2014-11-13T18:01:53-06:00 2013-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2013-01-01 134034061 AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER SENIOR VP/CFO 2125753322 2014-11-12 1 BERNARD GROTELL P01275277 2128674000 2013 2015-11-30 17:44:51Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 871440 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 AMSTERDAM TO SERVE SENIOR CITIZENS. 11 11 2 11 0 0 254050 308189 405900 517360 14318 14759 0 0 674268 840308 0 53431 0 0 428506 486651 6000 7500 78211 59434 7849 493940 555431 180328 284877 2392408 2677285 2267600 2267600 124808 409685 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 394209 53431 517360 SUPPORT OF SERVICES FOR THE ELDERLY 394209 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 2 0 2 1 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 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 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 BOARD MEMBER 0.30 0.50 X 0 0 0 DYER S WADSWORTH BOARD MEMBER 0.30 0.30 X 0 0 0 JAMES J 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 JAMES DAVIS PRESIDENT/CEO 8.50 41.50 X 329996 397708 38667 MARK PANCIRER SENIOR VP/ CFO 1.50 48.50 X 30000 270345 41638 359996 668053 80305 1 0 1 0 0 137368 170821 308189 MANAGEMENT SERVICES TO 561000 417360 417360 CONSULTING SERVICES 561000 100000 100000 517360 14759 14759 31132 137368 31132 0 840308 517360 0 14759 53431 53431 391724 313379 13319 65026 53300 53300 41627 27399 8543 5685 7500 7500 2615 2615 4827 4827 407 407 555431 394209 83011 78211 2202339 2427600 4828 7053 121594 121594 63647 121038 2392408 2677285 2267600 2267600 2267600 2267600 X 124808 409685 124808 409685 2392408 2677285 284877 0 X X 0 1 X 1 0 X 263457 208147 221889 254050 308189 1255732 263457 208147 221889 254050 308189 1255732 426158 829574 19430 9344 11629 14381 14759 69543 7778 9124 16902 2895 1376 1362 405900 517360 928893 2271070 517360 0.36530 0.38290 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISC INCOME - 2009 AMOUNT: $ 2,895. 2010 AMOUNT: $ 1,376. 2011 AMOUNT: $ 1,362. MANAGEMENT SERVICE INCOME - 2012 AMOUNT: $ 405,900. 2013 AMOUNT: $ 417,360. CONSULTING SERVICE INCOME - 2013 AMOUNT: $ 100,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 SUBVENTION -SUBORDINATE NOTE-ACCHS, INC 2267600 2267600 X PART X, LINE 2: UNCERTAINTY IN INCOME TAXES - 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, 2010 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. X X ANNUAL GOLF OUTING 168500 137368 31132 17653 9592 3887 168500 137368 31132 17653 9592 3887 31132 0 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 501(C)(3) 53431 REIMBURSEMENT PAID TO RELATED ORGANIZATION FOR EXPENSES 1 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 1 0 JAMES DAVIS PRESIDENT/CEO 264996 242708 65000 155000 0 0 0 18402 0 20265 329996 436375 0 0 MARK PANCIRER SENIOR VP/ CFO 30000 212821 0 50000 0 7524 0 18351 0 23287 30000 311983 0 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S CEO AND CFO. 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 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,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 THE ORGANIZATION HAS A PROCESS TO DETERMINE COMPENSATION FOR THE CEO/ EXECUTIVE DIRECTOR 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. THIS PROCESS INCLUDES A REVIEW OF TOTAL COMPENSATION INCLUDING BONUS CONSIDERATION. 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 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, 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 520014 1687642 N/A AMSTERDAM SERVICE CORP(S) 1060 AMSTERDAM AVENUE NEW YORK NY 10025 133902473 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES TO HEALTHCARE FACILITIES NY 9 501(C)(3) 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 9 501(C)(3) 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 9 501(C)(3) AMSTERDAM CONTINUING CARE HEALTH SYSTEM 1 AMSTERDAM SERVICES CORP 2001 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134184082 PROVIDING NURSING HOME CONSULTING AND ADMIN. 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