIC CHILD SUPPORT AMOUNT (From support chart using combined line 3 income) 6. ADDITIONAL CHILD-REARING COSTS OF PARENTS 6a (1). Reasonable work-related child care costs of the parent receiving support (Paragraph 8) 6a (2). Child Care Tax Credit (See Form 14 Directions) 6a. Reasonable work-related child care costs of the parent receiving support (Line 6a (1) minus Line 6a (2)) 6b. Reasonable work-related child care costs of the parent paying support (Paragraph 8) 6c. Health insurance costs for the children who are the subjects of this proceeding (Paragraph 4) 6d. Uninsured extraordinary medical costs (Paragraph 7) 6e. Other extraordinary child rearing costs (Paragraph 11a) 7. TOTAL ADDITIONAL CHILD-REARING COSTS (Sum of lines 6a, 6b, 6c, 6d and 6e) 8. TOTAL COMBINED CHILD SUPPORT COSTS (Sum of line 5 and line 7) 9. EACH PARENT'S SUPPORT OBLIGATION (Multiply line 8 by each parent's line 4) 10. CREDIT FOR ADDITIONAL CHILD-REARING COSTS (Line 7 for parent paying support) 11 (1). Total yearly number of overnight periods of visitation or custody for Parent Paying Support 11 (2) Requested Line 11 Visitation Credit Percentage % (When Line 11(1) exceeds 109 nights per year) 11. ADJUSTMENT FOR AMOUNTS EXPENDED DURING PERIODS OF OVERNIGHT VISITATION OR CUSTODY. (Multiply line 5 by ___________ ) 12. PRESUMED CHILD SUPPORT AMOUNT (Line 9 minus lines 10 and 11) Number of Children 6 5 4 3 2 1 Presumed Monthly Support Parenting Plan Part B – Support of Children – Page 6 Form CAFC502B-8/29/2009 American LegalNet, Inc. www.FormsWorkFlow.com