2023-10-15T16:30:59-05:00 2022-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2022-01-01 311631439 ACTIVE RETIREMENT COMMUNITY INC ACTI 6316502724 ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 BRIAN AMTMANN CFO 6316502724 2023-10-13 1 BRIAN AMTMANN XXX-XX-XXXX 0 KERRI N BOGDA CPA P00760402 7177404863 2023-10-13 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEFFERSON'S FERRY ROBERT E CAULFIELD ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 44807346 0 X WWW.JEFFERSONSFERRY.ORG X 1997 NY PROVIDING LONG-TERM CONTINUING CARE 12 11 393 11 0 0 3022889 87698 29482011 31870127 1279397 577989 355324 1467390 34139621 34003204 113683 96458 0 0 15000579 15542547 0 0 0 17221843 20671377 32336105 36310382 1803516 -2307178 204676750 201502362 239492580 244193700 -34815830 -42691338 X JEFFERSON'S FERRY IS COMMITTED TO SERVING OLDER ADULTS BY PROVIDING AN ACTIVE LIFESTYLE WITHIN AN ALL-INCLUSIVE LIFECARE RETIREMENT COMMUNITY. THE LIFECARE CONCEPT PROMOTES DIGNITY, PRIVACY, INDIVIDUALITY AND INDEPENDENCE FOR EACH RESIDENT. THIS IS ACCOMPLISHED THROUGH A CARING ENVIRONMENT WITH CONCERNED STAFF PROVIDING SECURITY AND PEACE OF MIND THROUGH A FOCUS ON RESIDENT SERVICE. 0 0 33060004 96458 31870127 ACTIVE RETIREMENT COMMUNITY, INC., DOING BUSINESS AS JEFFERSON'S FERRY, OPENED IN 2001 WITH THE MISSION TO SERVE OLDER ADULTS BY PROVIDING AN ACTIVE LIFESTYLE WITHIN AN ALL-INCLUSIVE LIFECARE RETIREMENT COMMUNITY. THE LIFECARE CONCEPT PROMOTES DIGNITY, PRIVACY, INDIVIDUALITY AND INDEPENDENCE FOR EACH RESIDENT. THIS IS ACCOMPLISHED THROUGH A CARING ENVIRONMENT WITH EXCEPTIONAL STAFF PROVIDING SECURITY AND PEACE OF MIND THROUGH A FOCUS ON RESIDENT SERVICE. 33060004 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 89 0 393 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X BRIAN AMTMANN CFO 6316502724 ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 ROBERT CAULFIELD CHIEF EXECUTIVE OFFICER 55.00 5.00 X X 559528 0 70879 VIVIAN M VILORIA-FISHER CHAIR 3.00 1.00 X X 0 0 0 GLORIA SNYDER VICE CHAIR 3.00 1.00 X X 0 0 0 JOHN SINI TREASURER 3.00 1.00 X X 0 0 0 WAYNE SHATTES SECRETARY 3.00 1.00 X X 0 0 0 JAMES DANOWSKI MEMBER 3.00 1.00 X 0 0 0 VINCENT P BASILICE MEMBER 3.00 1.00 X 0 0 0 VALERIE CARTRIGHT MEMBER 3.00 1.00 X 0 0 0 DEBRA ENGELHARDT MEMBER 3.00 1.00 X 0 0 0 KIM KUBASEK MEMBER 3.00 1.00 X 0 0 0 LAWRENCE DAVIDOW ESQ MEMBER 3.00 1.00 X 0 0 0 KENNETH ROBERTS MEMBER 3.00 1.00 X 0 0 0 BRIAN AMTMANN CHIEF FINANCIAL OFFICER 45.00 5.00 X 293726 0 21080 ANTHONY COMERFORD VP OF HEALTH SERVICES 50.00 0.00 X 268001 0 18506 CHRISTOPHER ADAMO VP HOSPITALITY SERVICES 50.00 0.00 X 221874 0 46719 LINDA KOLAKOWSKI VP OF RESIDENT SERVICES 50.00 0.00 X 182575 0 43873 MICHELE BERTI VP OF HUMAN RESOURCES 50.00 0.00 X 158825 0 12672 ELISSA GARGONE VP OF MARKETING 50.00 0.00 X 155745 0 37205 1840274 0 250934 18 0 1 0 ALL STAFF LLC 738 SMITHTOWN BYPASS SMITHTOWN NY 11727 STAFFING SERVICES 1428787 AFFINITY REHABILITATION PO BOX 69268 BALTIMORE MD 21264 THERAPEUTIC SERVICES 690553 CARLUCCI AND SONS 10 WINDSOR COURT CORAM NY 11727 GENERAL CONTRACTING 533307 GCD NEW YORK 225 E JOHN CARPENTER FREEWAY IRVING TX 75062 CONTRACTOR 429415 KDA ARCHITECTS 500 KINGS HIGHWAY SOUTH CHERRY HILL NJ 08034 ARCHITECTURAL SERVICES 371461 19 75237 12461 87698 RESIDENTIAL & HC SVCS 623000 30764602 30764602 MEDICARE/MEDICAID PAYMENTS 623000 1105525 1105525 31870127 767390 767390 10614741 10769063 35079 -154322 -35079 -189401 -189401 S. SETAUKET RE TAX REIM 900099 773854 773854 MARKETING REFURBISHMENTS 623000 379235 379235 CAFE/DINING 623000 133972 133972 180329 180329 1467390 34003204 31870127 0 2045379 X 31334 31334 65124 65124 945214 945214 11160165 9118122 2042043 520871 520871 2017268 2013375 3893 899029 768948 130081 68876 68876 108000 108000 1446 1446 151104 151104 3995242 3744892 250350 94551 94551 3071705 3039914 31791 405666 65145 340521 3832591 3807002 25589 67265 67265 2072495 2062034 10461 6013937 5985419 28518 REPAIRS & MAINTENANCE 320571 320571 STAFF DEVELOPMENT 115079 115079 RENTAL & LEASING 84662 84662 MINOR EQUIPMENT 76468 76468 191719 134014 57705 36310382 33060004 3250378 0 14100 5692263 13593433 7528989 1014678 884627 675855 1238490 183281970 79208252 82418340 104073718 104743690 80174319 2126635 1799900 90019 110056 204676750 201502362 6921414 8463954 27681437 35442818 121786586 101439962 83103143 98846966 239492580 244193700 X -36160046 -43989410 1344216 1298072 -34815830 -42691338 204676750 201502362 X -2307178 -5241595 -326735 X 0 1 X 1 0 X 185934 74271 539781 3022889 87698 3910573 27744880 29272061 29233250 29482011 31870127 147602329 27930814 29346332 29773031 32504900 31957825 151512902 0 0 0 151512902 752892 939353 764180 559537 767390 3783352 752892 939353 764180 559537 767390 3783352 458328 550349 293531 355324 1467390 3124922 29142034 30836034 30830742 33419761 34192605 158421176 0.95640 0.96300 0.02390 0.02350 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFE/DINING REVENUE - 2018 AMOUNT: $ 205,761. 2019 AMOUNT: $ 207,234. 2020 AMOUNT: $ 81,006. 2021 AMOUNT: $ 81,805. 2022 AMOUNT: $ 133,972. MARKETING REFURBISHMENTS - 2018 AMOUNT: $ 84,011. 2019 AMOUNT: $ 36,840. 2020 AMOUNT: $ 45,717. 2021 AMOUNT: $ 50,784. 2022 AMOUNT: $ 379,235. MISCELLANEOUS REVENUE - 2018 AMOUNT: $ 19,707. 2019 AMOUNT: $ 11,383. 2020 AMOUNT: $ 3,919. REIMBURSEMENT FROM RELATED ORG - 2019 AMOUNT: $ 148,476. 2020 AMOUNT: $ 24,192. RESIDENT SERVICES - 2018 AMOUNT: $ 21,613. 2019 AMOUNT: $ 21,613. 2020 AMOUNT: $ 16,327. 2021 AMOUNT: $ 18,267. 2022 AMOUNT: $ 8,950. TELEPHONE/CABLE REVENUE - 2018 AMOUNT: $ 127,236. 2019 AMOUNT: $ 124,803. 2020 AMOUNT: $ 122,370. 2021 AMOUNT: $ 116,655. 2022 AMOUNT: $ 114,975. INSURANCE REIMBURSEMENT - 2021 AMOUNT: $ 11,140. 2022 AMOUNT: $ 50,764. RESIDENT UNIT UPGRADE - 2021 AMOUNT: $ 12,185. 2022 AMOUNT: $ 5,640. S SETAUKET RE TAX REIM - 2021 AMOUNT: $ 64,488. 2022 AMOUNT: $ 773,854. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1446 1446 0 PART II-B, LINE 1: ACTIVE RETIREMENT COMMUNITY, INC. RECOGNIZES A PORTION OF DUES PAID TO LEADINGAGE NY ($1,306), AND NATIONAL LEADING AGE ($140) AS CONSIDERED TO BE RELATED TO LOBBYING ACTIVITIES. 5308000 5308000 142981966 72939768 70042198 7192481 5492133 1700348 27799523 776351 27023172 104073718 REFUNDABLE ADVANCE FEES AND DEPOSITS 98659676 RESIDENT DEPOSITS 117367 DUE TO/FROM 69923 98846966 28233152 -5241595 -412432 -5654027 33887179 151104 -35079 116025 34003204 36108660 35079 35079 36073581 151104 85697 236801 36310382 PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -326,735. CHARITY CARE -65,124. RECLASS OF CAFE/DINING INTER-CO REVENUE -20,573. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS -35,079. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 35,079. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE 65,124. RECLASS OF CAFE/DINING INTER-CO REVENUE 20,573. PART X, LINE 4- OTHER LIABILITIES ACTIVE RETIREMENT HOLDS FUNDS THAT ARE DESIGNATED TO BE USED BY ITS RESIDENTS. 1 JTM FOUNDATION 75 NORTH COUNTY ROAD PORT JEFFERSON NY 11777 111639818 501(C)(3) 8500 0 PROGRAM SUPPORT STONY BROOK FOUNDATION STALLER CENTER FOR THE ARTS 2032 STALLER CENTER STONY BROOK NY 11794 116077945 501(C)(3) 8000 0 PROGRAM SUPPORT LONG ISLAND MUSEUM 1200 NY-25A STONY BROOK NY 11790 111667767 501(C)(3) 5000 0 PROGRAM SUPPORT SETAUKET FIRE DEPARTMENT PO BOX 830 EAST SETAUKET NY 11733 112613006 501(C)(3) 5000 0 PROGRAM SUPPORT 4 0 CHARITY CARE 2 65124 PART I, LINE 2: THE ORGANIZATION EXERCISES ITS DUE DILIGENCE TO ASSURE COMPLIANCE WITH ITS STANDARDS. RESEARCH IS DONE VIA THE RECIPIENT ORGANIZATION'S WEBSITE OR VIA DIRECT CONTACT WITH THE EXECUTIVE DIRECTOR OR CEO OF THE DONEE ORGANIZATION. CHARITY CARE - WHEN A RESIDENT RUNS OUT OF ASSETS AND DOES NOT HAVE ENOUGH INCOME TO COVER THEIR MONTHLY SERVICE FEE AND OTHER MONTHLY EXPENSES, THEY WILL MEET WITH THE CFO AND PROVIDE THE 5 PRIOR YEARS BANK AND INVESTMENT STATEMENTS AND TAX RETURNS. THE CFO WILL VERIFY WITH THE INITIAL APPLICATION AND THE ACTUARIAL FINANCIAL CALCULATION TO DETERMINE IF THE RESIDENT WOULD BE IN THE TIMELINE OF THE PROJECTED NEED FOR ASSISTANCE. THE CFO WILL REVIEW THE PROVIDED RECORDS TO DETERMINE THAT THE RESIDENT DID NOT GIFT OR GAMBLE AWAY THEIR ASSETS. IF THE RESIDENT IS INDEED OF NEEDING ASSISTANCE, ARC WILL PROVIDE CHARITY CARE TO THE RESIDENT BY GIVING THEM A MONTHLY CREDIT ON THEIR STATEMENT EACH MONTH. THE AMOUNT IS DETERMINED BY THE PROJECTED MONTHLY COSTS AND THE SHORTFALL FROM THEIR MONTHLY INCOME. X X X X X 0 1 0 0 0 0 0 1 0 ROBERT CAULFIELD CHIEF EXECUTIVE OFFICER 495528 0 64000 0 0 0 34606 0 36273 0 630407 0 0 0 BRIAN AMTMANN CHIEF FINANCIAL OFFICER 261726 0 32000 0 0 0 18272 0 2808 0 314806 0 0 0 ANTHONY COMERFORD VP OF HEALTH SERVICES 240001 0 28000 0 0 0 15465 0 3041 0 286507 0 0 0 CHRISTOPHER ADAMO VP HOSPITALITY SERVICES 205874 0 16000 0 0 0 13736 0 32983 0 268593 0 0 0 LINDA KOLAKOWSKI VP OF RESIDENT SERVICES 166575 0 16000 0 0 0 11533 0 32340 0 226448 0 0 0 ELISSA GARGONE VP OF MARKETING 145745 0 10000 0 0 0 6013 0 31192 0 192950 0 0 0 MICHELE BERTI VP OF HUMAN RESOURCES 142825 0 16000 0 0 0 9690 0 2982 0 171497 0 0 0 PART I, LINE 4B THE FOLLOWING RECIEVED CONTRIBUTION/DEFERRAL FOR THE CURRENT YEAR: ROBERT CAULFIELD - $14,714 PART I, LINE 7 BONUS STRUCTURE FOR THE CEO, HEALTH CENTER ADMINISTRATOR AND CFO: THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS DETERMINES ALL BONUSES FOR THE OFFICERS AND OTHER KEY EXECUTIVES. THE KEY FACTORS THAT DETERMINE THE BONUS ARE: BENEFIT TO THE ORGANIZATION OF THE EMPLOYEES, EMPLOYEE'S PERFORMANCE AND PRODUCTIVITY, OVERALL PERFORMANCE AND PRODUCTIVITY OF THE ORGANIZATION AND THE EMPLOYEE'S ADMINISTRATIVE PERFORMANCE AND OTHER MARKET CONDITIONS. BONUSES REPORTED ON SCHEDULE J REFLECT BONUSES EARNED AND PAID IN 2022. A TOWN OF BROOKHAVEN LOCAL DEVELOPMENT CORPORATION 272768182 113168AY4 2016-12-01 41477003 ADVANCE REFUND OF 2006 BONDS, FUND DEBT SERVICE, AND FUND CAPITAL PROJECTS 0 0 0 B TOWN OF BROOKHAVEN LOCAL DEVELOPMENT CORPORATION 272768182 113168BL1 2020-11-12 89761456 TO FINANCE THE EXPANSION 0 0 0 A 9042593 41477003 3102565 34824187 757509 1608849 1252270 2018 1 0 1 1 B 18887757 89761456 4708756 4856688 1562916 57600025 2875405 18157667 2023 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: TOWN OF BROOKHAVEN LOCAL DEVELOPMENT CORPORATION DATE THE REBATE COMPUTATION WAS PERFORMED: 12/14/2021 ISSUE A PART I, COLUMN (E): THE ISSUE PRICE OF $41,477,003 IS THE STATED REDEMPTION PRICE AT MATURITY. PART II, LINE 3: THE TOTAL PROCEEDS OF ISSUE OF $41,477,003 IS THE BOND'S ISSUE PRICE OF $38,040,000 AT PAR VALUE PLUS THE ORIGINAL ISSUE DISCOUNT PREMIUM OF $3,437,003. FORM 990, PART VI, SECTION B, LINE 11B A FINAL COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES ARE PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY STATEMENT- OFFICERS, DIRECTORS AND KEY EMPLOYEES OF THE ORGANIZATION WILL, AT LEAST ANNUALLY, FILE A CONFLICT OF INTEREST DISCLOSURE STATEMENT/QUESTIONNAIRE WITH THE COMPLIANCE OFFICER. PERSONNEL SHALL DISCLOSE ALL SITUATIONS THAT POSE A POTENTIAL OR ACTUAL CONFLICT OF INTEREST. PERSONNEL HAVE AN AFFIRMATIVE OBLIGATION TO UPDATE THEIR ANNUAL DISCLOSURE STATEMENT/QUESTIONNAIRE WHENEVER NEW INFORMATION ARISES WHICH IS OTHERWISE REQUIRED TO BE DISCLOSED IN THE ANNUAL DISCLOSURE STATEMENT/QUESTIONNAIRE BY COMPLETING A NEW DISCLOSURE STATEMENT/QUESTIONNAIRE AND PROVIDING IT TO THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER WILL REVIEW DISCLOSURE STATEMENTS/QUESTIONNAIRES IN LIGHT OF THE PRINCIPLES SET FORTH IN THE CONFLICT OF INTEREST POLICY, CONSULT WITH OUTSIDE COUNSEL AS NECESSARY, SEEK ADDITIONAL INFORMATION AS NECESSARY, AND DETERMINE IF THE INFORMATION DISCLOSED CREATES A CONFLICT OF INTEREST, IS IMPROPER, OR CREATES THE APPEARANCE OF A CONFLICT OF INTEREST OR OF IMPROPER CONDUCT. THE COMPLIANCE COMMITTEE WILL REVIEW THE COMPLIANCE OFFICER'S REPORTS ANNUALLY AND ON A PERIODIC BASIS, AND CONDUCT ITS OWN REVIEW, AS NECESSARY, TO DETERMINE WHETHER A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF THE COMMITTEE DETERMINES THAT IT NEEDS TO CONDUCT A FURTHER REVIEW, THE CHAIRMAN OF THE COMPLIANCE COMMITTEE MAY APPOINT AN AD HOC COMMITTEE COMPRISED OF BOARD MEMBERS AND THE COMPLIANCE OFFICER TO REVIEW A PARTICULAR MATTER AND MAKE A RECOMMENDATION TO THE COMPLIANCE COMMITTEE. THE COMPLIANCE OFFICER AND OUTSIDE COUNSEL SHALL ASSIST THE COMPLIANCE COMMITTEE, WHICH SHALL REPORT ITS RECOMMENDATION AND FINDINGS TO THE ENTIRE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL REVIEW THE RECOMMENDATION AND FINDINGS OF THE COMPLIANCE COMMITTEE AND MAKE ITS FINDINGS WHICH SHALL BE FINAL AND BINDING. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PERIODICALLY ENGAGES WITH AN OUTSIDE CONSULTANT TO PREPARE A COMPENSATION REVIEW OF MANAGEMENT, INCLUDING THE CEO, CFO AND THE HEALTH CENTER ADMINISTRATOR. IN ADDITION, THE ORGANIZATION REGULARLY REVIEWS SALARY AND BENEFIT SURVEYS PREPARED BY INDUSTRY ASSOCIATIONS AND EVALUATES COMPENSATION STRUCTURES FOR LOCAL SIMILAR ORGANIZATIONS FOR ALL KEY EMPLOYEES. A COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION AND THE DECISIONS ARE DOCUMENTED IN THE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL FURNISHED TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES RELATED TO CONSULTANTS AND OUTSIDE CONTRACTS: PROGRAM SERVICE EXPENSES 3,744,892. MANAGEMENT AND GENERAL EXPENSES 250,350. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,995,242. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -326,735. SOUTH SETAUKET ILU LLC ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 850874473 REAL ESTATE HOLDING COMPANY NY 773854 388547 ACTIVE RETIREMENT COMMUNITY INC JEFFERSON'S FERRY FOUNDATION ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 205041160 FUNDRAISING & SUPPORT NY 501(C)(3) LINE 12A, I ACTIVE RETIREMENT COMMUNITY INC 1 LONG ISLAND SENIOR SERVICES INC ONE JEFFERSON FERRY DRIVE SOUTH SETAUKET NY 11720 611729265 SENIOR SERVICES NY 501(C)(3) LINE 10 MATHER HEALTH SYSTEM INC 0 CHARITABLE REMAINDER ANNUITY TRUSTS (4) ANNUITY TRUST NY N/A T 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 JEFFERSON'S FERRY FOUNDATION C 75237 COST