2014-11-13T17:59:47-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 133834710 AMSTERDAM NURSING HOME CORP (1992) AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIORVP/CFO 2125753322 2013-11-12 1 BERNARD GROTELL P01275277 2128674000 2013 2015-11-30 17:44:51Z AMSTERDAM NURSING HOME MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 58392505 0 X AMSTERDAMCARES.ORG X 1995 NY AMSTERDAM NURSING HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. 11 11 591 85 0 0 6682692 322216 53850901 56860160 67865 21275 603199 724854 61204657 57928505 0 0 0 0 31127609 30868235 0 0 0 24916856 26292095 56044465 57160330 5160192 768175 54825943 61859493 44288757 50554132 10537186 11305361 TO OPERATE A NOT FOR PROFIT NURSING HOME FACILITY WITH 409 SKILLEDNURSING HOME BEDS AND AN ADULT DAY CARE PROGRAM FOR 40 PARTICIPANTS. 0 0 50676883 57137169 THE HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. THE HOME HAS A CAPACITY OF 409 BEDS ALONG WITH AN ADULT DAY CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2013, THE NURSING HOME HAD 601 ADMISSIONS AND PROVIDED 13,689 ADULT DAY CARE VISITS. THE NURSING HOME HAD AN OCCUPANCY RATE OF 98.38 PERCENT. 50676883 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 74 0 591 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 0 0 NY X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 JAMES DAVIS PRESIDENT/CEO 20.50 29.50 X X 397708 329996 38667 MARK PANCIRER SENIOR VP/CFO 27.50 22.50 X X 270345 30000 41638 LAWRENCE B THOMPSON CHAIRMAN 2.00 3.00 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.50 0.80 X X 0 0 0 JOSEPH C HOOPES TREASURER 1.00 1.50 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.30 X X 0 0 0 REV JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.30 X 0 0 0 ISABEL M CARDEN BOARD MEMBER 0.50 0.50 X 0 0 0 JAY H MCDOWELL BOARD MEMBER 0.30 0.60 X 0 0 0 REV DEACON FRANK L PETERSON JR BOARD MEMBER 0.30 0.50 X 0 0 0 DYER S WADSWORTH BOARD MEMBER 0.30 0.30 X 0 0 0 JAMES J CAMPBELL BOARD MEMBER 0.30 0.50 X 0 0 0 DR KAREN M HOPKINS BOARD MEMBER 0.30 0.50 X 0 0 0 FRANCES R OLIVIERI BOARD MEMBER 0.30 0.50 X 0 0 0 FLORECITA NEBRES VICE PRESIDENT OF NURSING 35.00 X 99015 0 17394 JUDITH FENSTER SENIOR VP/ADMINISTRATOR 35.00 X 234202 0 18431 LORNA POON DIRECTOR OF FINANCE 35.00 X 158271 0 21585 GEETHA MURLI DIRECTOR OF PATIENT ACCOUNTS 35.00 X 117120 0 5963 MICHAEL WHITE DIRECTOR OF FINANCE 30.00 X 143017 0 13904 HARLAN RAGAY DIRECTOR OF NURSING 35.00 X 120861 0 7190 ANTONELLA VALENTINI ASSOC.DIR OF NURSING 35.00 X 112773 0 23954 RICHARD HARLEY DIRECTOR OF ENGINEERING 35.00 X 106547 0 20744 1759859 359996 209470 9 0 1 0 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 3273218 UNIDINE CORPORATION PO BOX 60479 CHARLOTTE NC 28260 FOOD SERVICE 1739715 AFFINITY REHABILITATION LLP 10600 YORK ROAD ST 105 COCKEYSVILLE MD 21030 PT & OT SERVICE 1580040 PARK AVE MEDICAL ASSOCIATES 1 BARKER AVE WHITE PLAINS NY 10601 MEDICAL SERVICES 941640 SENIOR RIDE TRANSPORTATION 855 BRUSH AVENUE BRONX NY 10465 TRANSPORTATION 668860 5 321471 745 322216 MEDICARE/MEDICAID 623000 47615667 47615667 PRIVATE PAY PATIENT CAR 623000 6672622 6672622 ADULT DAY CARE 623000 2571871 2571871 56860160 22513 22513 462762 464000 -1238 -1238 -1238 DISCOUNTS ON PURCHASES 623000 277009 277009 EXPENSE RECOVERY - ADMINISTRATION 623000 159730 159730 EMPLOYEE BENEFITS EXPENSE RECOVER 623000 137329 137329 150786 150786 724854 57928505 57137169 0 469120 X 1405416 1405416 19542718 18688427 854291 1796957 1621333 175624 6611741 6263503 348238 1511403 1417243 94160 264388 264388 110884 110884 46195 46195 7862719 7439442 423277 5720 448 5272 6188802 5034125 1154677 394368 394368 1057982 746455 311527 63291 40892 22399 2573671 2264830 308841 2895530 2548056 347474 678503 597082 81421 NYS ASSESSMENT 3038906 3038906 LOSS ON DISPOSAL 870344 765903 104441 OTHER EXPENSES 240792 210238 30554 57160330 50676883 6483447 0 X 1740 1740 13029784 18055326 11163843 12834513 141721 144701 1098760 1410024 78182688 51995851 28031811 26186837 1358284 3226352 54825943 61859493 6156486 6828474 36009678 40528449 2122593 3197209 44288757 50554132 X 10233680 11002000 303506 303361 10537186 11305361 54825943 61859493 768175 0 X X 0 1 X 1 1 1 X 2857 88503 52777 6682692 322216 7149045 54305948 57503099 54803742 54781112 56860160 278254061 54308805 57591602 54856519 61463804 57182376 285403106 0 0 0 285403106 113402 74656 49330 27462 22513 287363 113402 74656 49330 27462 22513 287363 317090 287028 630695 603200 724854 2562867 54739297 57953286 55536544 62094466 57929743 288253336 0.99010 0.98950 0.00100 0.00130 X SCHEDULE A, PART III, LINE 12 GIFT SHOP & MILLER INN RECOVERY OF EXPENSE PHONE & VENDING MACHINE DISCOUNT ON PURCHASES GENERAL ADMINISTRATION DIRECT TV FEES SECURITY RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 46195 46195 0 PART II-B, LINE 1: DUES AND OR FEES PAID TO THE FOLLOWING ORGANIZATIONS THAT HAD LOBBYING EXPENSES: 1199,LEADING AGE, BOLTON-ST.JOHNS AND CCLC 1432917 1432917 50007839 36136231 13871608 186383 141249 45134 18882675 15718371 3164304 7672874 7672874 26186837 OTHER RECEIVABLES 52755 OTHER ASSETS 147530 DUE FORM THIRD PARTY PAYOR 3026064 SUBVENTION CERTIFICATE FROM ACCHS, INC, 3 3226352 PATIENT FUNDS 464736 DUE TO THIRD PARTIES 2596027 ACCRUED INTEREST PAYABLE 136446 3197209 X 57928505 0 57928505 0 57928505 57160330 0 57160330 0 57160330 PART X, LINE 2: UNCERTAINTY IN INCOME TAXES - THE HOME HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 242708 264996 155000 65000 0 0 18402 0 20265 0 436375 329996 0 0 MARK PANCIRER SENIOR VP/CFO 212821 30000 50000 0 7524 0 18351 0 23287 0 311983 30000 0 0 JUDITH FENSTER SENIOR VP/ADMINISTRATOR 202602 0 25000 0 6600 0 14280 0 4151 0 252633 0 0 0 LORNA POON DIRECTOR OF FINANCE 157686 0 0 0 585 0 10043 0 11542 0 179856 0 0 0 MICHAEL WHITE DIRECTOR OF FINANCE 141730 0 0 0 1287 0 8723 0 5181 0 156921 0 0 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S OFFICERS. ADAM DAVIS SON OF CEO 20393 VARIOUS 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 AS PREPARED BY LOEB & TROPER LLP, ACCOUNTING FIRM, IS PROVIDED TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENTS AND TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C A 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 WHO 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 BECOME AWARE OF THE POTENTIAL FOR A CONFLICT IN CONNECTION WITH THE TRANSACTION WHO SHALL INFORM THE APPLICABLE BOARD.IF THE CHAIRMAN IN 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,EXCLUDED IN SUCH COUNTS THE INTERESTED DIRECTOR,SHALL BE REQUIRED BEFORE ENTERING INTO THE TRANSACTION. 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 15A FORM 990, PART VI, LINE 15: THE ORGANIZATION HAS A PROCESS TO DETERMINE COMPENSATION FOR THE CEO/ EXECUTIVE DIRECTOR 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. THIS PROCESS WAS LAST UNDERTAKEN IN 2013. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHARMACEUTICAL, PHYSICAL THERAPY AND HUMAN RESOURCE CONSULTING: PROGRAM SERVICE EXPENSES 7,439,442. MANAGEMENT AND GENERAL EXPENSES 423,277. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,862,719. FORM 990, PART X, LINE 15 OTHER RECEIVABLES $52,755 OTHER ASSETS $147,530 DUE FORM THIRD PARTY PAYOR $3,026,064 SUBVENTION CERTIFICATE FROM $3 ACCHS, INC. TOTAL-OTHER ASSETS $3,226,352 FORM 990, PART XII, LINE 2C: FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES NY 520014 1687642 N/A AMSTERDAM SERVICES CORP 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES TO HEALTHCARE FACILITIES NY 501(C)(3) 9 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEMS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADVICE, INFORMATION & MONETARY CONTRIBUTIONS TO ELDERLY & DISABLED NY 501(C)(3) 7 N/A 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE NY 501(C)(3) 9 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM SERVICES CORP 2001 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134184082 PROVIDING NURSING HOME CONSULTING AND ADMIN. OVERSITE. NY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0