2023-11-01T15:50:51-05:00 2022-12-31 873231666 PKF O'CONNOR DAVIES ADVISORY LLC 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2022-01-01 133834710 AMSTERDAM NURSING HOME CORPORATION (1992) AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2023-11-01 1 MARK PANCIRER XXX-XX-XXXX 1 EVA MRUK P00543254 9143818900 2023-10-31 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z AMSTERDAM NURSING HOME JAMES DAVIS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 67166381 0 X WWW.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. 10 10 344 13 0 0 3275229 9038 59044597 66787074 2996619 247121 2115 123148 65318560 67166381 6613076 3000 0 0 28218519 27984940 0 0 0 28222985 35516162 63054580 63504102 2263980 3662279 69684595 74531404 61297226 62481756 8387369 12049648 X AMSTERDAM NURSING HOME CORP. (1992) ("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, DIGNITY AND AUTONOMY OF EACH PERSON WHOM IT SERVES. 0 0 54890954 3000 66787074 AMSTERDAM NURSING HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. AMSTERDAM HAS A CAPACITY OF 409 SKILLED NURSING FACILITY BEDS ALONG WITH AN ADULT DAY HEALTH CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2022, AMSTERDAM HAD 1,405 ADMISSIONS AND PROVIDED 145,225 DAYS OF PATIENT CARE. AMSTERDAM HAD AN OCCUPANCY RATE OF 97.3 PERCENT IN THE NURSING FACILITY. 54890954 1 0 0 1 0 0 0 0 1 0 1 0 0 0 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 46 0 344 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 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 JOSEPH C HOOPES JR CHAIRMAN & TREASURER 2.00 4.50 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.75 1.75 X X 0 0 0 FRANCES R OLIVERI VICE CHAIRMAN 0.75 1.75 X X 0 0 0 JOSE V TORRES SECRETARY 0.50 1.00 X X 0 0 0 REVEREND JAMES G CALLAWAY JR DIRECTOR 0.50 1.50 X 0 0 0 JAMES J CAMPBELL DIRECTOR, THRU AUG. 1, 2022 0.50 1.50 X 0 0 0 ISABELL M CARDEN DIRECTOR 0.50 1.50 X 0 0 0 R SCOTT EDMONDS DIRECTOR 0.50 1.50 X 0 0 0 DR KAREN M HOPKINS DIRECTOR 0.50 1.50 X 0 0 0 JAY H MCDOWELL DIRECTOR 0.50 1.50 X 0 0 0 LAGDON VAN NORDEN DIRECTOR 0.50 1.50 X 0 0 0 JAMES DAVIS PRESIDENT / CEO 48.00 12.00 X 912335 7211 20522 MARK PANCIRER SENIOR VP / CFO 36.00 4.00 X 270642 6348 22018 SHLOMO KATZ ADMINISTRATOR, THRU DEC. 7, 2022 60.00 0.00 X 398717 0 0 MOSHE BLACKSTEIN ADMINISTRATOR, AS OF DEC. 8, 2022 67.50 0.00 X 19325 0 0 PAMELA LANDMAN SENIOR VP / GENERAL COUNSEL 20.00 28.53 X 170360 84069 40585 LORNA POON DIRECTOR OF FINANCE 48.00 0.00 X 214924 0 22453 STEPHAN LANSEY PHYSICIAN 35.00 0.00 X 357656 0 8029 JOERALIN LIM NURSE 62.00 0.00 X 249152 0 41109 CHERRYLLENE GUMPAY NURSE 54.00 0.00 X 189889 0 36904 MAE KEARNEY NURSE 53.00 0.00 X 189247 0 37100 BEEMAL SINGH NURSE 89.00 0.00 X 159322 0 35393 3131569 97628 264113 27 0 1 0 TOWNE NURSING 1413 38TH STREET BROOKLYN NY 11218 NURSING AGENCY 6959119 CENTERS FOR CARE 4770 WHITE PLAINS ROAD BRONX NY 10470 CONSULTING AND ADVISORY 5114759 RN EXPRESS REGISTRY LLC 71 WEST 23RD ST STE 1622 NEW YORK NY 10010 NURSING AGENCY 3980326 UNITED STAFFING REGISTRY INC 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 637075 CROWELL & MORING LLP 590 MADISON AVENUE SUITE 1827 NEW YORK NY 10022 LEGAL SERVICES 512343 22 2900 6138 9038 PATIENT SERVICE CARE 623000 66787074 66787074 66787074 247121 247121 MISC. INCOME 900099 85998 85998 INSURANCE PROCEEDS 900099 25902 25902 REBATES AND REFUNDS 900099 8560 8560 2688 2688 123148 67166381 66787074 0 370269 X 3000 3000 2058879 1766324 292555 18117265 15451884 2665381 1332415 1326300 6115 4383956 4363836 20120 2092425 2082822 9603 479152 479152 102926 102926 11875 11875 19914388 15142835 4771553 1049191 1033081 16110 756118 690252 65866 255695 185308 70387 1936409 1906242 30167 146028 144793 1235 2023513 1992884 30629 2214519 2180515 34004 NY CASH RECEIPT ASSMNT 2445549 2445549 MEDICAL SUPPLIES AND DR 2033927 2033927 DIETARY EXPENSES 1292639 1292639 REPAIRS AND MAINTENANCE 585400 580349 5051 268833 268414 419 63504102 54890954 8613148 0 11806913 13816660 23091906 28173008 8772319 9625941 131919 131919 3002692 2344241 87063657 69900904 18259349 17162753 4619497 3276882 69684595 74531404 12130583 11176204 768341 878679 22504895 19862566 25893407 30564307 61297226 62481756 X 8304658 11971170 82711 78478 8387369 12049648 69684595 74531404 3662279 0 X X 0 1 X 1 1 1 X 847512 84523 5325722 3275229 9038 9542024 64801198 64303979 51657631 59044597 66787074 306594479 65648710 64388502 56983353 62319826 66796112 316136503 0 0 0 316136503 120208 365402 99918 14558 247121 847207 120208 365402 99918 14558 247121 847207 630410 73763 713152 2115 123148 1542588 66399328 64827667 57796423 62336499 67166381 318526298 0.99250 0.99230 0.00270 0.00210 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: EXPENSE RECOVERY - 2018 AMOUNT: $ 10,427. 2019 AMOUNT: $ 17,040. 2020 AMOUNT: $ 9,748. 2022 AMOUNT: $ 2,688. MISC REVENUE - 2018 AMOUNT: $ 37,224. 2022 AMOUNT: $ 85,998. ESCROW DEPOSIT - 2018 AMOUNT: $ 525,298. MEDICAL INSURANCE SURPLUS - 2018 AMOUNT: $ 57,461. 2019 AMOUNT: $ 56,579. REBATES AND REFUNDS - 2019 AMOUNT: $ 144. 2020 AMOUNT: $ 27,378. 2022 AMOUNT: $ 8,560. RECOVERY OF BAD DEBT - 2020 AMOUNT: $ 676,026. TELEPHONE INCOME - 2021 AMOUNT: $ 2,115. INSURANCE PROCEEDS - 2022 AMOUNT: $ 25,902. 0 0 0 0 0 0 0 0 1 11875 11875 0 PART II-B, LINE 1: AMOUNTS REPORTED ON LINE 1I REPRESENTS THE PORTION OF MEMBERSHIP DUES PAID BY THE ORGANIZATION TO PROFESSIONAL ASSOCIATIONS AND SIMILAR ORGANIZATIONS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 0 1 X 1432917 1432917 60579659 48212373 12367286 24938443 21598746 3339697 112638 89785 22853 17162753 DUE TO THIRD PARTIES 6864112 ACCRUED INTEREST PAYABLE 67195 INSURANCE PAYABLE 4075400 CONTINGENCY FOR ASSET RETIREMENT 542000 PAYCHECK PROTECTION PROGRAM LOAN 6515600 DUE TO BUYERS 12500000 30564307 X 67166381 0 67166381 0 67166381 63504102 0 63504102 0 63504102 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 AUTHORIZED FAMILY MEMBERS OR REPRESENTATIVES. 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 DECEMBER 31, 2019. X X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT / CEO 568304 4886 0 0 344031 2325 13116 0 6226 1180 931677 8391 0 0 SHLOMO KATZ ADMINISTRATOR, THRU DEC. 7, 2022 396293 0 2000 0 424 0 0 0 0 0 398717 0 0 0 STEPHAN LANSEY PHYSICIAN 357232 0 0 0 424 0 0 0 8029 0 365685 0 0 0 MARK PANCIRER SENIOR VP / CFO 270218 2443 0 0 424 3905 12999 0 7739 1280 291380 7628 0 0 PAMELA LANDMAN SENIOR VP / GENERAL COUNSEL 149436 83564 0 0 20924 505 8289 0 445 31851 179094 115920 0 0 JOERALIN LIM NURSE 232002 0 17150 0 0 0 21559 0 19550 0 290261 0 0 0 LORNA POON DIRECTOR OF FINANCE 193900 0 17000 0 4024 0 6807 0 15646 0 237377 0 0 0 CHERRYLLENE GUMPAY NURSE 177214 0 12675 0 0 0 17354 0 19550 0 226793 0 0 0 MAE KEARNEY NURSE 177542 0 11705 0 0 0 17550 0 19550 0 226347 0 0 0 BEEMAL SINGH NURSE 157072 0 2250 0 0 0 15843 0 19550 0 194715 0 0 0 PART I, LINE 7 INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A DISCRETIONARY BONUS DURING CALENDAR YEAR 2022, WHICH WAS INCLUDED IN COLUMN B(II) HEREIN AND IN THEIR 2022 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. FORM 990, PART VI, SECTION B, LINE 11B AMSTERDAM 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 FORM 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. 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 BOARD. IF THE CHAIRMAN IS INVOLVED IN THE TRANSACTION, THE CHAIRMAN SHALL ADVISE THE SECRETARY, 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 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 PERSONS 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 COMPLIANCE OFFICER OF AMSTERDAM NURSING HOME. EXECUTIVE EMPLOYEES ARE ALSO REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL BASIS OR SOONER IF A POTENTIAL CONFFLICT OR ACTUAL CONFLICT SHOULD ARISE. 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 COMMITTEE AND OUTSIDE BENEFITS CONSULTANT, AND THE USE OF COMPARABLE DATA. THE COMPARABLE DATA IS MARKET DATA SURVEYS FROM THE NURSING HOME ASSOCIATION. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE COMMITTEE. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED WITHIN THE COMMITTEE MINUTES. THIS PROCESS WAS UNDERTAKEN IN DECEMBER 2021 FOR THE YEAR 2021 AND FUTURE YEARS, AND THEN IN DECEMBER 2022 EFFECTIVE DECEMBER 15, 2022. AMSTERDAM HAS A PROCESS TO DETERMINE COMPENSATION FOR OFFICERS OTHER THAN THE PRESIDENT & CEO, WHICH INCLUDES A REVIEW BY A COMPENSATION AND BENEFITS CONSULTANT, AND THE USE OF COMPARABLE DATA. THE COMPARABLE DATA IS MARKET DATA SURVEYS FROM THE NURSING HOME ASSOCIATION. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE PRESIDENT AND CEO. THE DECISIONS ARE DOCUMENTED IN WRITING. THIS WAS LAST DONE IN DECEMBER 2022. FORM 990, PART VI, SECTION C, LINE 19 AMSTERDAM 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 GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE 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 CLINICAL CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,078,340. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,078,340. NURSING AGENCIES: PROGRAM SERVICE EXPENSES 9,740,518. MANAGEMENT AND GENERAL EXPENSES 954,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,694,518. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 143,133. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 143,133. THERAPY FEES: PROGRAM SERVICE EXPENSES 1,421,407. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,421,407. OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,850,720. MANAGEMENT AND GENERAL EXPENSES 17,492. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,868,212. BILLING SERVICES: PROGRAM SERVICE EXPENSES 194,992. MANAGEMENT AND GENERAL EXPENSES 3,041. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 198,033. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 321,028. MANAGEMENT AND GENERAL EXPENSES 1,694,993. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,016,021. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 513,474. MANAGEMENT AND GENERAL EXPENSES 7,852. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 521,326. LAUNDRY AND LINEN SERVICES: PROGRAM SERVICE EXPENSES 478,251. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,251. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 222,149. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 222,149. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 257,163. MANAGEMENT AND GENERAL EXPENSES 2,629. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 259,792. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 13,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,206. 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 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 300 EAST OVERLOOK PORT WASHINGTON NY 11050 113711764 NURSING CARE NY 501(C)(3) LINE 12A, I 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 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 ADMIN & CONSULTING NY 501(C)(3) PF AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 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 1 1 0 0