2018-10-26T09:00:35-05:00 2017-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2017-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP AND CFO 2125753322 2018-10-25 1 AARON SHAPIRO P01333816 2128674000 64.22.227.161 2018-10-26 09:54:05 ED P 4275C7E7C8129915C35F764424C97B97C01C68F2 82FF71277CCFCE0526AA11C39E3CDADE20CEB2CB 2017 2018-06-14 16:35:46Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 26848472 0 X WWW.THEAMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE. 13 13 203 16 13662 7570 47467 59563 25016470 26577083 140324 181826 18322 13662 25222583 26832134 0 0 0 0 8601851 8893771 0 0 0 31308429 30749975 39910280 39643746 -14687697 -12811612 263120595 243525827 450975829 443391495 -187855234 -199865668 X AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. (AHCCRC, INC.) UNDERTOOK A PROJECT INVOLVING ACQUISITION, CONSTRUCTION, FURNISHING, AND EQUIPPING OF A NEW CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE AMSTERDAM AT HARBORSIDE, LOCATED IN PORT WASHINGTON, NEW YORK, WHICH INCLUDES: 229 INDEPENDENT LIVING APARTMENTS (THE "RESIDENTIAL UNITS"), 26 ENRICHED HOUSING UNITS AND 18 SPECIAL NEEDS ASSISTED LIVING UNITS (THE "ENRICHED HOUSING CENTER"), 56 SKILLED NURSING BEDS (THE "NURSING CENTER") AND RELATED COMMON AREAS AND AMENITIES AND RELATED INFRASTRUCTURE (COLLECTIVELY, THE "COMMUNITY"). 0 0 34736214 26577083 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE. 34736214 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 247 0 203 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 1 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 AVE NEW YORK NY 10025 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 JAY H MCDOWELL ESQ SECRETARY 0.30 0.50 X X 0 0 0 R SCOTT EDMONDS BOARD MEMBER 0.30 0.50 X 0 0 0 LAWRENCE H BOBER BOARD MEMBER 0.30 0.50 X 0 0 0 FRANCES R OLIVIERI BOARD MEMBER 0.30 0.50 X 0 0 0 RHODA FINER BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES J CAMPBELL BOARD MEMBER 0.30 0.50 X 0 0 0 ISABEL M CARDEN MBE BOARD MEMBER 0.50 0.50 X 0 0 0 THE REVEREND JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.50 X 0 0 0 KAREN HOPKINS MD BOARD MEMBER 0.30 0.50 X 0 0 0 THE REVEREND DEACON FRANK L PETERSO BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES DAVIS PRESIDENT/CEO 35.00 15.00 X 0 765700 105722 MARK PANCIRER SENIOR VICE PRESIDENT/CFO 42.50 7.50 X 0 326762 77111 SAMI GUEDOUAR EXECUTIVE DIRECTOR 40.00 X 265773 0 51104 LUCILLE MANSFIELD DIRECTOR OF FINANCE 40.00 X 129101 0 36627 JENNIFER FABER ADMINISTRATOR 40.00 X 104011 0 13849 498885 1092462 284413 3 0 1 0 RN EXPRESS STAFFING REGISTRY LLC 71 WEST 23RD ST SUITE 1622 NEW YORK NY 10010 AGENCY STAFFING 1684297 GREYSTONE DEVELOPMENT COMPANY II LP 225 E JOHN CARPENTER FWY IRVING TX 75062 FINANCIAL & MARKETING ADVISORY 1095856 THERADYNAMICS 225 CROSSWAYS PK DR WOODBURY NY 11797 THERAPY SERVICES 597149 AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVE NEW YORK NY 10025 CONSULTING AND MANAGEMENT 370166 GLYNNDEVINS ADVERTISING 8880 WARD PKWY STE 400 KANSAS CITY MO 64114 ADVERTISING 255600 21 56956 2607 59563 PRIVATE AND OTHER 623000 21599346 21599346 AMORTIZATION OF NON-REFUNDABLE EN 623000 4790577 4790577 OTHER OPERATING REVENUE 623000 187160 187160 26577083 181826 181826 30000 16338 13662 13662 13662 26832134 26577083 13662 181826 X 316877 316877 6533282 5749685 783597 85863 75467 10396 1395298 1156342 238956 562451 472378 90073 834334 834334 164575 164575 71882 71882 20000 20000 4185447 4032672 152775 368634 58067 310567 476279 311714 164565 28080 28080 2094000 2094000 22031 9308 12723 11463047 11249297 213750 8352689 6863693 1488996 224160 224160 FOOD 1164466 1164466 REPAIRS AND MAINTENANCE 578910 578231 679 SKILLED NURSING 399840 399840 301601 296894 4707 39643746 34736214 4907532 0 2734053 3196474 26387392 20012958 706298 708746 6338574 11652 8734 259730 193570 258499022 47373630 217028518 211125392 7148442 7263013 2505936 1016940 263120595 243525827 2316117 2497008 26660861 26594491 224246235 212289701 177620 107250 197574996 201903045 450975829 443391495 X -187855234 -199865668 -187855234 -199865668 263120595 243525827 X -12811612 -76822 878000 X X 0 1 X 1 0 X X 2 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 134034061 7 1 0 0 AMSTERDAM CONSULTING LLC 134034061 7 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 22353895 22353895 229782086 43637443 186144643 6218169 3736187 2481982 144872 144872 211125392 SUBORDINATE NOTE-ACCHS, INC 3000000 FUTURE SERVICE OBLIGATION 40514000 ACCRUED INTEREST 3104592 REFUNDABLE ENTRANCE FEES 155284453 201903045 X 26751650 -76822 16338 -60484 26812134 20000 20000 26832134 39640084 16338 16338 39623746 20000 20000 39643746 PART IV, LINE 2B: SECURITY DEPOSITS HELD IN TRUST ARE MAINTAINED IN A SEPERATE INTEREST-BEARING BANK ACCOUNT. PART X, LINE 2: AHCCRC, INC. HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2014 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 16,338. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 16,338. 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 0 617616 0 140000 0 8084 0 79212 0 26510 0 871422 0 0 MARK PANCIRER SENIOR VICE PRESIDENT/CFO 0 271592 0 50000 0 5170 0 43212 0 33899 0 403873 0 0 SAMI GUEDOUAR EXECUTIVE DIRECTOR 230661 0 25000 0 10112 0 15408 0 35696 0 316877 0 0 0 LUCILLE MANSFIELD DIRECTOR OF FINANCE 125185 0 3249 0 667 0 27738 0 8889 0 165728 0 0 0 PART I, LINE 7 THE PRESIDENT/CEO GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S EXECUTIVE DIRECTOR & DIRECTOR OF FINANCE BASED ON THEIR PERFORMANCE. A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 SEEPARTVI 2014-11-28 224965160 REFUND PRIOR ISSUE (12/20/07) 0 0 0 A 16292185 224965160 19241305 224965160 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 1 0 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION PART I, LINE A, COLUMN (C) - SERIES A - 63166UAM3, SERIES B - 63166UAP6, SERIES C - 63166UAQ4 PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE THE TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. FORM 990, PART VI, SECTION A, LINE 2 LAWRENCE B. THOMPSON AND R. SCOTT EDMONDS ARE PARTNERS IN THE SAME BUSINESS FIRM. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE. THE CFO MAKES THE 990 AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. 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 THEN 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 15 COMPENSATION FOR KEY EMPLOYEES (SAMI GUEDOUAR) IS BASED ON AN INFORMAL REVIEW BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF COMPARABLE DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON ON THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE AT HTTP://EMMA.MSRB.ORG/. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 700,845. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 700,845. SKILLED NURSING AND ENRICHED HOUSING: PROGRAM SERVICE EXPENSES 2,935,111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,935,111. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 257,944. MANAGEMENT AND GENERAL EXPENSES 148,970. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 406,914. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 105,513. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,513. PAYROLL PROCESSING: PROGRAM SERVICE EXPENSES 33,259. MANAGEMENT AND GENERAL EXPENSES 3,805. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,064. FORM 990, PART XI, LINE 9: FUTURE SERVICE OBLIGATION ADJUSTMENT 878,000. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMSTERDAM SERVICES CORP 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES TO HEALTHCARE FACILITIES NY 501(C)(3) LINE 10 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEMINC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADVICE, INFORMATION & MONETARY CONTRIBUTIONS TO ELDERLY & DISABLED NY 501(C)(3) LINE 7 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM NURSING HOME CORP (1992) 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133834710 PROVIDING SKILLED NURSING HOME BEDS AND ADULT DAY CARE SERVICES FOR SENIORS NY 501(C)(3) LINE 10 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 AMSTERDAM CONTINUING CARE HEALTH SYSTEM C 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0