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 133834710 AMSTERDAM NURSING HOME CORP (1992) AMST 2125753322 1060 AMSTERDAM AVE NEW YORK NY 10025 MARK PANCIRER 2125753322 2012-11-14 1 BERNARD GROTELL P01275277 2128674000 2011 2016-02-24 21:20:13Z AMSTERDAM NURSING HOME MARK PANCIRER 1060 AMSTERDAM AVE NEW YORK NY 10025 58157346 0 X AMSTERDAMCARES.ORG X 1995 NY AMSTERDAM NURSING HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. 12 12 601 22 0 0 88503 52777 57503099 54803742 90827 56133 287028 630695 57969457 55543347 0 0 0 0 32933047 33071175 0 0 0 25225127 23630807 58158174 56701982 -188717 -1158635 51931386 49843524 45340171 44466530 6591215 5376994 X TO OPERATE A NOT FOR PROFIT NURSING HOME FACILITY WITH 409 SKILLED NURSING HOME BEDS AND AN ADULT DAY CARE PROGRAM FOR 40 PARTICIPANTS. 0 0 50481448 55134863 THE HOME PROVIDES ROOM AND BOARD AND MEDICAL CARE FOR THE ELDERLY. THE HOME HAS A CAPACITY OF 409 BEDS ALONG WITH AN ADULT DAY CARE PROGRAM WITH A CAPACITY OF 40 REGISTRANTS. IN 2011, THE NURSING HOME HAD 573 ADMISSIONS AND PROVIDED 13,852 ADULT DAY CARE VISITS. THE NURSING HOME HAD AN OCCUPANCY RATE OF 98.51 PERCENT. 50481448 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 118 0 601 1 0 0 0 0 0 0 0 0 0 0 X 12 12 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 JOSE V TORRES 0.30 X X 0 0 0 REV JAMES G CALLAWAY JR 0.30 X 0 0 0 ISABEL M CARDEN 0.50 X 0 0 0 JAY H MCDOWELL 0.30 X 0 0 0 REV DEACON FRANK L PETERSON JR 0.30 X 0 0 0 DYER S WADSWORTH 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 30.50 X 352669 275008 44618 MARK PANCIRER 37.50 X 213526 30000 45890 FLORECITA NEBRES 35.00 X 153067 0 35729 JUDITH FENSTER 35.00 X 203974 0 18777 MICHAEL WHITE 30.00 X 137566 0 34470 ALFONSO GARCIA 35.00 X 106396 0 28071 SALLY NUNEZ 35.00 X 111389 0 16670 MARITES RODIL 37.50 X 107839 0 39369 ANTONELLA VALENTINI 35.00 X 115486 0 31749 1501912 305008 295343 14 0 1 0 UNITED HOME CARE 77-04 BROADWAY ELMHURST NY 11373 NURSING AGENCY 2788677 SENIOR RIDE TRANSPORTATION 855 BRUSH AVENUE BRONX NY 10465 TRANSPORTATION 536737 SECURITAS SECURITY SERVICE 1412 BROADWAY 17TH FL NEW YORK NY 10015 SECURITY SERV 366613 EDU TEK LIMITED 178 EAST BOSTON POST RD MAMARONECT NY 10543 INFORMATION TECH 343292 LOEB & TROPER 655 THIRD AVE 12TH FL NEW YORK NY 10017 AUDIT/CONSULTING 252731 11 9890 42887 52777 MEDICARE/MEDICAID 623000 45049745 45049745 PRIVATE PAY PATIENT CA 623000 7368941 7368941 ADULT DAY CARE 623000 2385056 2385056 54803742 49330 49330 2620802 2613999 6803 6803 6803 DISCOUNTS ON PURCHASES 623000 331121 331121 RECOVERY OF EMPLOYEE B 623000 186607 186607 ADM. FEE REL. ORG. 623000 55349 55349 57618 57618 630695 55543347 55134863 0 355707 1068250 1068250 21213178 19820102 1393076 1623409 1574070 49339 7519585 7135295 384290 1646753 1544160 102593 153436 153436 56583 56583 6199481 5639598 559883 20141 1922 18219 6578198 5235599 1342599 1076211 779116 297095 33278 18770 14508 3118287 2744093 374194 2780368 2446724 333644 606873 534048 72825 NYS ASSESSMENT 2913358 2913358 RESIDENTIAL/CLIENT ACTI 94593 94593 56701982 50481448 6220534 0 1400 1400 15993128 17236805 7804661 7965970 84352 88688 548489 391107 71119894 48092222 24736704 23027672 2762652 1131882 51931386 49843524 5435304 6078903 37905518 36996836 1999349 1390791 45340171 44466530 X 6290684 5077182 300531 299812 6591215 5376994 51931386 49843524 X -1158635 -55586 X X 0 1 1 X 1 1 X 37265 158939 2857 88503 52777 340341 49996515 55666730 54305948 57503099 54803742 272276034 50033780 55825669 54308805 57591602 54856519 272616375 0 0 0 272616375 338914 118412 113402 74656 49330 694714 338914 118412 113402 74656 49330 694714 843735 804202 317090 287028 630695 2882750 51216429 56748283 54739297 57953286 55536544 276193839 0.98700 0.98770 0.00250 0.00310 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: GIFT CART & MILLERINN RECOVERY OF EXPENSE PHONE & VENDING MACHINE DISCOUNT ON PURCHASES GENERAL ADMINISTRATION STAR PROGRAM DIRECT TV FEES SECURITY RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 26707 26707 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES PAID TO THE FOLLOWING ORGANIZATIONS THAT HAD LOBBYING EXPENSES: 1199, LEADING AGE, AND CCLC 1432917 1432917 50250530 33265701 16984829 210625 128718 81907 17807207 14697803 3109404 1418615 1418615 23027672 PATIENT FUNDS 492663 DUE TO THIRD PARTIES 641198 ACCRUED INTEREST PAYABLE 256930 1390791 55543347 56701982 -1158635 -55586 -55586 -1214221 55487761 -55586 -55586 55543347 0 55543347 56701982 0 56701982 0 56701982 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: UNCERTAINTY IN INCOME TAXES - THE HOME 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. X X X X X X 0 0 0 0 0 0 0 1 0 JAMES DAVIS 242553 265008 110000 10000 116 0 17778 0 26840 0 397287 275008 0 0 MARK PANCIRER 207808 30000 0 0 5718 0 14651 0 31239 0 259416 30000 0 0 FLORECITA NEBRES 146971 0 0 0 6096 0 8726 0 27003 0 188796 0 0 0 JUDITH FENSTER 203974 0 0 0 0 0 14086 0 4691 0 222751 0 0 0 MICHAEL WHITE 134992 0 0 0 2574 0 8667 0 25803 0 172036 0 0 0 PART I, LINE 7 THE BOARD OF DIRECTORS GATHERS COMPARABLE INFORMATION, EVALUATES AND APPROVES A BONUS FOR THE ORGANIZATION'S CEO. 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 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 FORM 990, PART VI, LINE 15: 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 2011. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -55,586. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. FORM 990, PART VII, SECTION A, COLUMN B: JAMES DAVIS AND MARK PANCIRER DEVOTED THEIR TIME TO A RELATED ORGANIZATION. JAMES DAVIS DEVOTED 19.5 HOURS. MARK PANCIRER DEVOTED 12.5 HOURS. OTHER ASSETS FORM 990, PART X, LINE 15 DESCRIPTION: AMOUNT: DUE FROM THIRD PARTIES - $650,776 OTHER RECEIVABLES - $358,473 OTHER ASSETS - $122,630 SUBVENTION CERTIFICATION - $3 FROM ACCHS,INC. TOTAL-OTHER ASSETS - $1,131,882 AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADMINISTRATIVE AND CONSULTING SERVICES NY 397309 1181716 N/A 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 SYSTEMS 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 PROVIDING ADVICE, INFORMATION & MONETARY CONTRIBUTIONS TO ELDERLY & DISABLED NY 501(C)(3) 7 N/A 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE 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 N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0