2012-03-29T13:59:20-05:00 2011-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-01-01 411703162 EPIPHANY SENIOR CITIZENS HOUSING CORP EPIP 7637721042 1800 111TH AVE NW COON RAPIDS MN 55433 JERRY HARPER 7637721042 2012-03-27 1 KIM HUNWARDSEN CPA P00484560 6122536500 2012-03-27 2011 2016-02-24 21:20:13Z JERRY HARPER 1800 111TH AVE NW COON RAPIDS MN 55433 4925533 0 X WWW.EPIPHANYSENIORHOUSING.ORG X 1981 MN TO PROVIDE HOUSING FOR THE ELDERLY AND TO PROVIDE SERVICES DESIGNED TO MEET THEIR NEEDS. 15 15 83 23 0 0 1780 3552 4461154 4821551 73010 100430 0 0 4535944 4925533 0 0 0 0 1818199 1870505 0 0 0 2429702 2518403 4247901 4388908 288043 536625 14389980 14272148 15386202 14805867 -996222 -533719 X TO PROVIDE AFFORDABLE, HIGH QUALITY HOUSING AND SERVICES WHICH WILL RESPECT AND ENHANCE THE LIVES OF RESIDENTS AND THOSE WHO ARE MAKING THE TRANSITION TO SENIOR HOUSING AND ASSISTED LIVING FACILITIES. 0 0 992258 1369908 EPIPHANY SENIOR CITIZENS HOUSING CORPORATION (ESCHC) OWNS AND OPERATES A SENIOR HOUSING COMPLEX CALLED EPIPHANY PINES WITH 107 INDEPENDENT LIVING UNITS LOCATED IN COON RAPIDS, MINNESOTA. EPIPHANY PINES PROVIDES A RENTAL ASSISTANCE GRANT PROGRAM TO ASSIST THOSE UNABLE TO CONTINUE TO PAY THEIR RENT WITHOUT HARDSHIP. EPIPHANY PINES IS LOCATED NEXT TO A WILDLIFE REFUGE AND NATURE PONDS. THERE IS AN OUTDOOR PATIO AND GAZEBO FOR RESIDENTS TO ENJOY THE BEAUTY AND TRANQUILITY. EPIPHANY PINES OFFERS SEVERAL COMMON AREAS WHICH GIVE OPPORTUNITY FOR INDOOR, RELAXED SOCIALIZATION. THE APARTMENTS RANGE FROM 604 TO 1,105 SQUARE FEET, DESIGNED TO MEET ALL RESIDENTS' BUDGET AND LIFESTYLE. AMENITIES OFFERED INCLUDE 24 HOUR SECURITY SYSTEM, EMERGENCY RESPONSE SYSTEM, SCHEDULED ACTIVITIES AND ENTERTAINMENT, TRANSPORTATION FOR SCHEDULED SHOPPING, ONSITE CHAPEL, AND HAIR SALON. IN ADDITION, EPIPHANY PINES ALSO OFFERS MEALS, HOUSEKEEPING, GARAGES, AND GUEST ROOMS. 2669211 3451643 ESCHC'S WHOLLY OWNED SUBSIDIARY, EPIPHANY ASSISTED LIVING, LLC (EAL), OWNS AND OPERATES A 67-UNIT ASSISTED LIVING COMPLEX LOCATED ON THE SAME CAMPUS AS EPIPHANY PINES. THE FEDERAL GOVERNMENT PROGRAM, MEDICAID, IS ACCEPTED AT A DISCOUNTED RATE FOR THOSE UNABLE TO PAY FOR THEIR SERVICES. THE STATE PROGRAM, GROUP RESIDENTIAL HOUSING, PAYS FOR RENT, AT A DISCOUNT, FOR THOSE UNABLE TO PAY FOR THEIR RENT. EAL OFFERS A WIDE RANGE OF SERVICES IN A HOMELIKE SETTING WHERE PRIVACY IS RESPECTED AND INDEPENDENCE IS SUPPORTED. SERVICES ARE PLANNED WITH EACH RESIDENT TO REFLECT PERSONAL NEEDS AND CHOICES. RESIDENTS AND THEIR GUESTS CAN VISIT IN ANY OF THE SEVERAL GATHERING ROOMS, RESERVE OUR PRIVATE DINING ROOM FOR SPECIAL OCCASIONS, AND ENJOY LOVELY VIEWS OF THE BEAUTIFULLY LANDSCAPED GROUNDS. AMENITIES OFFERED INCLUDE 24 HOUR ONSITE RESIDENT ASSISTANT STAFFING, EMERGENCY RESPONSE SYSTEM, REGISTERED NURSE ONSITE 40 HOURS PER WEEK & ON CALL 24 HOURS PER DAY, MEDICATION MANAGEMENT, WEEKLY HOUSEKEEPING, RESTAURANT-STYLE DINING, HAIR SALON, AND GENERAL STORE WITH SNACK BAR.WITHIN EAL IS A DISTINCTIVE NEIGHBORHOOD FOR THOSE WITH MEMORY LOSS. OUR SPECIALLY TRAINED STAFF RECOGNIZES THAT THOSE WITH MEMORY LOSS HAVE A VARIETY OF INDIVIDUAL NEEDS, INTERESTS AND ABILITIES. OUR PHILOSOPHY EMPHASIZES ACTIVITY-FOCUSED CARE AND SPECIALLY DESIGNED CARE PACKAGES THAT ENGAGE RESIDENTS IN ACTIVITIES THAT ARE MEANINGFUL TO THEM AS INDIVIDUALS, AND THAT FOCUS ON THEIR STRENGTHS. 3661469 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 43 0 1 83 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 0 0 MN X JULIE EMBRY 7637721043 1800 111TH AVE NW COON RAPIDS MN 55433 THOMAS JONES 5.00 X X 0 0 0 JOHN AHO 2.00 X X 0 0 0 JERRY HARPER 5.00 X X 0 0 0 JO ANNE BOCK 2.00 X X 0 0 0 DR RICK BERTIE 1.00 X 0 0 0 CONNIE CONNOR 1.00 X 0 0 0 ROBERT FRIIS 1.00 X 0 0 0 DICK GARDNER 1.00 X 0 0 0 MARTY GROSS 1.00 X 0 0 0 MIKE LENTZ 1.00 X 0 0 0 DR JOHN LOES 1.00 X 0 0 0 DENIS PLANKERS 1.00 X 0 0 0 JERRY WRIGHT 1.00 X 0 0 0 ED BOCK 1.00 X 0 0 0 KAREN DURBIN 1.00 X 0 0 0 MARY MCCARTY FROM MAY 45.00 X 66586 0 21658 TIM MEYER THRU APRIL 5.00 X 0 0 0 MARK PEDERSON THRU APRIL 5.00 X 0 0 0 66586 0 21658 0 0 0 0 NEW HORIZON FOODS 211 2ND STREET NW ST MICHAEL MN 55376 DIETARY SERVICES 220272 1 3552 3552 RESIDENT SERVICES 623000 4757975 4757975 OTHER INCOME 623000 63576 63576 4821551 100430 100430 4925533 4821551 0 100430 88244 88244 1448538 1187237 261301 13579 10585 2994 140369 109423 30946 179775 140142 39633 30000 30000 17174 553 16621 14935 14935 5985 5985 112760 69008 43752 28787 28787 406826 373565 33261 14470 14470 407766 407766 4544 896 3648 2983 2983 899968 899968 461724 461724 48638 48638 BAD DEBT 602 602 61241 61241 4388908 3661469 727439 0 150507 198904 1645255 1807177 192283 160051 25796 36941 14956631 4890412 10343743 10066219 1378994 1369225 653402 633631 14389980 14272148 360360 345861 14645234 14338462 107000 114580 273608 6964 15386202 14805867 X -996222 -533719 -996222 -533719 14389980 14272148 X 536625 -74122 X 0 1 1 X 0 X 6000 14255 4705 1780 3552 30292 3952143 4364498 4337947 4461154 4821551 21937293 3958143 4378753 4342652 4462934 4825103 21967585 0 111770 166927 278697 111770 166927 278697 21688888 112382 56525 31196 73010 100430 373543 112382 56525 31196 73010 100430 373543 4070525 4435278 4373848 4535944 4925533 22341128 0.97080 0.97780 0.01670 0.01700 X 0 1 575000 575000 13280940 4251106 9029834 852200 514288 337912 248491 125018 123473 10066219 4925533 4388908 536625 -74122 -74122 462503 4851411 -74122 -74122 4925533 0 4925533 4388908 0 4388908 0 4388908 PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF VARIOUS TENANT SECURITY DEPOSITS AND HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THESE FUNDS. THESE FUNDS ARE ON DEPOSIT IN SEPARATE BANK ACCOUNTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION AND ITS WHOLLY OWNED SUBSIDIARY, HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS ANNUALLY. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. CITY OF COON RAPIDS MINNESOTA 416008573 21660NAU0 2005-09-29 8753016 REFUND ANOKA COUNTY HOUSING & REDEVELOPMENT AUTHORITY SERIES 1999 BONDS 0 0 0 8753016 801000 494300 130000 2005 0 1 1 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF AT LEAST TWO DIRECTORS AND SUCH OTHER PERSONS AS THE BOARD OF DIRECTORS MAY APPOINT, FROM TIME TO TIME. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS AND PROVIDE REPORTS TO THE BOARD OF DIRECTORS UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAD CONTRACTED WITH HEALTH DIMENSIONS GROUP TO PROVIDE MANAGEMENT OVERSIGHT TO ITS DAY-TO-DAY OPERATIONS. THIS CONTRACT WAS TERMINATED ON APRIL 30, 2011. THE ORGANIZATION IS CURRENTLY UNDER SELF-MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 11 THE BUSINESS OFFICE MANAGER DOES A DETAILED REVIEW OF THE DRAFT AND FORWARDS IT TO THE BOARD FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE CURRENT POLICY COVERS ALL BOARD MEMBERS AND COMPANY COMMITTEE MEMBERS. THE EXECUTIVE DIRECTOR REVIEWS DISCLOSURES FOR POTENTIAL CONFLICTS. IF A BOARD MEMBER HAS A CONFLICT THEY MUST ABSTAIN FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A THROUGH APRIL, THE ORGANIZATION CONTRACTED WITH HEALTH DIMENSIONS GROUP TO PROVIDE MANAGEMENT SERVICES. THE EXECUTIVE/FINANCE COMMITTEE MEMBERS REVIEWED AND DISCUSSED THE CONTRACT AS WELL AS ANY CONCERNS. RATES WERE COMPARED TO OTHER MANAGEMENT COMPANY QUOTES AND WERE USED IN DETERMINING THE AMOUNT THAT WAS PROPOSED TO THE MANAGEMENT COMPANY. AS OF MAY, THE ORGANIZATION BECAME SELF-MANAGED WITH THE EXECUTIVE DIRECTOR COORDINATING THE MANAGEMENT OF EPIPHANY SENIOR HOUSING CORP AND EPIPHANY ASSISTED LIVING, LLC. THIS IS AN EXEMPT POSITION WITH ANNUAL PERFORMANCE REVIEWS CONDUCTED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE MEMBERS MAY PRESENT THEIR DETERMINATION BEFORE THE FULL BOARD BEFORE PROPOSING THE RESULTS OF THE REVIEW TO THE EXECUTIVE DIRECTOR. SALARY IS TO BE DETERMINED BY THE CURRENT WAGE SCALE FOR THIS INDUSTRY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -74,122. EPIPHANY ASSISTED LIVING LLC 1800 111TH AVE NW COON RAPIDS MN 55433 411703162 ASSISTED LIVING MN 3480966 8519608 EPIPHANY SENIOR CITIZENS HOUSING CORPORATION