2012-11-15T14:53:44-06:00 2011-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2011-01-01 113711764 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MARK PANCIRER 2125753322 2012-11-14 1 BERNARD GROTELL P01275277 2128674000 2011 2016-02-24 21:20:13Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 8115536 0 X WWW.AMSTERDAMATHARBORSIDE.COM X 2004 NY TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 10 10 193 10 0 0 0 0 396438 7251588 413872 766134 3220 69589 813530 8087311 0 0 0 0 738725 6477333 0 0 0 10437127 27544126 11175852 34021459 -10362322 -25934148 360406785 325668282 371822171 363017816 -11415386 -37349534 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 29145858 7251588 TO PROVIDE INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 29145858 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 0 1 37 0 193 1 0 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 X 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 MARGARET MARY MINICHINI 40.00 X 149755 0 26323 JAMES DAVIS 1.00 X 0 627678 44618 MARK PANCIRER 1.00 X 0 243526 45890 LISA MARIE BERNASCONI 40.00 X 120362 0 8114 MARY DONOVAN 40.00 X 116484 0 9029 386601 871204 133974 3 0 1 0 GLYNNDEVINS ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 ADVERTISING 767772 AMSTERDAM CONTINUING CARE HEALTH SYSTEM 1060 AMSTERDAM AVENUE NEW YORK NY 10025 MANAGEMENT CONSULTING 540000 GREYSTONE MANAGMNT SERVICES COMPANY 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 MANAGEMENT ADVISORY SERVICES 432076 CAPITAL PROJECTS CONSULTINGLLC 37 SAW MILL RIVER ROAD HAWTHORNE NY 10532 PROJECTS CONSULTING 352853 GREYSTONE DEVELOPMENT COMPANY LP 225 E JOHN CARPENTER FREEWAY IRVING TX 21030 DEVELOPMENT CONSULTING 211326 7 PRIVATE AND OTHER 623000 5833089 5833089 ENTRANCE FEES 623000 1407188 1407188 MEAL 623000 11311 11311 7251588 794359 794359 28225 -28225 -28225 -28225 OTHER REVENUE 623000 33919 33919 GUEST APARTMENTAL RENT 623000 23810 23810 MAINTENANCE SERVICE 623000 4996 4996 6864 6864 69589 8087311 7251588 0 835723 176078 176078 4811995 4385988 426007 1039004 913592 125412 450256 395908 54348 751281 751281 92106 92106 35951 35951 1134169 1010267 123902 279220 279220 292136 175484 116652 20004 20004 1942653 1942653 91789 10943 80846 11978996 11791496 187500 20617 4719 15898 8285125 5965290 2319835 168567 168567 LOC AND REMARKETING FEE 1674817 1674817 DINING SERVICES 569073 569073 SKILLED NURSING AND ENR 128147 128147 PREOPENING EXPENSES 16190 16190 63285 8914 54371 34021459 29145858 4875601 0 19856576 5866701 66846809 46150130 4734 144641 147308 4762527 11823 15006 322339 262341 252118038 8332421 247472651 243785617 25744545 24681319 360406785 325668282 3381100 1634272 296137851 253777713 58559569 95782767 13743651 11823064 371822171 363017816 X -11415386 -37349534 -11415386 -37349534 360406785 325668282 -25934148 0 X X 0 1 1 X 0 X X 0 0 0 AMSTERDAM HOUSE CONTINUING CARE HEALTH SYSTEMS 134034061 7 1 0 1 0 0 0 22353895 22353895 217306044 7224830 210081214 1787763 256103 1531660 10670336 851488 9818848 243785617 ADVERTISING AND MARKETING COSTS 10067206 DEFERRED FINANCING COSTS 14614113 24681319 SUBORDINATE NOTE-ACCHS, INC 3000000 RETAINAGE PAYABLE 1097286 ACCRUED INTEREST PAYABLE 7725778 11823064 8087311 34021459 -25934148 -25934148 8087311 0 8087311 0 8087311 34021459 0 34021459 0 34021459 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. 0 0 0 0 0 0 0 0 0 MARGARET MARY MINICHINI 149755 0 0 0 0 0 0 0 26323 0 176078 0 0 0 JAMES DAVIS 0 507562 0 120000 0 116 0 17778 0 26840 0 672296 0 0 MARK PANCIRER 0 237808 0 0 0 5718 0 14651 0 31239 0 289416 0 0 NASSAU COUNTY INDUSTRIAL DEV AGENCY 112559657 SEEPARTVI 2007-12-20 271231266 ACQUISITION AND CONSTRUCTION OF FACILITY 0 0 0 17480000 287427995 29685724 44005316 5316248 964288 3033933 213207234 1864497 2011 0 0 0 1 0 0 0 0 0 0 1 1 LEHMAN BROTHERS 2.700000000000 0 0 1 SEE PART VI 1 1 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 THE ORGANIZATION 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 2011. 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. COMPENSATION FROM RELATED ENTITIES FORM 990, PART VII, SECTION A: JAMES DAVIS AND MARK PENCIRER DEVOTED TIME TO RELATED ORGANIZATIONS. EACH DEVOTED 50 HOURS TO RELATED ORGANIZATIONS. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY 399000 1181716 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 N/A 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 N/A 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 0 0 0