2015-11-12T17:32:56-06:00 2014-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2014-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2015-11-11 1 ERIC GOLDFARB P01277125 2128674000 2014 2016-02-25 16:41:14Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 23510392 0 X WWW.AMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 11 11 218 11 0 -8518 53431 115091 19691955 23039700 564232 355601 -7949 0 20301669 23510392 0 0 0 0 9592019 9251471 0 0 0 33950709 33728988 43542728 42980459 -23241059 -19470067 295627979 271035788 436659480 435408726 -141031501 -164372938 X AHCCRC, INC. HAS UNDERTAKEN 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: 226 INDEPENDENT LIVING APARTMENTS (THE RESIDENTIAL UNITS), 26 ENRICHED HOUSING UNITS AND 18 ENRICHED HOUSING WITH DEMENTIA UNITS (THE ENRICHED HOUSING CENTER), 56 SKILLED NURSING BEDS (THE NURSING CENTER) AND RELATED COMMON AREAS AND AMENITIES AND RELATED INFRASTRUCTURE (COLLECTIVELY, THE COMMUNITY). CONSTRUCTION BEGAN IN JANUARY 2008 AND WAS COMPLETED IN JANUARY 2011. AHCCRC, INC. PLANS TO ADD THREE INDEPENDENT LIVING APARTMENTS, PENDING APPROVAL. INITIAL OCCUPANCY OCCURRED IN AUGUST 2010. 0 0 39041775 23039700 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 39041775 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 1 211 0 218 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 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 0.60 X X 0 0 0 THE REVEREND JAMES G CALLAWAY DD BOARD MEMBER 0.20 0.60 X 0 0 0 ISABEL M CARDEN MBE BOARD MEMBER 0.20 0.80 X 0 0 0 REV DEACON FRANK L PETERSON JR BOARD MEMBER 0.20 0.60 X 0 0 0 JAMES J CAMPBELL BOARD MEMBER 0.20 0.60 X 0 0 0 DR KAREN M HOPKINS MD BOARD MEMBER 0.20 0.60 X 0 0 0 FRANCES R OLIVIERI BOARD MEMBER 0.20 0.60 X 0 0 0 R SCOTT EDMONDS BOARD MEMBER 0.20 0.60 X 0 0 0 JAMES DAVIS CHIEF EXECUTIVE DIRECTOR 20.00 30.00 X 0 605242 42790 MARK PANCIRER CHIEF FINANCIAL OFFICER 20.00 30.00 X 0 255498 49509 SAMI GUEDOUAR EXECUTIVE DIRECTOR 40.00 X 165361 0 0 SARAH GILROY SALES AND MARKETING DIRECTOR 40.00 X 149272 0 0 ANATOLY VEKSLER HEALTH CARE ADMINISTRATOR 40.00 X 119277 0 0 LUCILLE MANSFIELD DIRECTOR OF FINANCE 40.00 X 114010 0 0 EILEEN FASULO DIRECTOR OF NURSING 40.00 X 110876 0 0 MARY DONOVAN MARKETING DIRECTOR 40.00 X 101892 0 0 760688 860740 92299 6 0 1 0 CADWALADER WICKERSHAM & TAFT LLP ONE WORLD FINANCIAL CENTER NEW YORK NY 10281 LEGAL SERVICES 1973017 RN EXPRESS STAFFING REGISTRY LLC 71 WEST 23RD STREET SUITE 1622 NEW YORK NY 10010 AGENCY STAFFING 1664593 GREYSTONE DEVELOPMENT COMPANY LP 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 DEVELOPMENT & MARKETING 1549022 GLYNNDEVINS ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 ADVERTISING SERVICES 807747 GRANT THORNTON LLP 33562 TREASURY CENTER CHICAGO IL 60694 PROFESSIONAL SERVICES 766930 21 115091 115091 PRIVATE AND OTHER 623000 19696233 19696233 AMORTIZATION OF NON-REFUNDABLE EN 623000 3209514 3209514 OTHER OPERATING REVENUE 623000 133953 133953 23039700 355601 355601 23510392 23039700 0 355601 169621 169621 6661749 5871386 790363 1897501 1445922 451579 522600 449161 73439 715753 715753 63308 2924 60384 55060 55060 3399063 3322714 76349 852546 7748 844798 478228 414105 64123 31569 31569 1785151 1785151 82966 984 81982 14335700 14148200 187500 8465899 8465899 207834 207834 FOOD 1004876 1004876 SKILLED NURSING AND ENR 642570 642570 REPAIRS AND MAINTENANCE 401946 399413 2533 LOC AND REMARKETING FEE 264896 264896 941623 607992 333631 42980459 39041775 3938684 0 2618697 1203126 25823863 21895468 1501593 879268 10800953 7449423 37159 14743 241288 133147 255920064 27748636 234198023 228171428 20406403 11289185 295627979 271035788 3884646 3420880 23310744 24730530 231149382 226549385 4443 178310265 180707931 436659480 435408726 X -141031501 -164372938 -141031501 -164372938 295627979 271035788 X -19470067 -3871370 X X 0 1 X 1 0 X X 2 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 134034061 7 1 33940 0 AMSTERDAM CONSULTING LLC 134034061 7 1 81151 0 2 115091 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 22353895 22353895 219558791 23686710 195872081 8601504 1848070 6753434 2094162 1095218 998944 3311712 1118638 2193074 228171428 SUBORDINATE NOTE-ACCHS, INC 3000000 FUTURE SERVICE OBLIGATION 47936000 ACCRUED INTEREST 2507092 REFUNDABLE ENTRANCE FEES 127189035 DUE TO THIRD PARTIES 75804 180707931 X 23510392 0 23510392 0 23510392 42980459 0 42980459 0 42980459 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, 2011 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 0 0 0 0 0 0 0 1 0 JAMES DAVIS CHIEF EXECUTIVE DIRECTOR 0 605242 0 0 0 0 0 18402 0 24388 0 648032 0 0 MARK PANCIRER CHIEF FINANCIAL OFFICER 0 255498 0 0 0 0 0 18351 0 31158 0 305007 0 0 SAMI GUEDOUAR EXECUTIVE DIRECTOR 148198 0 10000 0 7163 0 0 0 0 0 165361 0 0 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S CEO & CFO. A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 SEEPARTVI 2014-11-28 224965160 REFUND PRIOR ISSUE (12/20/07) 0 0 0 A 224965160 15269259 224965160 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 1 LEHMAN BROTHERS 2.700000000000 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 1-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. 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 11 A COPY OF THE FORM 990 AS PREPARED BY LOEB & TROPER LLP, ACCOUNTING FIRM, IS PROVIDED TO THE AUDIT COMMITTEE FOR REVIEW AND COMMENTS AND TO THE FULL BOARD 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 AMSTERDAM HEALTH SYSTEMS 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 2013. 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 FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON ON THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE AT HTTP://EMMA.MSRB.ORG/ FORM 990, PART XI, LINE 9: FUTURE SERVICE OBLIGATION ADJUSTMENT 9,245,000. WRITE-OFF OF DEFERRED FINANCING COSTS -12,935,770. WRITE-OFF OF ORIGINAL ISSUE DISCOUNT -180,600. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY AMSTERDAM CONTINUING CARE HEALTH SYSTEMINC 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 SYSTEMINC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADVICE, INFORMATION & MONETARY CONTRIBUTIONS TO ELDERLY & DISABLED NY 501(C)(3) 9 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) 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 AMSTERDAM CONTINUING CARE HEALTH SYSTEM C 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0