2014-11-13T18:01:07-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2014-11-13 1 BERNARD GROTELL P01275277 2128674000 2013 2015-11-30 17:44:51Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 20312618 0 X WWW.AMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 10 10 240 0 -7949 -7949 0 53431 14643784 19691955 674341 564232 111144 -7949 15429269 20301669 0 0 0 0 8136515 9592019 0 0 0 30552662 33950709 38689177 43542728 -23259908 -23241059 307841309 295627979 427321751 436659480 -119480442 -141031501 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 34989012 19694955 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 34989012 1 1 0 0 0 0 0 0 1 0 1 0 0 1 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 1 207 0 240 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 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 SECRETARY 0.30 0.60 X X 0 0 0 THE REVEREND JAMES G CALLAWAY JR BOARD MEMBER 0.20 0.60 X 0 0 0 ISABEL M CARDEN 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 BOARD MEMBER 0.20 0.60 X 0 0 0 FRANCES R OLIVIERI BOARD MEMBER 0.20 0.60 X 0 0 0 JAMES DAVIS CHIEF EXECUTIVE OFFICER 20.00 30.00 X 0 727704 38667 MARK PANCIRER CHIEF FINANCIAL OFFICER 20.00 30.00 X 0 300345 41638 0 1028049 80305 0 0 1 0 RN EXPRESS STAFFING REGISTRY LLC 71 WEST 23RD STREET SUITE 1622 NEW YORK NY 10010 AGENCY STAFFING 1267623 GREYSTONE DEVELOPMENT COMPANY LP 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 DEVELOPMENT & MARKETING 1203715 GLYNNDEVINS ADVERTISING 1230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING SERVICES 669745 GREYSTONE MANAGEMENT SERVICES COMPANY LL 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 MANAGEMENT ADVISORY SERVICES 563673 AFFINITY REHABILITATION LLP 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 THERAPY COMPANY 528873 12 53431 53431 PRIVATE AND OTHER 623000 17129280 17129280 AMORTIZATION OF NON-REFUNDABLE EN 623000 2498789 2498789 OTHER OPERATING REVENUE 623000 63886 63886 19691955 564232 564232 3000 10949 -7949 -7949 -7949 20301669 19691955 -7949 564232 7316676 6005982 1310694 275207 262041 13166 1347470 1080056 267414 652666 546133 106533 726676 726676 134725 400 134325 99329 99329 2893508 2626306 267202 792346 792346 338146 225942 112204 29459 29459 2543676 2541413 2263 132684 20226 112458 12088078 11900578 187500 26831 24681 2150 8804927 6339549 2465378 117328 117328 DEBT MODIFICATIONS 1801546 1801546 LOC AND REMARKETING FEE 1490587 1490587 DINING SERVICES 911454 911454 SKILLED NURSING AND ENR 784770 784770 234639 111566 123073 43542728 34989012 8553716 0 3802773 2618697 30143155 25823863 2171353 1501593 9129298 10800953 23372 37159 319254 241288 255519973 21321950 239548302 234198023 22703802 20406403 307841309 295627979 3715149 3884646 19913794 23310744 242058815 231149382 267452 4443 161366541 178310265 427321751 436659480 X -119480442 -141031501 -119480442 -141031501 307841309 295627979 X -23241059 1690000 X X 0 1 X 1 0 X X 0 0 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 134034061 7 1 53431 1 53431 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 22353895 22353895 219470315 18183752 201286563 8593946 1418021 7175925 2036219 917012 1119207 3065598 803165 2262433 234198023 ADVERTISING AND MARKETING COSTS 6977003 DEFERRED FINANCING COSTS 13429400 20406403 SUBORDINATE NOTE-ACCHS, INC 3000000 FUTURE SERVICE OBLIGATION 57181000 ACCRUED INTEREST 2319592 REFUNDABLE ENTRANCE FEES 115809673 178310265 X 20312618 10949 10949 20301669 0 20301669 43553677 10949 10949 43542728 0 43542728 PART IV, LINE 2B: CONVERSION DEPOSITS REFUNDABLE REPRESENT DEPOSITS MADE BY POTENTIAL BASED ON TEN% OF THE VALUE OF THE RESIDENTIAL UNIT. PIOR TO OCCUPANCY IN THE COMMUNITY, THESE DEPOSITS ARE FULLY REFUNDABLE, WITH INTERST ACCURING TO THE DEPOSITORS. THEY HAVE BEEN SEGREGATED IN AN INTERST-BEARING ESCROW ACCOUNT ON BEHALF OF EACH POTENTIAL RESIDENT. 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, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 10,949. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 10,949. 0 0 0 0 0 0 0 0 0 JAMES DAVIS CHIEF EXECUTIVE OFFICER 0 507704 0 220000 0 0 0 18402 0 20265 0 766371 0 0 MARK PANCIRER CHIEF FINANCIAL OFFICER 0 242821 0 50000 0 7524 0 18351 0 23287 0 341983 0 0 A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 SEEPARTVI 2007-12-20 271231266 ACQUISITION AND CONSTRUCTION OF FACILITY 0 0 0 A 46030000 287911441 19626266 38536198 5316248 6433406 2094716 216011030 4727520 2011 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 1 LEHMAN BROTHERS 2.700000000000 0 0 1 SEE PART VI 1 1 1 A 0 SCHEDULE K SUPPLENTAL INFORMATION (A) ISSUER NAME: NASSAU COUNTY INDUSTRIAL DEV AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/30/2012 PART I, LINE A, COLUMN C: SERIES A-63166UAF8, SERIES B-63166UAA9, SERIES C-63166UAB7 PART I, LINE A, COLUMN (F)- AQUIRE AND CONTRUCT FACILITY PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART II, LINE 3: THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4-12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. PART IV, COLUMN A, LINE 4B: PROJECT FUND-AEGON, CAPITALIZED INTEREST FUND-EAGON, RESERVE FUND-RBC CAPITAL MARKETS PART IV, COLUMN A, LINE 4C:PROJECT FUND-2.6 YEARS, CAPITALIZED INTEREST FUND-3 YEARS, RESERVE FUND-19.9 YEARS 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 15A 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 KEY EMPLOYEES IS BASED ON AN INFORMAL REVIEW 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 1,690,000. AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY 520014 1687642 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 13510 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0