2011-11-12T23:04:37-06:00 2010-12-31 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2010-01-01 134034061 AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC AMST 2125753322 1060 AMSTERDAM AVENUE NEW YORK NY 10025 JAMES DAVIS 2125753322 2011-11-10 1 BERNARD GROTELL 2128674000 2010 2016-03-07 17:11:31Z MARK PANCIRER 1060 AMSTERDAM AVENUE NEW YORK NY 10025 790867 0 X WWW.AMSTERDAMCARES.ORG X 1997 NY AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC. (HEALTH SYSTEM) IS THE SOLE CORPORATE MEMBER OF AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. (RETIREMENT COMMUNITY), WHICH WAS ESTABLISHED AS A NOT-FOR-PROFIT CORPORATION ON JANUARY 30, 2004. THE RETIREMENT COMMUNITY IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). 12 12 2 0 0 0 263457 208147 0 540000 19430 9344 2694 9154 285581 766645 4569 693 0 0 169622 215795 0 0 40650 9577 5156 183768 221644 101813 545001 1283807 1835076 2272827 2281654 -989020 -446578 THE PRIMARY PURPOSE OF THE ORGANIZATION IS TO OBTAIN CONTRIBUTIONS, GRANTS AND HOLD SPECIAL EVENTS TO SUPPORT THE AMSTERDAM NURSING HOME. ANNUALLY, THE ORGANIZATION HOLDS A GOLF OUTING EVENT. 0 0 173628 693 540000 SUPPORT OF SERVICES FOR THE ELDERLY 173628 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 2 0 1 2 1 0 0 0 0 0 1 1 0 0 0 0 X 12 12 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 570 SEVENTH AVENUE 6TH FLOOR NEW YORK NY 10018 X LAWRENCE B THOMPSON 1.00 X 0 0 0 GEORGE L VAN AMSON 0.30 X 0 0 0 JOSEPH C HOOPES JR 0.50 X 0 0 0 JOSE V TORRES 0.30 X 0 0 0 THE REVEREND JAMES G CALLAWAY JR 0.30 X 0 0 0 ISABEL M CARDEN 0.30 X 0 0 0 KAREN M HOPKINS MD 0.30 X 0 0 0 JAY H MCDOWELL 0.30 X 0 0 0 THE REVEREND DEACON FRANK L PETERSO 0.30 X 0 0 0 JAMES J CAMPBELL 0.30 X 0 0 0 DYER S WADSWORTH 0.30 X 0 0 0 FRANCES R OLIVIERI 0.30 X 0 0 0 JAMES DAVIS 15.50 X 173752 448881 44728 MARK PANCIRER 10.00 X 30000 212957 41218 203752 661838 85946 1 0 1 0 0 79500 128647 208147 MANAGEMENT SERVICES TO 561000 540000 540000 540000 9344 9344 32000 79500 24222 7778 7778 MISCELLANEOUS 623000 1376 1376 1376 766645 540000 0 18498 693 693 203752 163000 6955 33797 12043 9634 411 1998 1500 1500 1529 301 1228 1827 1827 MISCELLANEOUS 300 300 221644 173628 7366 40650 1093975 1064721 1827 6044 121594 121594 66411 642717 1283807 1835076 14054 2272827 2267600 2272827 2281654 X -989020 -446578 -989020 -446578 1283807 1835076 X 545001 -2559 X X 0 1 1 X 0 X 252516 247461 189305 263457 208147 1160886 252516 247461 189305 263457 208147 1160886 479964 680922 9432 15512 18955 19430 9344 72673 46000 24684 279000 33963 33376 417023 1650582 540000 0.41250 0.36850 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISC. INCOME SPECIAL EVENT MANAGEMENT SERVICE INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INVESTMENT IN AMSTERDAM SERVICES CORP. (2001) 121594 C 121594 SUBVENTION 1 OTHER RECEIVABLES 550706 CONSTRUCTION IN PROGRESS 85390 DUE FROM GERMAN MASONIC HOME CORPORATION 6620 642717 SUBVENTION -SUBORDINATE NOTE-ACCHS, INC 2267600 2267600 766645 221644 545001 -2559 -2559 542442 1819003 1076358 1076358 742645 24000 24000 766645 11573030 11351386 11351386 221644 0 221644 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2007 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENT 24,222. UNREALIZED LOSS -2,559. RELATED ENTITY REVENUE 1,054,695. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM AMSTERDAM SERVICE CORP. 24,000. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT COST OF SPECIAL EVENT 24,222. RELATED ENTITY EXPENSES 11,327,164. ANNUAL GOLF OUTING 111500 79500 32000 13099 9303 1820 111500 79500 32000 13099 9303 1820 24222 7778 0 0 0 0 0 0 0 0 0 JAMES DAVIS 173752 315482 0 110000 0 23399 0 17778 0 26950 173752 493609 0 0 MARK PANCIRER 30000 202719 0 0 0 10238 0 11985 0 29233 30000 254175 0 0 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 ANY POTENTIAL CONFLICTS OF INTERESTS ARE DISCUSSED WITH BOARD MEMBERS. IF A CONFLICT EXISTS THE PERSON IS RECUSED FROM VOTING ON SAID MATTER. ANNUALLY, SENIOR MANAGEMENT SIGNS A DOCUMENT REQUIRING THEM TO IDENTIFY ANY POTENTIAL CONFLICTS OF INTEREST. 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 2010. 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 AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN B: JAMES DAVIS AND MARK PANCIRER DEVOTED THEIR TIME TO A RELATED ORGANIZATION. JAMES DAVIS DEVOTED 19 HOURS AND MARK PANCIRER 30 HOURS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,559. FORM 990, PART XI, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 10A, 12, 13,AND 14: THE ORGANIZATION DOES NOT HAVE WRITTEN POLICIES AND PROCEDURES GOVERNING THE ACTIVITIES. HOWEVER, AMSTERDAM CONTINUING CARE HEALTH SYSTEM FOLLOWS THE POLICIES OF RELATED ORGANIZATION OF AMSTERDAM NURSING HOME CORP (1992). AMSTERDAM HOUSE CCRC LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 412126554 PROVIDING SKILLED NURSING HOME CARE AND LIVING PROGRAMS TO ELDERLY NY 813530 360406785 N/A AMSTERDAM CONSULTING LLC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134034061 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY 540285 784706 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) 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 9 501(C)(3) N/A 0 AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY INC 1060 AMSTERDAM AVENUE NEW YORK NY 10025 113711764 PROVIDING SKILLED NURSING HOME, HOME FOR INDEPENDENT LIVING FOR SENIORS NY 9 501(C)(3) N/A 0 AMSTERDAM SERVICES CORP 2001 1060 AMSTERDAM AVENUE NEW YORK NY 10025 134184082 ADMINISTRATIVE AND CONSULTING SERVICES TO OTHER FACILITIES NY N/A C 241165 144879 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0