2024-11-15T16:48:23-06:00 2023-12-31 873231666 PKF O'CONNOR DAVIES ADVISORY LLC 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2023-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 300 EAST OVERLOOK PORT WASHINGTON NY 11050 BROOKE NAVARRE PRESIDENT/CEO 2125753322 2024-11-15 1 1 MELISSA MODELSON P01603524 9143818900 2024-11-13 2023 2024-10-15 13:58:12Z SEE SCHEDULE O BROOKE NAVARRE 300 EAST OVERLOOK PORT WASHINGTON NY 11050 30847610 0 X WWW.THEHARBORSIDE.ORG X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE. 9 9 134 10 0 0 1595058 8817705 25563463 21836491 273250 25729 219105 162375 27650876 30842300 3875 0 0 0 7151158 6670236 0 0 0 31899648 33177012 39054681 39847248 -11403805 -9004948 205746668 185372355 368212447 370444254 -162465779 -185071899 X SEE SCHEDULE O 0 0 26526021 0 21836491 AMSTERDAM HOUSING CONTINUING CARE RETIREMENT COMMUNITY, INC. ("AHCCRC, INC.") OPERATES A CONTINUING CARE RETIREMENT COMMUNITY, LICENSED UNDER ARTICLE 46 OF THE PUBLIC HEALTH LAW, KNOWN AS THE HARBORSIDE LOCATED IN PORT WASHINGTON, NEW YORK, WHICH INCLUDES: 229 INDEPENDENT LIVING APARTMENTS, 26 ENRICHED HOUSING UNITS AND 18 SPECIAL NEEDS ASSISTED LIVING, AND 56 SKILLED NURSING BEDS.ON MARCH 22, 2023, AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. D/B/A THE HARBORSIDE FILED A PETITION IN THE UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF NEW YORK SEEKING RELIEF UNDER CHAPTER 11 OF THE UNITED STATES BANKRUPTCY CODE. 26526021 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 179 0 134 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X X LUCILLE MANSFIELD 2125753322 300 EAST OVERLOOK PORT WASHINGTON NY 11050 JOSEPH C HOOPES JR CHAIRMAN & TREASURER 2.00 4.25 X X 0 0 0 FRANCES R OLIVIERI VICE CHAIR 0.75 1.00 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIR 0.75 1.50 X X 0 0 0 JAY H MCDOWELL ESQ SECRETARY 0.50 0.75 X X 0 0 0 REV CANON JAMES CALLAWAY JR DIRECTOR 0.50 0.75 X 0 0 0 SYLVIA DUNSKY DIRECTOR 0.50 0.00 X 0 0 0 R SCOTT EDMONDS DIRECTOR 0.50 1.25 X 0 0 0 RHODA FINER DIRECTOR 0.50 0.00 X 0 0 0 LANGDON VAN NORDEN DIRECTOR 0.50 1.25 X 0 0 0 BROOKE NAVARRE PRESIDENT/CEO 40.00 0.00 X 298750 0 26901 PAMELA LANDMAN SENIOR VP & GENERAL COUNSEL 24.73 24.02 X 84409 224526 45476 SURESH BALA REGISTERED NURSE 40.00 0.00 X 140867 0 26468 LUCILLE MANSFIELD DIRECTOR OF FINANCE 40.00 0.00 X 140545 0 12883 ELLEN NIZICH DIRECTOR OF CULTURE OPERATIONS 40.00 0.00 X 121233 0 16113 KELLY ANN DEJESUS HEALTH CENTER ADMINISTRATOR 40.00 0.00 X 117542 0 21294 RICHARD PINEDA DIRECTOR OF INFORMATION TECHNOLOGY 40.00 0.00 X 110736 0 37467 1014082 224526 186602 7 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 DINING MANAGEMENT 4048429 DLA PIPER LLP PO BOX 75190 BALTIMORE MD 21275 LEGAL SERVICES 3585906 ANKURA CONSULTING GROUP LLC PO BOX 74007043 CHICAGO IL 06674 FISCAL BANKRUPTCY COUNSELING 2027769 PROMED STAFFING RESOURCES 146 SECOND ST NORTH SUITE 1622 ST PETERSBURG FL 33701 AGENCY STAFFING 1722296 COOLEY LLP 3 EMBARACADERO CENTER 20TH FLLOR SAN FRANCISCO CA 94111 LEGAL SERVICES 804428 16 8800000 17705 8817705 RESIDENT & PATIENT SERVICE REVENU 623000 18052173 18052173 AMORTIZATION OF NONREFUNDABLE ENT 623000 3784318 3784318 21836491 25729 25729 70460 0 70460 70460 70460 10577 5310 5267 5267 MISC. REVENUE 900099 47140 47140 INSURANCE REIMBURSEMENTS 900099 23897 23897 SERVICE REVENUE 900099 8967 8967 6644 6644 86648 30842300 21836491 0 188104 X 455136 455136 40505 40505 4591854 4011693 580161 100905 77451 23454 824794 688330 136464 657042 504323 152719 35085 35085 117830 117830 7445182 6830736 614446 115505 18896 96609 818257 747383 70874 62478 21800 40678 4504498 4504498 33600 32020 1580 67742 67742 6562448 6562448 760011 760011 DEBT RESTRUCTURING FEES 10810047 10810047 FOOD & DIETARY EXPENSES 926796 926796 REPAIRS AND MAINTENANCE 268045 268045 MEDICAL SUPPLIES AND DR 265578 265578 383910 306013 77897 39847248 26526021 13321227 0 2045063 3532960 18973891 249089 1402535 1065768 38811 35187 224788 821089 261940037 87142343 181074959 174797694 1775026 0 211595 4870568 205746668 185372355 2993605 7069873 18102359 14040407 129079930 127448153 349922 194110 42541950 41537332 175144681 180154379 368212447 370444254 X -162465779 -185071899 0 0 -162465779 -185071899 205746668 185372355 X -9004948 83958 -13685130 X 0 0 0 X X 1 AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC 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. ("AHCCRC, INC.") SUPPORTS AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC., ITS PARENT ORGANIZATION. AHCCRC, INC. 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. PART I, LINE 12G, COLUMN IV: AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. ("AHCCRC, INC.") SUPPORTS AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC., ITS PARENT ORGANIZATION. AHCCRC, INC. 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 22353895 22353895 231346057 80730202 150615855 7270485 6412141 858344 969600 969600 174797694 SUBORDINATE NOTE - ACCHS INC 3000000 FUTURE SERVICE OBLIGATION 36708000 ACCRUED INTEREST 4278511 REFUNDABLE ENTRANCE FEES 136167868 180154379 PART IV, LINE 2B: AHCCRC, INC. ACCEPTS WAITLIST DEPOSITS AND RESERVATION DEPOSITS FOR THE ENTRANCE FEE ON THE RESERVED INDEPENDENT LIVING APARTMENT. THESE DEPOSITS ARE HELD IN ESCROW AT A FINANCIAL INSTITUTION UNTIL THE TIME OF MOVE-IN OR REFUND (IF DEPOSIT IS CANCELLED). X X 0 0 0 0 0 0 0 0 0 PAMELA LANDMAN SENIOR VP & GENERAL COUNSEL 84298 188522 0 13504 111 22500 0 0 45077 399 129486 224925 0 0 BROOKE NAVARRE PRESIDENT/CEO 297800 0 0 0 950 0 0 0 26901 0 325651 0 0 0 SURESH BALA REGISTERED NURSE 140736 0 0 0 131 0 0 0 26468 0 167335 0 0 0 LUCILLE MANSFIELD DIRECTOR OF FINANCE 140545 0 0 0 0 0 0 0 12883 0 153428 0 0 0 A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 63166UAS0 2021-09-08 127327200 REFUND PRIOR ISSUE (11/28/14) 0 0 0 A 127327200 127327200 2011 1 0 1 1 A 0 1 1 0 1 0 0 0 0 A 0 JADE NAVARRE FAMILY MEMBER OF PRESIDENT/CEO 40505 EMPLOYMENT 0 FORM 990, BOX C: THE ORGANIZATION DOES BUSINESS UNDER THE FOLLOWING NAMES: THE HARBORSIDE HARBORSIDE LEGACY FOUNDATION THE AMSTERDAM AT HARBORSIDE FORM 990, PART III, LINE 1: AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC.'S MISSION (AHCCRC, INC.) IS TO ESTABLISH, CONSTRUCT, OWN, OPERATE AND MAINTAIN A CONTINUING CARE RETIREMENT COMMUNITY AS DEFINED IN ARTICLE 46 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK; TO MEET THE SPECIAL HOUSING NEEDS OF ELDERLY PERSONS BY PLANNING, DEVELOPING, ORGANIZING, CONSTRUCTING, ACQUIRING, ALTERING, RECONSTRUCTING, REHABILITATING, OWNING, OPERATING AND MAINTAINING HOUSING FOR ELDERLY INDIVIDUALS AND FAMILIES IN ORDER TO PROMOTE THEIR GENERAL WELFARE BY PROVIDING THEM WITH SAFE, SANITARY AND INDEPENDENT LIVING FACILITIES; TO ENGAGE IN ANY OTHER LAWFUL ACTIVITY FOR WHICH A CORPORATION MAY BE FORMED UNDER THE NOT-FOR-PROFIT CORPORATION LAW; THE PUBLIC OR QUASI-PUBLIC OBJECTIVE TO BE ACHIEVED BY THESE PURPOSES IS TO MAKE AVAILABLE SPECIAL HOUSING FOR THE ELDERLY WHERE SUCH HOUSING IS NOT CURRENTLY AVAILABLE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A A MEETING OF THE MEMBER IS 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. THE BOARD OF AHCCRC, INC. RATIFIES THE ELECTION OF DIRECTORS AND ELECTS OFFICERS AND AN ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER IS AUTHORIZED TO APPROVE MATERIAL ACTIONS PURSUANT TO NEW YORK NOT-FOR-PROFIT CORPORATION LAW. ANY OR ALL OF THE DIRECTORS MAY BE REMOVED BY THE MEMBER OR THE BOARD OF DIRECTORS UPON THE MEMBER'S CONSENT. THE MEMBER MAY AMEND, REPEAL, OR ADOPT BY-LAWS OF THE CORPORATION OR TWO-THIRDS OF THE BOARD OF DIRECTORS UPON THE MEMBER'S CONSENT. FORM 990, PART VI, SECTION B, LINE 11B AHCCRC, 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. A PERSON HAS A "FINANCIAL INTEREST" IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH BUSINESS, INVESTMENT OR FAMILY: A. AN OWNERSHIP OR INVESTMENT INTEREST IN ANY ENTITY WITH WHICH THE AMSTERDAM ENTITY HAS A TRANSACTION OR ARRANGEMENT; B. A COMPENSATION ARRANGEMENT WITH THE AMSTERDAM ENTITY OR WITH ANY ENTITY OR INDIVIDUAL WITH WHICH THE AMSTERDAM ENTITY HAS A TRANSACTION OR ARRANGEMENT; OR C. A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, ANY ENTITY OR INDIVIDUAL WITH WHICH THE AMSTERDAM ENTITY IS NEGOTIATING A TRANSACTION OR ARRANGEMENT. 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 15A THE COMPENSATION FOR THE PRESIDENT AND CEO IS SET USING COMPARABLE DATA. COMPARABLE DATA INCLUDED PUBLICLY AVAILABLE COMPENSATION DATA FROM SIMILARLY SITUATED CCRCS, SUCH AS COMPENSATION DATA IN THE FORM 990S FILED WITH THE IRS. THE COMPENSATION REVIEW PROCESS WAS APPROVED BY THE BOARD AND IS INCLUDED IN THE BOARD MINUTES. THIS REVIEW PROCESS WAS LAST CONDUCTED IN DECEMBER 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION 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 THE NEW YORK ATTORNEY GENERAL CHARITIES BUREAU WEBSITE AND GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, 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 MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,881,771. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,881,771. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 628,108. MANAGEMENT AND GENERAL EXPENSES 161,142. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 789,250. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 136,847. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,847. THERAPISTS: PROGRAM SERVICE EXPENSES 571,641. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,641. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 39,294. MANAGEMENT AND GENERAL EXPENSES 11,899. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,193. FINANCIAL ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 728,625. MANAGEMENT AND GENERAL EXPENSES 384,291. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,112,916. BOND TRUSTEE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,000. DINING SERVICES: PROGRAM SERVICE EXPENSES 1,844,450. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,844,450. MARKETING ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 47,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,114. FORM 990, PART XI, LINE 9: LOSS ON DISPOSAL OF ASSET -13,685,130. 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 N/A 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 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0