Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC |
134034061 | 7 | No | 0 | 0 | |
|
Total 1
|
0 | 0 | ||||
Calendar year
(or fiscal year beginning in)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, SECTION A, LINE 1: | AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC. ("AHCCRC, INC.") SUPPORTS AMSTERDAM CONTINUING CARE HEALTH SYSTEM INC., ITS PARENT ORGANIZATION. AHCCRC, INC. PROVIDES INDEPENDENT LIVING, ENRICHED HOUSING AND SKILLED NURSING CARE TO ITS RESIDENTS. THE HEALTH SYSTEM ALSO PROVIDES SUPPORT SERVICES TO THE ELDERLY. BOTH ORGANIZATION SUPPORT THE SAME CHARITABLE CLASS OF PEOPLE. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, BOX C: | THE ORGANIZATION DOES BUSINESS UNDER THE FOLLOWING NAMES: THE HARBORSIDE HARBORSIDE LEGACY FOUNDATION THE AMSTERDAM AT HARBORSIDE |
| FORM 990, PART III, LINE 1: | AMSTERDAM HOUSE CONTINUING CARE RETIREMENT COMMUNITY, INC.'S MISSION (AHCCRC, INC.) IS TO ESTABLISH, CONSTRUCT, OWN, OPERATE AND MAINTAIN A CONTINUING CARE RETIREMENT COMMUNITY AS DEFINED IN ARTICLE 46 OF THE PUBLIC HEALTH LAW OF THE STATE OF NEW YORK; TO MEET THE SPECIAL HOUSING NEEDS OF ELDERLY PERSONS BY PLANNING, DEVELOPING, ORGANIZING, CONSTRUCTING, ACQUIRING, ALTERING, RECONSTRUCTING, REHABILITATING, OWNING, OPERATING AND MAINTAINING HOUSING FOR ELDERLY INDIVIDUALS AND FAMILIES IN ORDER TO PROMOTE THEIR GENERAL WELFARE BY PROVIDING THEM WITH SAFE, SANITARY AND INDEPENDENT LIVING FACILITIES; TO ENGAGE IN ANY OTHER LAWFUL ACTIVITY FOR WHICH A CORPORATION MAY BE FORMED UNDER THE NOT-FOR-PROFIT CORPORATION LAW; THE PUBLIC OR QUASI-PUBLIC OBJECTIVE TO BE ACHIEVED BY THESE PURPOSES IS TO MAKE AVAILABLE SPECIAL HOUSING FOR THE ELDERLY WHERE SUCH HOUSING IS NOT CURRENTLY AVAILABLE. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS AMSTERDAM CONTINUING CARE HEALTH SYSTEM, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | A MEETING OF THE MEMBER IS HELD ANNUALLY FOR THE ELECTION OF DIRECTORS AND THE TRANSACTION OF OTHER BUSINESS AT A PLACE AND TIME FIXED FROM TIME TO TIME BY THE MEMBER. IN ANY CASE IN WHICH THE MEMBER IS ENTITLED TO VOTE, THE MEMBER SHALL HAVE ONE VOTE. THE BOARD OF AHCCRC, INC. RATIFIES THE ELECTION OF DIRECTORS AND ELECTS OFFICERS AND AN ANNUAL MEETING. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER IS AUTHORIZED TO APPROVE MATERIAL ACTIONS PURSUANT TO NEW YORK NOT-FOR-PROFIT CORPORATION LAW. ANY OR ALL OF THE DIRECTORS MAY BE REMOVED BY THE MEMBER OR THE BOARD OF DIRECTORS UPON THE MEMBER'S CONSENT. THE MEMBER MAY AMEND, REPEAL, OR ADOPT BY-LAWS OF THE CORPORATION OR TWO-THIRDS OF THE BOARD OF DIRECTORS UPON THE MEMBER'S CONSENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | AHCCRC, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY MANAGEMENT AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, A COPY OF THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE. THE CFO MAKES THE 990 AVAILABLE TO ALL BOARD MEMBERS. ANY ISSUES ARE DISCUSSED AND RESOLVED. ONCE THE BOARD HAS APPROVED THE RETURN IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS, AND KEY PERSONS MUST COMPLETE AN ANNUAL DISCLOSURE AND AFFIRMATION FORM IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY. A PERSON HAS A "FINANCIAL INTEREST" IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH BUSINESS, INVESTMENT OR FAMILY: A. AN OWNERSHIP OR INVESTMENT INTEREST IN ANY ENTITY WITH WHICH THE AMSTERDAM ENTITY HAS A TRANSACTION OR ARRANGEMENT; B. A COMPENSATION ARRANGEMENT WITH THE AMSTERDAM ENTITY OR WITH ANY ENTITY OR INDIVIDUAL WITH WHICH THE AMSTERDAM ENTITY HAS A TRANSACTION OR ARRANGEMENT; OR C. A POTENTIAL OWNERSHIP OR INVESTMENT INTEREST IN, OR COMPENSATION ARRANGEMENT WITH, ANY ENTITY OR INDIVIDUAL WITH WHICH THE AMSTERDAM ENTITY IS NEGOTIATING A TRANSACTION OR ARRANGEMENT. 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 BECOMES 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 SHALL BE REQUIRED BEFORE ENTERING INTO THE TRANSACTION (EXCLUDED IN SUCH COUNTS IS THE INTERESTED DIRECTOR). 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 ON AN ANNUAL BASIS OR SOONER IF A POTENTIAL CONFLICT OR ACTUAL CONFLICT SHOULD ARISE. POTENTIAL CONFLICTS OR ACTUAL CONFLICTS ARE REVIEWED BY THE CHIEF COMPLIANCE OFFICER OF AMSTERDAM NURSING HOME. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE COMPENSATION FOR THE PRESIDENT AND CEO IS SET USING COMPARABLE DATA. COMPARABLE DATA INCLUDED PUBLICLY AVAILABLE COMPENSATION DATA FROM SIMILARLY SITUATED CCRCS, SUCH AS COMPENSATION DATA IN THE FORM 990S FILED WITH THE IRS. THE COMPENSATION REVIEW PROCESS WAS APPROVED BY THE BOARD AND IS INCLUDED IN THE BOARD MINUTES. THIS REVIEW PROCESS WAS LAST CONDUCTED IN DECEMBER 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS ALSO POSTED ON THE NEW YORK ATTORNEY GENERAL CHARITIES BUREAU WEBSITE AND GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY. MONTHLY FINANCIAL STATEMENTS, AND AUDITED FINANCIAL STATEMENTS, ARE AVAILABLE TO THE PUBLIC ON THE ELECTRONIC MUNICIPAL MARKET ACCESS WEBSITE AT HTTPS://EMMA.MSRB.ORG/. |
| FORM 990, PART IX, LINE 11G | MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,971,950. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,971,950. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 597,233. MANAGEMENT AND GENERAL EXPENSES 266,111. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 863,344. SECURITY SERVICES: PROGRAM SERVICE EXPENSES 132,693. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,693. THERAPISTS: PROGRAM SERVICE EXPENSES 571,270. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,270. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 42,361. MANAGEMENT AND GENERAL EXPENSES 12,828. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,189. FINANCIAL ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 714,230. MANAGEMENT AND GENERAL EXPENSES 339,804. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,054,034. BOND TRUSTEE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 15,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,000. DINING SERVICES: PROGRAM SERVICE EXPENSES 1,858,468. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,858,468. MARKETING ADVISORY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 327,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 327,903. |
| FORM 990, PART XI, LINE 9: | FUTURE SERVICE OBLIGATION ADJUSTMENT -16,341,000. LOSS ON DISPOSAL OF ASSET -4,753. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |