2013-11-14T14:05:36-06:00 2012-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2012-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER 2125753322 2013-11-13 1 BERNARD GROTELL P01275277 2128674000 2012 2016-02-24 21:20:13Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 15441739 0 X WWW.AMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 10 10 211 0 -8870 -12025 0 0 7251588 14643784 766134 674341 69589 111144 8087311 15429269 0 0 0 0 6477333 8136515 0 0 0 27544126 30552662 34021459 38689177 -25934148 -23259908 325668282 307841309 363017816 427321751 -37349534 -119480442 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 32058767 14643784 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 32058767 1 0 0 0 0 0 0 0 0 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 1 118 0 211 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 MARK PANCIRER 2125753322 570 7TH AVENUE 6TH FLOOR NEW YORK NY 10018 LAWRENCE B THOMPSON 2.00 X X 0 0 0 GEORGE L VAN AMSON 0.50 X X 0 0 0 JOSEPH C HOOPES 1.00 X X 0 0 0 JAY H MCDOWELL 0.30 X X 0 0 0 THE REVEREND JAMES G CALLAWAY JR 0.30 X 0 0 0 ISABEL M CARDEN 0.50 X 0 0 0 REV DEACON FRANK L PETERSON JR 0.30 X 0 0 0 JAMES J CAMPBELL 0.30 X 0 0 0 DR KAREN M HOPKINS 0.30 X 0 0 0 FRANCES R OLIVIERI 0.30 X 0 0 0 JAMES DAVIS 1.00 X 0 627716 43681 MARK PANCIRER 1.00 X 0 250912 41745 SAM GUEDOUAR 40.00 X 110316 0 3375 LISA MARIE BERNASCON 40.00 X 119673 0 4998 MARY DONOVAN 40.00 X 133206 0 6448 ANTHONY COMERFORD 40.00 X 111755 0 22561 474950 878628 122808 4 0 1 0 GREYSTONE DEVELOPMENT COMPANY LP 225 E JOHN CARPENTER FREEWAY IRVING TX 21030 DEVELOPMENT CONSULTING 894172 AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MANAGEMENT SERVICES 737250 AFFINITY REHABILITATION LLP 10600 YORK ROAD SUITE 105 COCKEYSVILLE MD 21030 REHAB 564297 GREYSTONE MANAGMNT SERVICES COMPANY 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 MANAGEMENT ADVISORY SERVICES 553211 RN EXPRESS STAFFING REGISTRY LLC 71 WEST 23RD STREET SUITE 1622 NEW YORK NY 10010 RN STAFFING 395288 9 PRIVATE AND OTHER 623000 12494813 12494813 ENTRANCE FEES 623000 2138889 2138889 MEAL 623000 10082 10082 14643784 674341 674341 3600 12470 -8870 -8870 -8870 GUEST APARTMENTAL RENTAL 623000 23765 23765 MAINTENANCE SERVICE 623000 1576 1576 94673 94673 120014 15429269 14643784 -8870 794355 110316 110316 50521 50521 6131520 5181470 950050 1273314 1048516 224798 570844 470064 100780 748931 748931 159205 159205 24887 24887 2278016 2068828 209188 710010 710010 259123 157656 101467 29204 29204 2338008 2338008 189198 19435 169763 11900562 11713062 187500 15465 13583 1882 6499651 6120288 379363 93920 93920 AMORTIZATION OF FINANCI 1997434 1997434 LOC AND REMARKETING FEE 1367831 1367831 DINING SERVICES 782092 782092 SKILLED NURSING AND ENR 593875 593875 565250 90139 475111 38689177 32058767 6630410 0 5866701 3802773 46150130 29910475 144641 232680 4762527 11300651 15006 23372 262341 319254 254382585 14834283 243785617 239548302 24681319 22703802 325668282 307841309 1634272 3715149 253777713 236277629 95782767 117277243 11823064 70051730 363017816 427321751 X -37349534 -119480442 -37349534 -119480442 325668282 307841309 X -23259908 -56966000 -1905000 X X 0 1 X 1 0 X X 0 0 0 AMSTERDAM CONTINUING CARE HEALTH SYSTEMS 134034061 7 1 0 1 0 0 0 22353895 22353895 218593822 12704026 205889796 1919388 615581 1303807 157146 11358334 1514676 10000804 239548302 ADVERTISING AND MARKETING COSTS 8682856 DEFERRED FINANCING COSTS 14020946 22703802 SUBORDINATE NOTE-ACCHS, INC 3000000 ACCRUED INTEREST PAYABLE 7913278 FUTURE SERVICE OBLIGATION 58871000 CONVERSION DEPOSITS REFUNDABLE 267452 70051730 X 15441739 12470 12470 15429269 0 15429269 38701647 12470 12470 38689177 0 38689177 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2009 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 12,470. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 12,470. 0 0 0 0 0 0 0 0 0 JAMES DAVIS 0 485612 0 120000 0 22104 0 17646 0 26035 0 671397 0 0 MARK PANCIRER 0 242692 0 0 0 8220 0 14945 0 26800 0 292657 0 0 A NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 SEEPARTVI 2007-12-20 271231266 ACQUISITION AND CONSTRUCTION OF FACILITY 0 0 0 A 35000000 287911441 21156403 38536198 5316248 6433406 2094716 216011030 2011 0 0 1 1 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 PART I, LINE A, COLUMN C: SERIES A-63166UAF8, SERIES B-63166UAA9, SERIES C-63166UAB7 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 2012. 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, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FUTURE SERVICE OBLIGATION ADJUSTMENT -1,905,000. 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 360051 1541767 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