2017-11-06T05:49:29-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 134034061 AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2017-11-03 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-03 15:31:36 ED P D7076C0EC39B17C3336BFEA465ABF20A32036F2A 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2021-01-29 14:40:06Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 776489 0 X WWW.AMSTERDAMCARES.ORG X 1997 NY THE PURPOSE OF THE ORGANIZATION IS TO OBTAIN CONTRIBUTIONS, GRANTS AND HOLD FUNDRAISING EVENTS TO SUPPORT THE PROGRAMS AND SERVICES PROVIDED TO THE RESIDENTS OF THE AMSTERDAM NURSING HOME AND THE AMSTERDAM AT HARBORSIDE OR FOR ANY OTHER PURPOSE THAT ENHANCES THE OVERALL MISSION OF THE ORGANIZATION TO SERVE SENIOR CITIZENS. 12 12 2 12 0 0 313370 216825 438478 438478 35234 83121 0 0 787082 738424 156276 34056 0 0 266279 154735 0 0 0 6769 63328 429324 252119 357758 486305 3370470 3856775 2267600 2267600 1102870 1589175 X THE PURPOSE OF THE ORGANIZATION IS TO OBTAIN CONTRIBUTIONS, GRANTS AND HOLD FUNDRAISING EVENTS TO SUPPORT THE PROGRAMS AND SERVICES PROVIDED TO THE RESIDENTS OF THE AMSTERDAM NURSING HOME AND THE AMSTERDAM AT HARBORSIDE OR FOR ANY OTHER PURPOSE THAT ENHANCES THE OVERALL MISSION OF AMSTERDAM TO SERVE SENIOR CITIZENS. 0 0 123404 34056 438478 SUPPORT OF SERVICES FOR THE ELDERLY 123404 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 2 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 NY X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 LAWRENCE B THOMPSON CHAIRMAN 1.00 4.00 X X 0 0 0 GEORGE L VAN AMSON VICE CHAIRMAN 0.30 1.00 X X 0 0 0 JOSEPH C HOOPES JR TREASURER 0.50 2.00 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.30 X X 0 0 0 REV JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.50 X 0 0 0 ISABEL M CARDEN BOARD MEMBER 0.30 0.70 X 0 0 0 JAY H MCDOWELL BOARD MEMBER 0.30 0.60 X 0 0 0 REV DEACON FRANK L PETERSON JR BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES C CAMPBELL BOARD MEMBER 0.30 0.50 X 0 0 0 DR KAREN M HOPKINS BOARD MEMBER 0.30 0.50 X 0 0 0 FRANCES R OLIVIERI BOARD MEMBER 0.30 0.50 X 0 0 0 R SCOTT EDMONDS BOARD MEMBER 0.30 0.50 X 0 0 0 JAMES DAVIS PRESIDENT/CEO 2.00 48.00 X 52999 4035317 45111 MARK PANCIRER SENIOR VP/CFO 0.50 49.50 X 30000 287181 48084 82999 4322498 93195 0 0 1 0 0 150595 66230 216825 MANAGEMENT SERVICES 561000 438478 438478 438478 83121 83121 38065 150595 38065 0 738424 438478 0 83121 34056 34056 82999 82999 55230 55230 5932 5932 10574 6349 4225 48921 48921 8155 8155 6252 6252 252119 123404 128715 0 389825 461796 2751598 3192380 183 1039 121594 121594 107270 79966 3370470 3856775 2267600 2267600 2267600 2267600 X 1102870 1589175 1102870 1589175 3370470 3856775 486305 0 X X 0 1 X 1 0 X 254050 308189 452965 313370 216825 1545399 254050 308189 452965 313370 216825 1545399 433915 1111484 14381 14759 32948 35234 83121 180443 100000 100000 1825842 2225923 0.60880 0.65500 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 SUBVENTION -SUBORDINATE NOTE-ANH, CORP. 2267600 2267600 X PART X, LINE 2: AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC. (HEALTH SYSTEM) HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. ANNUAL GOLF OUTING 188660 150595 38065 31729 6336 188660 150595 38065 31729 6336 38065 0 1 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 501(C)(3) 34056 REIMBURSEMENT PAID TO RELATED ORGANIZATION FOR EXPENSES 1 0 PART I, LINE 2: THE ORGANIZATION REQUIRES SUFFICIENT DOCUMENTATION FROM THE GRANTEE PRIOR TO REIMBURSEMENT OF EXPENDITURES. X X X X X X 0 0 0 0 0 0 0 0 0 JAMES DAVIS PRESIDENT/CEO 52999 456936 0 0 0 3578381 0 19110 0 26001 52999 4080428 0 19110 MARK PANCIRER SENIOR VP/CFO 30000 229657 0 50000 0 7524 0 19110 0 28974 30000 335265 0 19110 PART II, LINE 1 (II), COL. (III): THE BOARD OF DIRECTORS OF AMSTERDAM NURSING HOME CORP. (1992) RECOGNIZED THE NEARLY THREE DECADES OF DISTINGUISHED SERVICE BY ITS PRESIDENT AND CHIEF EXECUTIVE OFFICER BY AUTHORIZING A SUPPLEMENTAL RETIREMENT BENEFIT. THE ORGANIZATION ENTERED INTO A WRITTEN AGREEMENT PROVIDING FOR A LUMP SUM SUPPLEMENTAL RETIREMENT PAYMENT OF $3,575,000 TO MAKE THE PRESIDENT AND CHIEF EXECUTIVE OFFICER'S OVERALL COMPENSATION PACKAGE COMPETITIVE WITH PEER ORGANIZATIONS AND TO ENCOURAGE THE PRESIDENT AND CHIEF EXECUTIVE OFFICER TO CONTINUE HIS EMPLOYMENT, TAKING INTO ACCOUNT THE ADVICE OF AN INDEPENDENT COMPENSATION CONSULTANT RETAINED TO ASSESS REASONABLE COMPENSATION BASED ON COMPARABLE MARKET DATA. FORM 990, PART VI, SECTION A, LINE 2 TWO MEMBERS OF THE BOARD OF DIRECTORS 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 FOR REVIEW.THE CFO MAKES THE 990 AVAIABLE 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 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 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. SAID CONFLICTS ARE ADDRESSED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION HAS A PROCESS TO DETERMINE COMPENSATION AND BONUS FOR THE OFFICERS 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 UNDERTAKEN IN 2015 FOR THE YEAR 2016. 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. FORM 990, PART XII, LINE 2C: HEALTH SYSTEM 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 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY 438480 2742480 N/A AMSTERDAM SERVICE 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 1 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 7 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 1 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 PROVIDING INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE NY 501(C)(3) LINE 12A, I AMSTERDAM CONTINUING CARE HEALTH SYSTEM 1 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 13208 1.00000 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY B 156276 ACTUAL COST AMSTERDAM NURSING HOME CORP (1992) E 2267600 ACTUAL COST