2016-11-14T17:50:23-06:00 2015-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2015-01-01 133834710 AMSTERDAM NURSING HOME CORP (1992) AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2016-11-14 1 AARON SHAPIRO P01333816 2128674000 2015 2017-02-10 21:41:12Z AMSTERDAM NURSING HOME MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 62560053 0 X AMSTERDAMCARES.ORG X 1995 NY AMSTERDAM NURSING HOME CORP. (1992) (AMSTERDAM) WAS FOUNDED IN 1872 TO PROVIDE A HOME FOR "OLD MEN AND AGED COUPLES; 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, AS WELL 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 CARE REGISTRANTS. AMSTERDAM IS PROUD TO OFFER INDIVIDUALIZED CARE IN A SETTING THAT SUPPORTS THE QUALITY OF LIFE, DIGNITY, AND AUTONOMY OF EACH PERSON THAT IT SERVES. 12 12 597 97 0 0 5009 1365071 58975995 60380596 20608 31142 693292 783244 59694904 62560053 0 0 0 0 31861982 33525416 0 0 0 25697526 26953752 57559508 60479168 2135396 2080885 61537830 62275214 48097073 46763049 13440757 15512165 X TO OPERATE A NOT FOR PROFIT NURSING HOME WITH 409 NURSING FACILITY BEDS AND AN ADULT DAY CARE PROGRAM FOR 40 REGISTRANTS. 0 0 53736170 60380596 AMSTERDAM PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. AMSTERDAM HAS A CAPACITY OF 409 NURSING FACILITY BEDS ALONG WITH AN ADULT DAY CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2015, AMSTERDAM HAD 1,006 ADMISSIONS AND PROVIDED 13,970 ADULT DAY CARE VISITS. AMSTERDAM HAD AN OCCUPANCY RATE OF 97.15 PERCENT IN THE NURSING FACILITY. 53736170 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 1 76 0 597 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X MARK PANCIRER 2125753322 1060 AMSTERDAM AVENUE 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 JR TREASURER 1.00 1.50 X X 0 0 0 JOSE V TORRES SECRETARY 0.30 0.30 X X 0 0 0 REVEREND JAMES G CALLAWAY JR BOARD MEMBER 0.30 0.50 X 0 0 0 DR KAREN M HOPKINS BOARD MEMBER 0.30 0.50 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 R SCOTT EDMONDS BOARD MEMBER 0.30 0.50 X 0 0 0 FRANCES R OLIVIERI 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 BOARD MEMBER 0.50 0.50 X 0 0 0 JAMES DAVIS PRESIDENT/CEO 35.00 15.00 X 459255 168583 44021 MARK PANCIRER SENIOR VP/CFO 42.50 7.50 X 283698 27500 55080 JUDITH FENSTER SENIOR VP/COO 35.00 X 243936 0 19093 GERTRUDES DE GUZMAN DIR. OF NURSING 35.00 X 110606 0 25903 LORNA POON DIRECTOR OF FINANCE 35.00 X 175215 0 24303 MICHAEL WHITE DIRECTOR OF FINANCIAL PLAN & ANALYSIS 30.00 X 203810 0 32410 BEEMAL SINGH NURSING DEPARTMENT 37.50 X 122987 0 13793 GEETHA MURLI DIRECTOR OF PATIENT ACCOUNTS 35.00 X 122049 0 6030 1721556 196083 220633 14 0 1 0 THERADYNAMICS PHY REHAB PC 225 CROSSWAYS PARK DRIVE WOODBURY NY 11797 PHYSICAL THERAPY 3884804 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 3336149 INPATIENT HOSPITALISTS SERV PO BOX 92284 LOS ANGELES CA 90009 PHYSICIAN SERVICES 1068985 PARTNER PHARMACY OF NY LLC PO BOX 11839 NEWARK NJ 07101 PHARMACY 844463 SENIOR RIDE TRANSPORTATION 700 HAVEMEYER AVE BRONX NY 10473 RESIDENT TRANSPORTATION 711844 11 1252071 113000 1365071 PATIENT SERVICE REVENUE 623000 59273135 59273135 UNIVERSAL SETTLEMENT 623000 1107461 1107461 60380596 31142 31142 DISCOUNTS ON PURCHASES 623990 474390 474390 EXPENSE RECOVERY 623990 176245 176245 EMPLOYEE BENEFITS EXPENSE RECOVER 623990 132264 132264 345 345 783244 62560053 60380596 0 814386 X 1105083 1105083 21402079 20141577 1260502 1908014 1839015 68999 7375000 6860350 514650 1735240 1627134 108106 904776 904776 65600 65600 17707 17707 10579500 9835385 744115 2544 1327 1217 6987265 5989229 998036 2472206 1988886 483320 23156 6501 16655 9966 8770 1196 2293502 2018282 275220 721744 635135 86609 NYS ASSESSMENT 2528542 2528542 OTHER 347244 256037 91207 60479168 53736170 6742998 0 X 2318488 2014635 21094273 18520000 10585599 11740025 116920 124831 1403896 1700270 82097926 56344106 24671388 25753820 1347266 2421633 61537830 62275214 6921293 7748092 618560 479006 38593971 36579876 1963249 1956075 48097073 46763049 X 13300678 15404903 140079 107262 13440757 15512165 61537830 62275214 2080885 -9477 0 X X 0 1 X 1 1 1 X 52777 6682692 322216 5009 1365071 8427765 54803742 54781112 56860160 58975995 60380596 285801605 54856519 61463804 57182376 58981004 61745667 294229370 0 0 0 294229370 49330 27462 22513 23622 31142 154069 49330 27462 22513 23622 31142 154069 630695 603200 724854 693292 783244 3435285 55536544 62094466 57929743 59697918 62560053 297818724 0.98790 0.98930 0.00050 0.00070 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: GIFT CART MILLERINN RECOVERY OF EXPENSE PHONE VENDING MACHINE DISCOUNT ON PURCHASES MISCELLANEOUS STAR PROGRAM DIRECT TV FEES SECURITY RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 17707 17707 0 PART II-B, LINE 1: DUES AND OR FEES PAID TO THE FOLLOWING ORGANIZATIONS THAT HAD LOBBYING EXPENSES: 1199/SEIU HEP - $421, NY PRESBYTERIAN - $233, CCLC - $1,303, AND BOLTON-ST.JOHN - $15,750. 0 618560 139554 479006 1 X 1432917 1432917 51080239 39632260 11447979 102698 89644 13054 20943669 16550744 4392925 8538403 71458 8466945 25753820 DUE TO THIRD PARTIES 1832923 ACCRUED INTEREST PAYABLE 123152 1956075 X 62550576 -9477 -9477 62560053 0 62560053 60479168 0 60479168 0 60479168 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 FAMILIES. PART X, LINE 2: THE HOME HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2012 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X X X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS PRESIDENT/CEO 459255 48583 0 120000 0 0 19110 0 24911 0 503276 168583 18720 0 MARK PANCIRER SENIOR VP/CFO 226174 27500 50000 0 7524 0 19110 0 35970 0 338778 27500 18700 0 JUDITH FENSTER SENIOR VP/COO 218207 0 25000 0 729 0 14964 0 4129 0 263029 0 14506 0 LORNA POON DIRECTOR OF FINANCE 164884 0 10000 0 331 0 10484 0 13819 0 199518 0 10177 0 MICHAEL WHITE DIRECTOR OF FINANCIAL PLAN & ANALYSI 197302 0 5000 0 1508 0 13886 0 18524 0 236220 0 13600 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S OFFICERS BASED ON PERFORMANCE. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WILL BE PROVIDED TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENTS AND TO THE FULL BOARD PRIOR TO BEING FILED. 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 BECOMES AWARE OF THE POTENTIAL FOR A CONFLICT IN CONNECTION WITH THE TRANSACTION, WHO 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 15 AMSTERDAM HAS A PROCESS TO DETERMINE COMPENSATION FOR THE CEO 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 LAST UNDERTAKEN IN 2015. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS BASED ON AN INFORMAL REVIEW BY THE PRESIDENT/CEO OF COMPARABLE DATA. 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 IX, LINE 11G NURSING HOME CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 9,835,385. MANAGEMENT AND GENERAL EXPENSES 744,115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,579,500. FORM 990, PART X, LINE 15 OTHER RECEIVABLES $43,155 OTHER ASSETS $144,035 DUE FORM THIRD PARTY PAYOR $2,234,440 SUBVENTION CERTIFICATE FROM $3 TOTAL-OTHER ASSETS $2,421,633 FORM 990, PART XII, LINE 2C: AMSTERDAM 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 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES NY 453817 2365573 N/A AMSTERDAM SERVICES CORP 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES TO HEALTHCARE FACILITIES NY 501(C)(3) 9 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEMS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADVICE, INFORMATION & MONETARY CONTRIBUTIONS TO ELDERLY & DISABLED NY 501(C)(3) 7 N/A 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE NY 501(C)(3) 9 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 N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0