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10 <br />EXHIBIT A <br />BUSINESS ASSISTANCE APPLICATION <br />A. APPLICANT INFORMATION <br />Name of Corporation/Partnership Presbyterian Homes Housing and Assisted Living, Inc. <br />Address 2845 Hamline Ave N, Roseville, MN 55413 <br />Primary Contact Sam Jagodzinski <br />Address 2845 Hamline Ave N, Roseville, MN 55413 <br />Phone <br />651-383-5689 Fax N/A <br />E-mail sjagodzinski@seniorpartners.com <br />Type of business assistance requested (select one): <br />❑ Tax Abatement •Tax Increment Financing ❑Revolving Loan Fund Other <br />Have you been, or are you currently, involved in any bankruptcy proceedings or lawsuits related to <br />other development projects with which you have been involved? If yes, please provide an <br />explanation. <br />❑ Yes ❑No <br />On a separate sheet, please provide the following: <br />• Brief description of the corporation/partnership's business, including history, principal product <br />or service, etc. Attach as Part 1. <br />• List names of officers and shareholders/partners with more than five percent (5%) interest in <br />the corporation/partnership. Attach as Part 2. <br />• Brief description of the proposed project. Attach as Part 3. <br />• A but for analysis and narrative. Attach as Part 4. <br />• Completed Revolving Loan Fund Application. Attach as Part 5 if required. <br />Attorney Name Vantage Law Group <br />Address <br />Phone <br />125 SE Main St, Minneapolis, MN 55414 <br />612-353-1984 Fax N/A E-mail jerry.perron@vantage.Iaw <br />Contractor Name To Be Determined <br />Address <br />Phone Fax N/A <br />E-mail <br />Engineer Name Kimley-Horn <br />Address 67 N. Eustis Street, Suite 100, St. Paul, MN 55114 <br />Phone 612-294-7250 Fax N/A E-mail mitchell.cookas@kimley-horn.com <br />Architect Name BKV Group <br />Address 222 North 2nd Street, Suite 101 Minneapolis MN 55401 <br />Phone 612-373-9110 Fax N/A <br />E-mail cpalkowitsch@bkvgroup.com <br />