2022-11-09T11:43:21-06:00 2021-12-31 271728945 PKF O'CONNOR DAVIES LLP 500 MAMARONECK AVENUE SUITE 301 HARRISON NY 105281633 990 2021-01-01 134034061 AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2022-11-09 1 MARK PANCIRER XXX-XX-XXXX EVA MRUK P00543254 9143818900 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JAMES DAVIS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 474193 0 X N/A X 1997 NY THE PURPOSES OF ACCHS INCLUDE THE PROVISION OF ADVISORY AND OTHER SUPPORT TO INDEPENDENT NOT-FOR-PROFIT ORGANIZATIONS DEVOTED TO THE PROVISION OF HEALTH CARE, HOUSING AND SERVICES TO THE ILL , THE IMPAIRED, THE DISABLED, AND THE ELDERLY. X 11 11 2 11 0 0 242830 130230 333811 315589 25145 2124 1196 -4658 602982 443285 10347 3365187 0 0 143747 145529 0 0 0 76739 259983 230833 3770699 372149 -3327414 5776766 2457362 2267600 2275958 3509166 181404 THE PURPOSES OF ACCHS INCLUDE THE PROVISION OF ADVISORY AND OTHER SUPPORT TO INDEPENDENT NOT-FOR-PROFIT ORGANIZATIONS DEVOTED TO THE PROVISION OF HEALTH CARE, HOUSING AND SERVICES TO THE ILL, THE IMPAIRED, THE DISABLED, AND THE ELDERLY. 0 0 3510716 3365187 315589 SUPPORT SERVICES TO RELATED FACILITY-BASED LONG-TERM CARE SERVICE PROVIDERS 3510716 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1 5 0 2 1 0 0 0 0 0 1 1 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 0 1 1 0 NY X X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 JOSEPH C HOOPES JR CHAIRMAN & TREASURER 1.00 4.25 X X 0 0 0 FRANCES R OLIVIERI VICE CHAIRMAN 0.30 1.50 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.30 1.75 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.80 X X 0 0 0 REV CANON JAMES CALLAWAY JR DIRECTOR 0.30 1.10 X 0 0 0 JAMES C CAMPBELL DIRECTOR 0.30 1.10 X 0 0 0 ISABEL M CARDEN DIRECTOR 0.30 1.10 X 0 0 0 R SCOTT EDMONDS DIRECTOR 0.30 1.10 X 0 0 0 DR KAREN M HOPKINS DIRECTOR 0.30 1.10 X 0 0 0 JAY H MCDOWELL DIRECTOR 0.30 1.35 X 0 0 0 LANGDON VAN NORDEN DIRECTOR 0.30 1.10 X 0 0 0 JAMES DAVIS PRESIDENT/ CEO 2.00 58.00 X 106750 843415 51032 MARK PANCIRER SR. VP. / CFO 2.00 58.00 X 30888 250569 48178 137638 1093984 99210 1 0 1 0 MORITT HOCK & HAMROFF LLP 1407 BROADWAY 39TH FLOOR NEW YORK NY 10018 LEGAL SERVICES 118364 1 103450 26780 25000 130230 MANAGEMENT SERVICES 561000 315589 315589 315589 2124 2124 26250 103450 30908 -4658 -4658 443285 315589 0 -2534 3359285 3359285 5902 5902 135000 135000 10529 10529 144561 144561 18000 18000 68000 68000 4803 4803 7399 7399 11924 11924 5296 5296 3770699 3510716 259983 0 198262 159553 4983785 2094267 140 705 53721 11924 0 41797 121594 121594 472985 39446 5776766 2457362 0 8358 2267600 2267600 2267600 2275958 X 3509166 181404 3509166 181404 5776766 2457362 -3327414 -347 -1 0 X X 0 1 X 1 0 X 330261 295590 323748 242830 130230 1322659 330261 295590 323748 242830 130230 1322659 561277 761382 65922 78385 92710 25145 2124 264286 1196 1196 1588141 1702971 0.47940 0.47120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 53721 11924 41797 41797 SUBVENTION - SUBORDINATE NOTE 2267600 2267600 X 110258010 -347 113489946 113489599 -3231589 3674874 3674874 443285 34867111 35000073 35000073 -132962 3903661 3903661 3770699 PART X, LINE 2: THE HEALTH SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE ENTITY HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HEALTH SYSTEM IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO DECEMBER 31, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM RELATED ORGANIZATIONS 113,489,946. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS 3,674,874. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM RELATED ORGANIZATIONS 35,000,073. PART XII, LINE 4B - OTHER ADJUSTMENTS: ELIMINATIONS 3,903,661. ANNUAL GOLF OUTING 129700 103450 26250 24295 6613 129700 103450 26250 24295 6613 30908 -4658 1 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 300 E OVERLOOK PORT WASHINGTON NY 11050 113711764 501(C)(3) 3359285 0 GENERAL SUPPORT 1 0 CHILDREN'S SUMMER PROGRAM FUNDING AWARDS 6 5902 PART I, LINE 2: GRANTS TO ORGANIZATIONS: THE HEALTH SYSTEM GAVE A CONTRIBUTION TO A RELATED ORGANIZATION, AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. THE ORGANIZATIONS HAVE OVERLAPPING MANAGEMENT AND BOARD MEMBERS, WHICH IS HOW THE HEALTH SYSTEM ENSURES THAT THE ORGANIZATION WILL USE THE FUNDS FOR THE INTENDED PURPOSE. THE HEALTH SYSTEM ALSO REQUIRES SUFFICIENT DOCUMENTATION FROM THE GRANTEE PRIOR TO REIMBURSEMENT OF EXPENDITURES. CHILDREN'S SUMMER PROGRAM FUNDING AWARDS: THE DR. AND MRS. F. LANDMAN SUMMER SCHOLARSHIP FUND IS AVAILABLE TO THE BIOLOGICAL, ADOPTED, OR FOSTER CHILDREN AND STEPCHILDREN OF EMPLOYEES OF AMSTERDAM NURSING HOME AND THE AMSTERDAM AT HARBORSIDE, WHO HAVE WORKED FOR AMSTERDAM FOR A MINIMUM OF THREE YEARS. CHILDREN MUST BE 25 YEARS OLD OR YOUNGER AND MUST USE THE FUNDING TO SUPPORT SUMMER LEARNING EXPERIENCES, INCLUDING EDUCATIONAL, TRAINING, AND RECREATIONAL SUMMER PROGRAMS, CAMPS, AND OTHER DEVELOPMENTAL OPPORTUNITIES. GRANTEES WILL BE REQUIRED TO SUBMIT EVIDENCE OF THE USE OF THE FUNDS. X X X 0 0 0 0 0 0 0 0 0 JAMES DAVIS PRESIDENT/ CEO 105000 830915 0 0 1750 12500 0 12969 0 38063 106750 894447 0 0 MARK PANCIRER SR. VP. / CFO 30000 250569 0 0 888 0 0 12969 0 35209 30888 298747 0 0 RESTRUCTURING CASH GRANT 2021-09-08 3359285 BOOK VALUE 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 300 E OVERLOOK PORT WASHINGTON NY 11050 501(C)(3) 1 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: (A) GEORGE L. VAN AMSON, JOSEPH C HOOPES, JR., REV. CANON JAMES G. CALLAWAY, JR., ISABEL M. CARDEN, JAY H. MCDOWELL, JAMES C. CAMPBELL, DR. KAREN M. HOPKINS, FRANCES R. OLIVIERI, R. SCOTT EDMONDS, LAGDON VAN NORDEN(B) JAMES DAVIS AND MARK PANCIRER PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: (A) THE ABOVE BOARD MEMBERS ARE ALSO BOARD MEMBERS OF THE TRANSFEREE ORGANIZATION.(B) THE ABOVE OFFICERS AND EMPLOYEES ARE ALSO OFFICERS AND EMPLOYEES OF THE TRANSFEREE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B AMSTERDAM CONTINUING CARE HEALTH SYSTEM, 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 AND REVIEWED BY THE AUDIT COMMITTEE. ANY ISSUES ARE REVIEWED AND CORRECTED. THE CFO THEN MAKES THE FULL 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 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. EXECUTIVE EMPLOYEES ARE ALSO REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST ON AN ANNUAL BASIS OR SOONER IF A POTENTIAL CONFLICT OR ACTUAL CONFLICT SHOULD ARISE. FORM 990, PART VI, SECTION B, LINE 15 ACCHS 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. 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 SEPTEMBER 2019 FOR THE YEAR 2020, AND THEN IN 2021 FOR THE YEAR 2021 AND FUTURE YEARS. ACCHS 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. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION BY THE PRESIDENT/CEO AND ARE DOCUMENTED IN WRITING. THIS PROCESS WAS LAST UNDERTAKEN IN 2020, AS THERE WAS NO CHANGE IN COMPENSATION IN 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 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 XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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