2013-11-14T14:07:39-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 133834710 AMSTERDAM NURSING HOME CORP (1992) AMST 2125753322 1060 AMSTERDAM AVE NEW YORK NY 10025 MARK PANCIRER 2125753322 2013-11-13 1 BERNARD GROTELL P01275277 2128674000 2012 2016-02-24 21:20:13Z AMSTERDAM NURSING HOME MARK PANCIRER 1060 AMSTERDAM AVE NEW YORK NY 10025 63305452 0 X AMSTERDAMCARES.ORG X 1995 NY AMSTERDAM NURSING HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. 12 12 605 30 0 0 52777 6682692 54803742 53850901 56133 67865 630695 603199 55543347 61204657 0 0 0 0 33071175 31127609 0 0 0 23630807 24916856 56701982 56044465 -1158635 5160192 49843524 54825943 44466530 44288757 5376994 10537186 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 50403306 54119806 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 2012, THE NURSING HOME HAD 514 ADMISSIONS AND PROVIDED 14,234 ADULT DAY CARE VISITS. THE NURSING HOME HAD AN OCCUPANCY RATE OF 98.56 PERCENT. 50403306 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 1 124 0 605 1 0 0 0 0 0 0 0 0 0 0 X 12 12 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 570 7TH AVENUE 6TH FLOOR NEW YORK NY 10018 LAWRENCE B THOMPSON 2.00 X X 0 0 0 GEORGE L VAN AMSON 0.50 X X 0 0 0 JOSEPH C HOOPES 1.00 X X 0 0 0 JOSE V TORRES 0.30 X X 0 0 0 REV JAMES G CALLAWAY JR 0.30 X 0 0 0 ISABEL M CARDEN 0.50 X 0 0 0 JAY H MCDOWELL 0.30 X 0 0 0 REV DEACON FRANK L PETERSON JR 0.30 X 0 0 0 DYER S WADSWORTH 0.30 X 0 0 0 JAMES J CAMPBELL 0.30 X 0 0 0 DR KAREN M HOPKINS 0.30 X 0 0 0 FRANCES R OLIVIERI 0.30 X 0 0 0 JAMES DAVIS 30.50 19.50 X 297714 330002 43681 MARK PANCIRER 37.50 12.50 X 220912 30000 41745 FLORECITA NEBRES 35.00 X 150992 0 35294 JUDITH FENSTER 35.00 X 206257 0 14674 LORNA POON 35.00 X 130079 0 6374 GEETHA MURLI 35.00 X 111245 0 5840 MYLENE MERCADO 37.50 X 114670 0 41721 SHELLY ANN STEWART 37.50 X 112462 0 14652 IMEE R VILLAVICENCIO 37.50 X 112912 0 41475 SALLY NUNEZ 35.00 X 111039 0 15512 1568282 360002 260968 8 0 1 0 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 2853875 UNIDINE CORPORATION PO BOX 60479 CHARLOTTE NC 28260 FOOD SERVICE 1378018 PARK AVE MEDICAL ASSOCIATES 1 BARKER AVE WHITE PLAINS NY 10601 MEDICAL SERVICES 1167815 SENIOR RIDE TRANSPORTATION 855 BRUSH AVENUE BRONX NY 10465 TRANSPORTATION 690866 EDU TEK LIMITED 178 EAST BOSTON POST RD MAMARONECT NY 10543 INFORMATION TECH 643486 11 6678529 4163 6682692 MEDICARE/MEDICAID 623000 42969632 42969632 ADULT DAY CARE 623000 5820081 5820081 PRIVATE PAY PATIENT CAR 623000 5061188 5061188 53850901 27462 27462 2141198 2100795 40403 40403 40403 DISCOUNTS ON PURCHASES 623000 268905 268905 RECOVERY OF EMPLOYEE BENEFITS 623000 197484 197484 ADM. FEE REL. ORG. 623000 49973 49973 86837 86837 603199 61204657 54119806 0 402159 X 1011269 1011269 20353091 19538265 814826 1614292 1611510 2782 6537511 6280043 257468 1611446 1511053 100393 213213 213213 70462 70462 7379489 6736654 642835 9467 176 9291 6285425 4971406 1314019 977831 685981 291850 40232 19873 20359 3039266 2674554 364712 3022773 2660040 362733 631504 555724 75780 NYS ASSESSMENT 2919146 2919146 OTHER EXPENSES 309563 220396 89167 LOSS ON DISPOSAL 18485 18485 56044465 50403306 5641159 0 X 1400 1740 17236805 13029784 7965970 11163843 88688 141721 391107 1098760 78886453 50854642 23027672 28031811 1131882 1358284 49843524 54825943 6078903 6156486 36996836 36009678 1390791 2122593 44466530 44288757 X 5077182 10233680 299812 303506 5376994 10537186 49843524 54825943 5160192 0 X X 0 1 X 1 1 1 X 158939 2857 88503 52777 6682692 6985768 55666730 54305948 57503099 54803742 54781112 277060631 55825669 54308805 57591602 54856519 61463804 284046399 0 0 0 284046399 118412 113402 74656 49330 27462 383262 118412 113402 74656 49330 27462 383262 804202 317090 287028 630695 603200 2642215 56748283 54739297 57953286 55536544 62094466 287071876 0.98950 0.98700 0.00130 0.00250 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: GIFT CART MILLERINN RECOVERY OF EXPENSE PHONE VENDING MACHINE DISCOUNT ON PURCHASES GENERAL ADMINISTRATION STAR PROGRAM DIRECT TV FEES SECURITY RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13798 13798 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 50476708 35403123 15073585 186383 143435 42948 18441605 15308084 3133521 8348840 8348840 28031811 PATIENT FUNDS 576832 DUE TO THIRD PARTIES 1295670 ACCRUED INTEREST PAYABLE 250091 2122593 X 61204657 0 61204657 0 61204657 56044465 0 56044465 0 56044465 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009 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 220610 265002 55000 65000 22104 0 17646 0 26035 0 341395 330002 0 0 MARK PANCIRER 212692 30000 0 0 8220 0 14945 0 26800 0 262657 30000 0 0 FLORECITA NEBRES 144424 0 0 0 6568 0 8784 0 26510 0 186286 0 0 0 JUDITH FENSTER 206257 0 0 0 0 0 13295 0 1379 0 220931 0 0 0 MYLENE MERCADO 114670 0 0 0 0 0 10727 0 30994 0 156391 0 0 0 IMEE R VILLAVICENCIO 112912 0 0 0 0 0 10563 0 30912 0 154387 0 0 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S CEO. ADAM DAVIS SON OF CEO 71913 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 2012. 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. OTHER FEES FORM 990, PART IX, LINE 11G PHARMACEUTICAL, PHYSICAL THERAPY AND HUMAN RESOURCE CONSULTING : PROGRAM SERVICE EXPENSES 6,736,654. MANAGEMENT AND GENERAL EXPENSES 642,835. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,379,489. OTHER ASSETS FORM 990, PART X, LINE 15 OTHER RECEIVABLES - $ 166,221 OTHER ASSETS - $ 139,130 DUE FORM THIRD PARTY PAYOR - $1,052,930 SUBVENTION CERTIFICATE FROM - $ 3 ACCHS, INC. TOTAL-OTHER ASSETS - $1,358,284 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 360051 1541767 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