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~ Form 1023 (Rev, 9-90) Page 23 Schedule F.~Homes for the Aged or Handicapped 1 What are ~he reguire(T1ents for admissior) to reside.ncy? E;xplainjully andtlttach promotional literature rand ap.plication forms. Th Promot1onal l1terature and appl1cat10n forms uave not been deve opetl as yet. e Senior Housing Project will be limited to senior adults, 55 years and older who do not require special physical assistance. The Assisted Living Project will be for frail and fragile adults wo need special physical assistance but less than full* f~~!5 2 Does or will the home charge an entrance or founder's fee? . . . . . . . . . . . . . . . . . 0 Yes rn 0 If .Yes,' explain and specify the amount charged. 3 What periodic fees or maintenance charges are or will be required of its residents? See attached ~ forma financials. t~~ ,ft\ ",,)) ;'\. \ l 'v=' \ . ~ ~, ~ ,J ,NVv'" )vJ\"'t'r .c,~ ' .,,,,,,,$- \ '" . .--\),,-., ""'~ !,lJ'- i} y+-;J. r~ 4a What established policy does the home have concerni;'~eside who become unable to pay their regular charges? See attached ~ forma.financials;. % of revepues at Assisted-Living facility will be set aside to assist os' reside~ts. Also~itionalHundraising proj ects will be undertaken .to. furthe. ssi ~resi nts~. (10% of the. units at the Senior Housing Project will be rented or one~ a renta..~ '-/V\.iN'," ~ [\i"1I,,".N"\ ~^<1 t-~ J '--<"'>-S7 < I:<.I~ ,,\~~V1ic, , , , b What arrangements does the home have or will it make with local and Federal welfare units, sponsoring organizations, or others to ab or art t of maintaining those residents? ~~ome Care rtified Agent~~(Medicare~ Medical Assistance Certified Home Care Agency 1M~J~~aid); Centra~ witn MSA (Minn. Supplemental Assistance); MHFA (Minn. Housing Finance Agency) for low income assistance. Other fundraising activites from private sources. 5 What arrangements does or will the home have to provide for the health needs of its residents? Home Heal~h Agency co~tract wit~ ~;esbyteri~n Homes.of ~innesotr' care .prov1der. ~I MI.-o \'vy,-\ ~'\~') ~ ~~ c~ p-o\" L'i-..1 \.~,...\ "'- '\ _~ ':, I:"" '\ ['-it)\i..J\ }.J\JVJ) Iv'J'.Jf'<\'vU IV tv\l Inc., a health 6 In what way are the home's residential facilities designed to meet some combination of the physical, emotional, recreational, social, religious! and similar needs of the aged or handicapped? Facil1ties will be specially designed to meet the needs of the types of residents for whom they are scheduled to serve. They will have special dietary kitchens; 110 foot distance from any room to dining; whirlpools; lounge areas in hallways; physical, therapy and physical exercise areas; handicapped and senior transportation programs; emergency response systems which are radio activatea; lowered windows; windows raised** . . . fSee 7 Provide a description of the home's facilities and specify both the residential capacity of the home and the current number of residents.s i~ ~ ~ Homes not yet constructed and therefore there are no current residents. The organization hopes to construct the following: Approximately 140 units for the Senior Housing Project; Approximately 90 units for the Assisted-Living Project; and Approximately 36 units for the Alzheimer's Project. 8 Attach a sample copy of the contract or agreement the organization makes with or requires of its residents. *** (See reverse s id~ For more information, see back of Schedule F.