2020-11-16T21:48:35-06:00 2019-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE HARRISON NY 105281633 990 2019-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2020-11-16 1 GARRETT M HIGGINS P00543209 9143818900 2020-11-16 24.190.81.120 2020-11-16 21:48:30 ES P F6241A67CEA968FA82FDD3F36018BF333AFB8C14 9616F4B14A694591D1E716C270910E6FA5556DA3 2019 2021-01-29 14:40:06Z THE AMSTERDAM AT HARBORSIDE JAMES DAVIS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 28572088 0 X THEAMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE. 11 11 131 12 0 0 18887 0 26839864 28066801 274072 339889 13636 153863 27146459 28560553 0 3645 0 0 7050577 6195386 0 0 0 32963743 32057011 40014320 38256042 -12867861 -9695489 234450414 229515666 441046729 439505484 -206596315 -209989818 X SEE SCHEDULE O 0 0 34781879 3645 28066801 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE. IN 2019, THE ORGANIZATION SERVED APPROXIMATELY 635 RESIDENTS. 34781879 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 250 0 131 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 JAMES DAVIS PRESIDENT/CEO 15.00 35.00 X 0 992821 50108 MARK PANCIRER SENIOR VP / CFO 7.50 42.50 X 0 344196 52315 BROOKE NAVARRE EXECUTIVE DIRECTOR 40.00 X 200780 0 30625 LUCILLE MANSFIELD DIRECTOR OF FINANCE 40.00 X 136287 0 18068 MICHAEL TARTAGLIA TUTTLE CENTER ADMINSTRATOR 40.00 X 109213 0 15376 LAWERNCE B THOMPSON CHAIR (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 CHAIR 0.50 0.80 X X 0 0 0 FRANCES R OLIVIERI VICE CHAIR 0.50 0.80 X X 0 0 0 JAY H MCDOWELL ESQ SECRETARY 0.30 0.50 X X 0 0 0 REV CANON JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES J CAMPBELL BOARD MEMBER 0.30 0.50 X 0 0 0 ISABEL M CARDEN MBE BOARD MEMBER 0.30 0.50 X 0 0 0 R SCOTT EDMONDS BOARD MEMBER 0.30 0.50 X 0 0 0 RHODA FINER BOARD MEMBER 0.30 0.50 X 0 0 0 KAREN M HOPKINS MD BOARD MEMBER 0.30 0.50 X 0 0 0 REV DEACON FRANK L PETERSON JR BOARD MEMBER 0.30 0.50 X 0 0 0 446280 1337017 166492 3 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15219 DINING MANAGEMENT 3734609 RN EXPRESS STAFFING REGISTRY 71 W 23RD STREET NEW YORK NY 10010 STAFFING 1101836 ADVANCED MEDICAL STAFFING PO BOX 6100028 DALLAS TX 75261 STAFFING 865972 GREYSTONE DEVELOPMENT COMPANY 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 MARKETING ADVISORY 733465 THERADYNAMICS PHYSICAL REHAB 337 CROSSWAYS PARK DRIVE WOODBURY NY 11797 THERAPY SERVICES 683981 14 RESIDENT AND PATIENT SERVICE REVE 623000 22348859 22348859 AMORTIZATION OF NONREFUNDABLE ENT 623000 5631451 5631451 UNIVERSAL SETTLEMENT 623000 86491 86491 28066801 149398 149398 190491 190491 79414 0 79414 79414 79414 8036 11535 -3499 -3499 INSURANCE REIMBURSEMENTS 900099 40490 40490 MEALS AND FOOD REVENUE 900099 18428 18428 SERVICE REVENUE 900099 13771 13771 5259 5259 77948 28560553 28066801 0 493752 X 3645 3645 231405 231405 4536806 4080631 456175 71330 67989 3341 829677 735267 94410 526168 453663 72505 291360 291360 176097 176097 87718 87718 20000 20000 7354440 6217627 1136813 335268 19405 315863 909883 820373 89510 136270 10411 125859 2040234 2040234 33022 24350 8672 11171790 10923074 248716 7050223 7050223 362635 362635 UBIT EXPENSE 2767 2767 FOOD AND DIETARY EXPENS 992532 992532 REPAIRS AND MAINTENANCE 477128 476703 425 MEDICAL SUPPLIES AND DR 209913 209913 405731 290437 115294 38256042 34781879 3474163 0 2053030 1527315 16696976 18705450 2712050 1020468 32233 35494 274528 247812 259714516 60879924 204955790 198834592 7725807 8977891 0 166644 234450414 229515666 2459689 2535559 26808413 27054507 212296264 212223518 209210 491815 199273153 197200085 441046729 439505484 X -206596315 -209989818 -206596315 -209989818 234450414 229515666 X -9695489 203325 1 6098660 X X 0 1 X 1 0 X X 1 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 134034061 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 1: AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. (THE ORGANIZATION") SUPPORTS AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC., ITS PARENT ORGANIZATION. THE ORGANIZATION PROVIDES INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE TO ITS RESIDENTS. THE HEALTH SYSTEM ALSO PROVIDES SUPPORT SERVICES TO THE ELDERLY. BOTH ORGANIZATION SUPPORT THE SAME CHARITABLE CLASS OF PEOPLE. 0 1 X 22353895 22353895 230351003 55924034 174426969 6692577 4955890 1736687 317041 317041 198834592 SUBORDINATE NOTE - ACCHS INC 3000000 FUTURE SERVICE OBLIGATION 28207000 ACCRUED INTEREST 3591154 REFUNDABLE ENTRANCE FEES 162401931 197200085 28743878 203325 203325 28540553 20000 20000 28560553 38236042 0 38236042 20000 20000 38256042 PART IV, LINE 2B: THE ORGANIZATION ACCEPTS WAITLIST DEPOSITS OF $10,000 AND RESERVATION DEPOSITS OF 10% OF THE ENTRANCE FEE ON THE RESERVED IL APARTMENT. THESE DEPOSITS ARE HELD IN ESCROW AT AMALGAMATED BANK UNTIL THE TIME OF MOVE-IN OR REFUND (IF DEPOSIT IF CANCELLED). 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 0 723349 0 250000 0 19472 0 19614 0 30494 0 1042929 0 0 MARK PANCIRER SENIOR VP / CFO 0 293567 0 50000 0 629 0 19614 0 32701 0 396511 0 0 BROOKE NAVARRE EXECUTIVE DIRECTOR 178106 0 10147 0 12527 0 7525 0 23100 0 231405 0 0 0 LUCILLE MANSFIELD DIRECTOR OF FINANCE 131783 0 3249 0 1255 0 3968 0 14100 0 154355 0 0 0 PART I, LINE 3 THE PRESIDENT/CEO AND CFO ARE COMPENSATED BY A RELATED ORGANZIATION, AMSTERDAM NURSING HOME CORPORATION (1992). BELOW IS THEIR COMPENSATION REVIEW PROCESS: 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. PART I, LINE 7 THE PRESIDENT / CEO GATHERS COMPARABLE INFORMATION AND EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S EMPLOYEES BASED ON THEIR PERFORMANCE. THE FOLLOWING EMPLOYEES RECEIVED PERFORMANCE-BASED BONUSES IN 2019: - BROOKE NAVARRE, EXECUTIVE DIRECTOR $10,147 - LUCILLE MANSFIELD, DIRECTOR OF FINANCE $3,249 - MICHAEL TARTAGLIA, TUTTLE CENTER ADMINISTRATOR $1,083 A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 2014-11-28 224965160 REFUND PRIOR ISSUE (12/20/07) 0 0 0 A 17737587 225155651 12969175 224965160 2011 1 0 1 1 A 0 1 1 0 0 0.00100 0.00000 0.00100 0 0 0 A 0 0 1 1 0 0 0 0 0 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: DATE THE REBATE COMPUTATION WAS PERFORMED: 10/31/2019 SCHEDULE K, PART I, LINE A, COLUMN (C) SERIES A - 63166UAM3, SERIES B - 63166UAP6, SERIES C - 63166UAQ4 SCHEDULE K PART II, LINE 3: THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4 -12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. FORM 990, PART III, LINE 1: AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. (AHCCRC, INC.) UNDERTOOK A PROJECT INVOLVING ACQUISITION, CONSTRUCTION,FURNISHING, AND EQUIPPING OF A NEW CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE AMSTERDAM AT HARBORSIDE, LOCATED IN PORT WASHINGTON, NEW YORK, WHICH INCLUDES: 229 INDEPENDENT LIVING APARTMENTS (THE RESIDENTIAL UNITS), 26 ENRICHED HOUSING UNITS AND 18 SPECIAL NEEDS ASSISTED LIVING UNITS (THE ENRICHED HOUSING CENTER), 56 SKILLED NURSING BEDS (THE NURSING CENTER) AND RELATED COMMON AREAS AND AMENITIES AND RELATED INFRASTRUCTURE (COLLECTIVELY, THE COMMUNITY). FORM 990, PART VI, SECTION A, LINE 2 LAWERENCE B. THOMPSON AND R. SCOTT EDMONDS HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION USES AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC., A RELATED ORGANZIATION FOR MANAGEMENT SERVICES. THE TWO OFFICERS LISTED IN PART VII, JAMES DAVIS AND MARK PANCIRER ARE PAID BY THE RELATED ORGANIZATION. THEIR CALENDAR YEAR 2019 COMPENSATION IS REPORTED IN PART VII, SECTION A. THE ORGANZIATION PAID THE MANAGEMENT COMPANY $291,360 FOR MANAGEMENT SERVICES IN 2019. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION SHALL CONSIST OF AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC. MEMBERSHIP OF THE MEMBER SHALL CONTINUE UNTIL RESIGNATION. FORM 990, PART VI, SECTION A, LINE 7A A MEETING OF THE MEMBER SHALL BE HELD ANNUALLY FOR THE ELECTION OF DIRECTORS AND THE TRANSACTION OF OTHER BUSINESS AT A PLACE AND TIME FIXED FROM TIME TO TIME BY THE MEMBER. IN ANY CASE IN WHICH THE MEMBER IS ENTITLED TO VOTE, THE MEMBER SHALL HAVE ONE VOTE. FORM 990, PART VI, SECTION A, LINE 7B ANY OR ALL OF THE DIRECTORS MAY BE REMOVED BY THE MEMBER OR THE BOARD OF DIRECTORS UPON MEMBER'S CONSENT. THE MEMBER MAY AMEND, REPEAL, OR ADOPT BY-LAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. 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 THE AUDIT COMMITTEE. THE CFO MAKES THE 990 AVAILABLE TO ALL BOARD MEMBERS. ANY ISSUES ARE DISCUSSED AND RESOLVED. 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 COMPENSATION FOR THE EXECUTIVE DIRECTOR IS BASED ON AN INFORMAL REVIEW BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF COMPARABLE DATA. 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. MONTHLY FINANCIAL STATEMENTS, AUDITS, ARE AVAILABLE TO THE PUBLIC ON THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE AT HTTP://EMMA.MSRB.ORG/. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,054,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,054,708. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 839,050. MANAGEMENT AND GENERAL EXPENSES 180,047. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,019,097. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 132,842. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,842. THERAPISTS: PROGRAM SERVICE EXPENSES 651,932. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 651,932. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 26,287. MANAGEMENT AND GENERAL EXPENSES 4,201. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,488. FINANCIAL ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 640,696. MANAGEMENT AND GENERAL EXPENSES 460,584. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,101,280. BOND COUNSEL TRUSTEE FEES: PROGRAM SERVICE EXPENSES 73,880. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,880. DINING SERVICES: PROGRAM SERVICE EXPENSES 1,798,232. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,798,232. MARKETING ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 491,981. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 491,981. FORM 990, PART XI, LINE 9: FUTURE SERVICE OBLIGATION ADJUSTMENT 6,106,000. LOSS ON DISPOSAL OF ASSET -7,340. 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 NURSING HOME CORPORATION (1992) 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133834710 NURSING HOME NY 501(C)(3) LINE 10 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) 0 AMSTERDAM SERVICES CORP (2001) 1060 AMSTERDAM AVENUE 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 1 0 1 1 1 0 0