2021-11-15T11:00:13-06:00 2020-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2020-01-01 133834710 AMSTERDAM NURSING HOME CORPORATION (1992) AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2021-11-15 1 MARK PANCIRER XXX-XX-XXXX GARRETT M HIGGINS P00543209 9143818900 2021-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z AMSTERDAM NURSING HOME JAMES DAVIS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 59219423 0 X WWW.AMSTERDAMCARES.ORG X 1995 NY TO OPERATE A NOT FOR PROFIT NURSING HOME WITH 409 NURSING FACILITY BEDS AND AN ADULT DAY HEALTH CARE PROGRAM FOR 40 REGISTRANTS. 11 11 466 11 0 0 84523 5325722 64303979 51657631 3194138 105672 73763 713152 67656403 57802177 0 0 0 0 36939056 33347379 0 0 0 30482021 26454591 67421077 59801970 235326 -1999793 62016883 58569678 46809531 45296233 15207352 13273445 X AMSTERDAM NURSING HOME CORP. (1992) ("AMSTERDAM") IS A 409 BED SKILLED NURSING FACILITY (SNF) AND A 40 REGISTRANT ADULT DAY HEALTH CARE (ADHC) PROVIDING LONG AND SHORT TERM RESIDENTIAL CARE, ASWELL AS DAY CARE, TO PERSONS LIVING IN THE COMMUNITY. AMSTERDAM'S MISSION IS TO PROVIDE THE HIGHEST STANDARD OF HEALTH CARE TO ITS RESIDENTS, PATIENTS AND DAY HEALTH CARE REGISTRANTS. AMSTERDAM IS PROUD TO OFFER INDIVIDUALIZED CARE IN A SETTING THAT SUPPORTS THE QUALITY OF LIFE, DIGNITY AND AUTONOMY OF EACH PERSON THAT IT SERVES. 0 0 53738960 0 51657631 AMSTERDAM NURSING HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. AMSTERDAM HAS A CAPACITY OF 409 SKILLED NURSING FACILITY BEDS ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2020, AMSTERDAM HAD 891 ADMISSIONS AND PROVIDED 1,874 ADULT DAY HEALTH CARE IN-PERSON VISITS AND 303 ADULT DAY HEALTH CARE TELEHEALTH VISITS. AMSTERDAM HAD AN OCCUPANCY RATE OF 82.3 PERCENT IN THE NURSING FACILITY. 53738960 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 124 0 466 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 JOSEPH C HOOPES JR CHAIRMAN & TREASURER 2.00 3.25 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.50 1.55 X X 0 0 0 FRANCES R OLIVERI VICE CHAIRMAN 0.50 1.30 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.80 X X 0 0 0 REVEREND JAMES G CALLAWAY JR DIRECTOR 0.30 1.10 X 0 0 0 JAMES J CAMPBELL DIRECTOR 0.30 1.10 X 0 0 0 ISABELL M CARDEN DIRECTOR 0.30 1.10 X 0 0 0 R SCOTT EMONDS DIRECTOR 0.30 1.10 X 0 0 0 DR KAREN M HOPKINS DIRECTOR 0.30 1.10 X 0 0 0 JAY H MCDOWELL DIRECTOR 0.30 1.35 X 0 0 0 LAGDON VAN NORDEN DIRECTOR 0.30 1.10 X 0 0 0 JAMES DAVIS PRESIDENT/CEO 35.00 14.50 X 584489 100667 43492 MARK PANCIRER SENIOR VP/CFO 42.50 7.50 X 265631 30000 42940 WILLIAM J PASCOCELLO SENIOR VP/COO 35.00 0.00 X 235260 0 36593 GERTRUDES DE GUZMAN DIRECTOR OF NURSING 35.00 0.00 X 171610 0 45082 LORNA POON DIRECTOR OF FINANCE 35.00 0.00 X 188017 0 22745 PAMELA LANDMAN GENERAL COUNSEL 35.00 0.00 X 191438 0 43747 CELMA C DUMAGUING ASST. DIRECTOR OF FINANCE 35.00 0.00 X 134545 0 41918 JOREALIN LIM NURSE 37.50 0.00 X 133520 0 31448 RONALD CAMARA NURSE 37.50 0.00 X 121543 0 14972 2026053 130667 322937 26 0 1 0 MORRISON MANAGEMENT SPECIALISTS INC 400 NORTH RIDGE RD STE 600 SANDY SPRING GA 30350 DIETARY SERVICES 3226071 THERADYNAMICS REHAB MGMT LLC 337 CROSSWAYS PARK DRIVE WOODBURY NY 11787 PHYSICAL THERAPY SERVICES 2616668 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 2377928 MILCON CONSTRUCTION CORP 142 DALE STREET WEST BABYLON NY 11704 CONSTRUCTION 2250037 RN EXPRESS REGISTRY LLC 71 WEST 23RD ST STE 1622 NEW YORK NY 10010 NURSING AGENCY 1313288 26 5089671 236051 128290 5325722 PATIENT SERVICE CARE 623000 51657631 51657631 51657631 99918 99918 1423000 1417246 5754 5754 5754 RECOVERY OF BAD DEBT 900099 676026 676026 REBATES AND REFUNDS 900099 27378 27378 EXPENSE RECOVERY 900099 9748 9748 713152 57802177 51657631 0 818824 X 1635860 1635860 20351539 19159704 1191835 1994267 1945439 48828 6323703 6187676 136027 3042010 2907690 134320 1063891 1063891 130750 130750 3984 3984 12749025 11441737 1307288 4691 4691 625925 363020 262905 343125 313015 30110 2037804 2007308 30496 101802 100294 1508 2047185 2017844 29341 1263103 1240820 22283 NY CASH RECEIPT ASSMNT 2186202 2186202 MEDICAL SUPPLIES AND DR 1992791 1992791 DIETARY EXPENSES 1287786 1287786 REPAIRS AND MAINTENANCE 447729 444568 3161 168798 143066 25732 59801970 53738960 6063010 0 1985400 4626378 14554469 10784842 0 195247 7620693 4276702 96286 473599 3646941 3758698 85024144 65902224 18489180 19121920 41457 50150 15582457 15282142 62016883 58569678 9555012 8622140 1554187 0 457096 572252 27371963 25038824 7871273 11063017 46809531 45296233 X 15122206 13188762 85146 84683 15207352 13273445 62016883 58569678 X -1999793 8693 57193 X X 0 1 X 1 1 1 X 2823914 362066 847512 84523 5325722 9443737 61061024 61102735 64801198 64303979 51657631 302926567 63884938 61464801 65648710 64388502 56983353 312370304 0 0 0 312370304 51472 65941 120208 365402 99918 702941 51472 65941 120208 365402 99918 702941 664547 323971 630410 73763 713152 2405843 64600957 61854713 66399328 64827667 57796423 315479088 0.99010 0.99030 0.00220 0.00200 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: DISCOUNTS ON PURCHASES - 2016 AMOUNT: $ 165,425. EXPENSE RECOVERY - 2016 AMOUNT: $ 238,871. 2017 AMOUNT: $ 8,220. 2018 AMOUNT: $ 10,427. 2019 AMOUNT: $ 17,040. 2020 AMOUNT: $ 9,748. MISC REVENUE - 2016 AMOUNT: $ 260,251. 2017 AMOUNT: $ 9,896. 2018 AMOUNT: $ 37,224. ESCROW DEPOSIT - 2017 AMOUNT: $ 250,000. 2018 AMOUNT: $ 525,298. MEDICAL INSURANCE SURPLUS - 2017 AMOUNT: $ 55,855. 2018 AMOUNT: $ 57,461. 2019 AMOUNT: $ 56,579. REBATES AND REFUNDS - 2019 AMOUNT: $ 144. 2020 AMOUNT: $ 27,378. RECOVERY OF BAD DEBT - 2020 AMOUNT: $ 676,026. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3984 3984 0 PART II-B, LINE 1: THE HOME PAYS DUES AND ASSOCIATION FEES TO 1199 SEIU, AND LEADING AGE AND CONTINUING CARE LEADERSHIP COALITION. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE LOBBYING ACTIVITIES APPLICABLE TO LEADING AGE AND CONTINUING CARE LEADERSHIP COALITION DUES WERE $3,984. 0 1 X 1432917 1432917 59591777 45673687 13918090 70774 70283 491 23629139 20071358 3557781 299537 86896 212641 19121920 ASSETS HELD FOR AHCCRC 10758533 DUE FROM THIRD PARTIES 1918886 INSURANCE RECOVERY 1904290 OTHER ASSETS 427823 457B PENSION ASSETS 272610 15282142 DUE TO THIRD PARTIES 6991871 ACCRUED INTEREST PAYABLE 84825 INSURANCE PAYABLE 3444321 CONTINGENCY FOR ASSET RETIREMENT 542000 11063017 X 57554401 8693 81567 90260 57464141 338036 338036 57802177 59488308 0 59488308 313662 313662 59801970 PART IV, LINE 2B: PATIENT FUNDS ARE HELD FOR THE RESIDENTS IN SEPARATE BANK ACCOUNTS TO BE USED AT THE DISCRETION OF THE PATIENTS AND/OR THEIR FAMILIES. PART X, LINE 2: THE HOME RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY WHEN THE TAX POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOME HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOME IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: WRITE-OFF OF GRANT PAYABLE RECLASSED TO PART XI, LINE 9 81,567. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE RECLASSED TO PART IX 13,032. LOSS ON DISPOSAL OF FIXED ASSETS RECLASSED TO PART XI, LINE 9 24,374. PAYROLL TAX CREDITS RECLASSED TO PART VIII, LINE 1E 300,474. TAX REFUND RECLASSED TO PART VIII 156. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE RECLASSED TO PART IX 13,032. PAYROLL TAX CREDITS RECLASSED TO PART VIII, LINE 1E 300,474. TAX REFUND RECLASSED TO PART VIII 156. X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 575137 100667 0 0 9352 0 13129 0 30363 0 627981 100667 0 0 MARK PANCIRER SENIOR VP/CFO 265087 30000 0 0 544 0 13129 0 29811 0 308571 30000 0 0 WILLIAM J PASCOCELLO SENIOR VP/COO 225580 0 0 0 9680 0 0 0 36593 0 271853 0 0 0 PAMELA LANDMAN GENERAL COUNSEL 171287 0 0 0 20151 0 0 0 43747 0 235185 0 0 0 GERTRUDES DE GUZMAN DIRECTOR OF NURSING 169957 0 1000 0 653 0 6905 0 38177 0 216692 0 0 0 LORNA POON DIRECTOR OF FINANCE 183940 0 0 0 4077 0 7878 0 14867 0 210762 0 0 0 CELMA C DUMAGUING ASST. DIRECTOR OF FINANCE 134041 0 0 0 504 0 4624 0 37294 0 176463 0 0 0 JOREALIN LIM NURSE 133520 0 0 0 0 0 15582 0 15866 0 164968 0 0 0 PART I, LINE 7 THE FOLLOWING INDIVIDUALS RECEIVED DISCRETIONARY BONUSES INCLUDED IN THEIR REPORTABLE COMPENSATION FOR THE 2020 CALENDER YEAR: - GERTRUDES DE GUZMAN, DIRECTOR OF NURSING $1,000 X 1 128290 COST 0 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION B, LINE 11B AMSTERDAM HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE AUDIT COMMITTEE. ANY ISSUES ARE REVIEWED AND CORRECTED. THE CFO THEN MAKES THE FORM 990 AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS, AND KEY PERSONS MUST COMPLETE AN ANNUAL DISCLOSURE AND AFFIRMATION FORM IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY. AN INTERESTED DIRECTOR MEANS ANY AMSTERDAM DIRECTOR WHO HAS AN INTEREST AS A PRINCIPAL, PARTNER, DIRECTOR, OFFICER, EMPLOYEE, AGENT, OR STOCKHOLDER (OTHER THAN A STOCKHOLDER OF A PUBLICLY TRADED CORPORATION WHOSE STOCK IS WIDELY HELD) OF ANY ENTITY WITH WHICH AMSTERDAM HAS OR CONTEMPLATES TRANSACTING BUSINESS. AN INTERESTED DIRECTOR MUST DISCLOSE THE RELATIONSHIP OR INTEREST IN THE TRANSACTION TO THE BOARD OF DIRECTORS OF THE APPLICABLE AMSTERDAM ENTITY. DISCLOSURE SHALL BE MADE TO THE CHAIRMAN OF THE BOARD AS SOON AS THE INTERESTED DIRECTOR BECOMES AWARE OF THE POTENTIAL FOR A CONFLICT IN CONNECTION WITH THE TRANSACTION, WHO THEN SHALL INFORM THE APPLICABLE BOARD. IF THE CHAIRMAN IS INVOLVED IN THE TRANSACTION, THE CHAIRMAN SHALL ADVISE THE SECRETARY OF THE APPLICABLE AMSTERDAM ENTITY WHO SHALL ARRANGE FOR BOARD DISCLOSURE. NO INTERESTED DIRECTOR SHALL PARTICIPATE IN THE DISCUSSION, DELIBERATIONS AND VOTING REGARDING A TRANSACTION. THE AFFIRMATIVE VOTE OF THE MAJORITY OF ALL THE DIRECTORS OF THE APPLICABLE AMSTERDAM ENTITY SHALL BE REQUIRED BEFORE ENTERING INTO THE TRANSACTION (EXCLUDED IN SUCH COUNTS IS THE INTERESTED DIRECTOR). NO TRANSACTION SHALL BE INVALIDATED OR AFFECTED IN ANY WAY IF THIS POLICY IS FOLLOWED. ALL OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL BASIS OR SOONER IF A POTENTIAL CONFLICT OR ACTUAL CONFLICT SHOULD ARISE. POTENTIAL CONFLICTS OR ACTUAL CONFLICTS ARE REVIEWED BY THE CHIEF COMPLIANCE OFFICER OF AMSTERDAM NURSING HOME. FORM 990, PART VI, SECTION B, LINE 15 AMSTERDAM HAS A PROCESS TO DETERMINE COMPENSATION FOR THE PRESIDENT/CEO WHICH INCLUDES A REVIEW BY A COMPENSATION COMMITTEE AND OUTSIDE BENEFITS CONSULTANT, AND THE USE OF COMPARABLE DATA. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE COMMITTEE. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED WITHIN THE COMMITTEE MINUTES. AMSTERDAM HAS A PROCESS TO DETERMINE COMPENSATION FOR OFFICERS, WHICH INCLUDES A REVIEW BY A COMPENSATION AND BENEFITS CONSULTANT, AND THE USE OF COMPARABLE DATA. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE PRESIDENT AND CEO USING COMPARABLE DATA. THE DECISIONS ARE DOCUMENTED IN WRITING. THIS WAS LAST DONE IN 2020. FORM 990, PART VI, SECTION C, LINE 19 AMSTERDAM MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS ALSO POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY. FORM 990, PART IX, LINE 11G CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 1,203,841. MANAGEMENT AND GENERAL EXPENSES 785,460. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,989,301. NURSING AGENCIES: PROGRAM SERVICE EXPENSES 3,693,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,693,708. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 944,945. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 944,945. THERAPY FEES: PROGRAM SERVICE EXPENSES 2,352,417. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,352,417. OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 232,204. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 232,204. BILING SERVICES: PROGRAM SERVICE EXPENSES 100,037. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,037. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,170,189. MANAGEMENT AND GENERAL EXPENSES 1,205. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,171,394. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 511,333. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 511,333. LAUNDRY AND LINEN SERVICES: PROGRAM SERVICE EXPENSES 427,454. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,454. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,077,377. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,077,377. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 239,565. MANAGEMENT AND GENERAL EXPENSES 9,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 248,855. FORM 990, PART XI, LINE 9: LOSS ON DISPOSAL OF FIXED ASSETS -24,374. WRITE OFF OF GRANT PAYABLE 81,567. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMSTERDAM SERVICES CORP 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 ADMIN & CONSULTING NY 501(C)(3) PF AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 ASSIST ELDERLY NY 501(C)(3) LINE 7 N/A 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 NURSING CARE NY 501(C)(3) LINE 12A, I AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 ANH FOUNDATION 1060 AMSTERDAM AVENUE NEW YORK NY 10025 137099598 GRANTMAKING NY 501(C)(3) PF AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM 2012 INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 461715083 DEV RENT PROP NY 501(C)(3) LINE 10 AMSTERDAM NURSING HOME CORPORATION (1992) 1 AMSTERDAM SERVICES CORP (2001) 1060 AMSTERDAM AVE NEW YORK NY 10025 134184082 ADMIN & CONSULTING NY AMSTERDAM CONTINUING CARE HEALTH SYSTEM C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0