2020-11-16T21:50:13-06:00 2019-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2019-01-01 133834710 AMSTERDAM NURSING HOME CORPORATION (1992) AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2020-11-16 1 GARRETT M HIGGINS P00543209 9143818900 2020-11-14 24.190.81.120 2020-11-16 21:50:09 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9616F4B14A694591D1E716C270910E6FA5556DA3 2019 2021-01-29 14:40:06Z JAMES DAVIS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 76101227 0 X 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 11 509 87 0 0 847512 84523 64801198 64303979 121499 3194138 630410 73763 66400619 67656403 0 0 0 0 36393041 36939056 0 0 0 29165013 30482021 65558054 67421077 842565 235326 58252072 62016883 40919781 46809531 17332291 15207352 X AMSTERDAM NURSING HOME CORP. (1992) (AMSTERDAM) WAS FOUNDED IN 1872 TO PROVIDE A HOME FOR OLD MEN AND AGED COUPLES; 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, DIGNIT AND AUTONOMY OF EACH PERSON THAT IT SERVES. 0 0 58696239 64303979 AMSTERDAM PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. AMSTERDAM HAS A CAPACITY OF 409 NURSING FACILITY BEDS ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2019, AMSTERDAM HAD 1,091 ADMISSIONS AND PROVIDED 8,477 ADULT DAY HEALTH CARE VISITS. AMSTERDAM HAD AN OCCUPANCY RATE OF 97.3 PERCENT IN THE NURSING FACILITY. 58696239 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 0 0 0 0 0 1 1 0 0 0 1 177 0 509 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 1 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 JAMES DAVIS PRESIDENT/CEO 35.00 15.00 X 889822 102999 50108 MARK PANCIRER SENIOR VP/CFO 42.50 7.50 X 314196 30000 52315 WILLIAM J PASCOCELLO SENIOR VP/COO 35.00 X 245557 0 36575 LORNA POON DIRECTOR OF FINANCE 35.00 X 199710 0 29189 GERTRUDES DE GUZMAN VP OF NURSING 35.00 X 174299 0 51827 PAMELA LANDMAN CORPORATE COUNSEL 37.50 X 144506 0 31829 JOREALIN LIM NURSE 37.50 X 151671 0 14721 CELMA C DUMAGUING ASST. DIRECTOR OF FINANCE 35.00 X 136590 0 25147 MYLENE MERCADO NURSE 35.00 X 122025 0 14721 LAWRENCE B THOMPSON CHAIRMAN (THRU SEPT. 2019) 2.00 3.00 X X 0 0 0 JOSEPH C HOOPES JR CHAIRMAN & TREASURER 1.00 1.50 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.50 0.80 X X 0 0 0 FRANCES R OLIVERI VICE CHAIRMAN 0.50 1.80 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.30 X X 0 0 0 REVEREND JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.50 X 0 0 0 R SCOTT EMONDS BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES J CAMPBELL BOARD MEMBER 0.30 0.50 X 0 0 0 ISABELL M CARDEN BOARD MEMBER 0.30 0.50 X 0 0 0 DR KAREN M HOPKINS BOARD MEMBER 0.30 0.50 X 0 0 0 JAY H MCDOWELL BOARD MEMBER 0.30 0.50 X 0 0 0 REV DEACON FRANK PETERSON JR BOARD MEMBER 0.30 0.50 X 0 0 0 2378376 132999 306432 21 0 1 0 THERADYAMICS PHY REHAB 225 CROSSWAYS PARK DRIVE WOODBURY NY 11787 PHYSICAL THERAPY SERVICES 3857516 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 3223284 MORRISON MANAGEMENT 400 NORTH RIDGE CANON SUITE 600 SANDY SPRING GA 30350 DIETARY SERVICES 2438830 RN EXPRESS REGISTRY LLC 71 WEST 23RD ST STE 1622 NEW YORK NY 10010 NURSING AGENCY 1428564 INPATIENT HPOSITALIST SERVICES PO BOX 92284 LOS ANGELES CA 90009 PHYSICIAN SERVICES 1017665 19 84523 84523 PATIENT SERVICE CARE 623000 63196517 63196517 UNIVERSAL SETTLEMENT 623000 1107462 1107462 64303979 365402 365402 403101 10870459 403179 8041645 -78 2828814 2828736 2828736 MEDICAL INSURANCE SURPLUS 900099 56579 56579 EXPENSE RECOVERY 900099 17040 17040 REBATES AND REFUNDS 900099 144 144 73763 67656403 64303979 0 3267901 X 1814701 1814701 22719580 21204468 1515112 2266410 2208468 57942 6677809 6503858 173951 3460556 3300421 160135 694503 694503 51725 51725 5860 5860 14179640 12737152 1442488 8636 8636 754947 400424 354523 314798 21680 293118 2172053 2141122 30931 427903 411068 16835 1899204 1870550 28654 1102885 1083022 19863 NYS CASH ASSESSMENT 2782679 2782679 BAD DEBT EXPENSE 2045670 2045670 MEDICAL SUPPLIES AND DR 1724097 1724097 DIETARY EXPENSES 1649833 1649833 667588 657397 10191 67421077 58696239 8724838 0 1568288 1985400 16087584 14554469 9154972 7620693 72564 96286 3045221 3646941 82511678 64022498 19134524 18489180 40979 41457 9147940 15582457 58252072 62016883 8598871 9555012 1554187 447445 457096 29710966 27371963 2162499 7871273 40919781 46809531 X 17235450 15122206 96841 85146 17332291 15207352 58252072 62016883 X 235326 12353 -2376274 3656 X X 0 1 X 1 1 1 X 1365071 2823914 362066 847512 84523 5483086 60380596 61061024 61102735 64801198 64303979 311649532 61745667 63884938 61464801 65648710 64388502 317132618 0 0 0 317132618 31142 51472 65941 120208 365402 634165 31142 51472 65941 120208 365402 634165 783244 664547 323971 630410 73763 2475935 62560053 64600957 61854713 66399328 64827667 320242718 0.99030 0.98920 0.00200 0.00090 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: DISCOUNTS ON PURCHASES - 2015 AMOUNT: $ 474,390. 2016 AMOUNT: $ 165,425. EXPENSE RECOVERY - 2015 AMOUNT: $ 308,509. 2016 AMOUNT: $ 238,871. 2017 AMOUNT: $ 8,220. 2018 AMOUNT: $ 10,427. 2019 AMOUNT: $ 17,040. MISC REVENUE - 2015 AMOUNT: $ 345. 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5860 5860 0 PART II-B, LINE 1: DUES AND OR FEES PAID TO THE FOLLOWING ORGANIZATIONS THAT HAD LOBBYING EXPENSES: CCLC - $1,800, AND LEADING AGE - $4,060. 0 1 X 1432917 1432917 57530650 44527060 13003590 70774 70161 613 23299909 19341270 3958639 177428 84007 93421 18489180 ASSETS HELD FOR AHCCRC 10725654 ESTIMATED DUE TO THIRD PARTIES 2226942 INSURANCE RECOVERY 2172482 OTHER ASSET 457379 15582457 DUE TO THIRD PARTIES 3499211 ACCRUED INTEREST PAYABLE 93121 INSURANCE PAYABLE 3736941 CONTINGENCY FOR ASSET RETIREMENT 542000 7871273 X 67672412 12353 3656 16009 67656403 0 67656403 67421077 0 67421077 0 67421077 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 2016. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF FIXED ASSETS 3,656. X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 620350 102999 250000 0 19472 0 19614 0 30494 0 939930 102999 0 0 MARK PANCIRER SENIOR VP/CFO 263567 30000 50000 0 629 0 19614 0 32701 0 366511 30000 0 0 WILLIAM J PASCOCELLO SENIOR VP/COO 231424 0 10000 0 4133 0 0 0 36575 0 282132 0 0 0 LORNA POON DIRECTOR OF FINANCE 189379 0 10000 0 331 0 11853 0 17336 0 228899 0 0 0 GERTRUDES DE GUZMAN VP OF NURSING 168714 0 5000 0 585 0 9984 0 41843 0 226126 0 0 0 PAMELA LANDMAN CORPORATE COUNSEL 134406 0 10000 0 100 0 0 0 31829 0 176335 0 0 0 JOREALIN LIM NURSE 151671 0 0 0 0 0 0 0 14721 0 166392 0 0 0 CELMA C DUMAGUING ASST. DIRECTOR OF FINANCE 135116 0 1000 0 474 0 0 0 25147 0 161737 0 0 0 PART I, LINE 7 THE FOLLOWING INDIVIDUALS RECEIVED DISCRETIONARY BONUSES INCLUDED IN HIS OR HER 2019 W-2: - JAMES DAVIS, PRESIDENT/CEO $250,000 - MARK PANCIRER, SENIOR VP/CEO $50,000 - WILLIAM PASCOCELLO, SENIOR VP/COO $10,000 - GERTRUDES DE GUZMAN, DIRECTOR OF NURSING $5,000 - LORNA POON, DIRECTOR OF FINANCE $10,000 - PAMELA LANDMAN, CORPORATE COUNSEL $10,000 - CELMA DUMAGUING, ASST. DIRECTOR OF FINANCE $1,000 FORM 990, PART VI, SECTION A, LINE 2 LAWRENCE B. THOMPSON AND R. SCOTT EDMONDS HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B AMSTERDAM NURSING HOME CORPORATION (1992) 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 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. SAID CONFLICTS ARE ADDRESSED BY MANAGEMENT. 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 AND OUTSIDE BENEFITS CONSULTANT. THE USE OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN THE DELIBERATION AND THE FINAL DECISION. THIS PROCESS WAS UNDERTAKEN IN DECEMBER 2018 FOR THE YEAR 2019. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE BOARD. AMSTERDAM HAS A PROCESS TO DETERMINE COMPENSATION FOR OFFICERS, WHICH INCLUDES A REVIEW BY A COMPENSATION AND BENEFITS CONSULTANT, THE USE OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN THE DELIBERATION, AND THE FINAL DECISION. COMPENSATION OF KEY EMPLOYEES IS BASED ON AN INFORMAL REVIEW BY THE PRESIDENT/CEO OF COMPARABLE DATA. THIS WAS LAST DONE IN 2019. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 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 FORM 1023, 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 1,117,698. MANAGEMENT AND GENERAL EXPENSES 882,692. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,000,390. NURSING AGENCIES: PROGRAM SERVICE EXPENSES 4,699,082. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,699,082. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,119,393. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,119,393. THERAPY FEES: PROGRAM SERVICE EXPENSES 3,500,592. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,500,592. OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 166,854. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 166,854. BILING SERVICES: PROGRAM SERVICE EXPENSES 295,302. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 295,302. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 282,481. MANAGEMENT AND GENERAL EXPENSES 41,873. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 324,354. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 515,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 515,193. LAUNDRY AND LINEN SERVICES: PROGRAM SERVICE EXPENSES 482,889. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 482,889. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 897,791. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 897,791. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 175,070. MANAGEMENT AND GENERAL EXPENSES 2,730. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,800. FORM 990, PART XI, LINE 9: GAIN ON DISPOSAL OF FIXED ASSETS 3,656. 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. FORM 990, PART XI, LINE 8: THE HOME IDENTIFIED APPROXIMATELY $1.8 MILLION OF SICK PAY ACCRUAL AND $0.5 MILLION OF ASSET RETIREMENT OBLIGATIONS THAT WAS NOT RECORDED WHICH RESULTED IN UNDERSTATING THE HOME'S LIABILITIES AT DECEMBER 31, 2018. AS A RESULT, THE HOME RESTATED ITS OPENING NET ASSETS AT JANUARY 1, 2019. THE EFFECT OF THE RESTATEMENT ON THE PREVIOUSLY REPORTED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS WOULD BE AN INCREASE IN EXPENSES OF APPROXIMATELY $2.4 MILLION, DECREASING THE OPERATING GAIN. THIS RESULTED IN A PRIOR PERIOD ADJUSTMENT ON THE FORM 990 OF $2,376,274. 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 0 0 0