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Continuing Care Retirement Community - General Filing Instructions

This annual statement is for use by Continuing Care Retirement Communities authorized pursuant to Article 46 of the Public Health Law.

Each Continuing Care Retirement Community is required to submit a paper version of page 1 of the Jurat with original signatures of the officers and notary. Photocopies of signatures and/or notarization will NOT be accepted.

This Web site also provides specific instructions for filing the New York CONTINUING CARE RETIREMENT COMMUNITY Annual Statement with the Insurance Department and Department of Health. A copy of the New York CONTINUING CARE RETIREMENT COMMUNITY Annual Statement and Instructions are available as indicated below.

The Insurance Department recommends that each Continuing Care Retirement Community download the forms packet and return the annual statement material electronically (e.g., via email or on a compact disc). A Continuing Care Retirement Community may contact the Insurance Department as indicated below and request a copy of the annual statement material.

Continuing Care Retirement Community - Specific Filing Information

The Continuing Care Retirement Community Filing INSTRUCTIONS AND FORMS PACKET is a self extracting zipped file; after downloading file, run EXE to obtain the following files. The Instructions are in PDF format and you will need the Adobe Acrobat Reader to view or print this file. The Jurat and Interrogatories are Microsoft Office Word 2003 files. The Statement Blank is a Microsoft Office Excel 2003 file. The instructions and forms are set up to use standard 8.5" x 11" paper.

FORMS included for Download and/or Print:

To view full instructions for unzipping compressed files, please select this link.


The annual statement is required to be filed within four months of the close of the community's fiscal year, unless an extension has been granted by the Department of Health. (Any request for extension should be addressed to the Department of Health, with a copy to the Insurance Department, and be sent to the email addresses or mailing addresses indicated below. All extension requests must clearly state the reason for the extension, whether or not the audited financial statement will be ready to be submitted by the required filing date, and the extension date being requested.)

It is recommended that an electronic copy of the jurat file, blank file, interrogatories file, audited financial statement, and any supporting material, be submitted to the Insurance Department (email Gary Teitel: and to the Department of Health (email Loretta Grose:

Electronic material on a compact disc is to be sent to the addresses indicated below.

Page 1 of the Jurat with ORIGINAL signatures, and any material that was not submitted electronically, are to be sent to the addresses indicated below. Two paper copies are to be submitted to the Insurance Department and one paper copy to the Department of Health. One Jurat with ORIGINAL signatures must be sent to the Insurance Department.

New York State Insurance Department
Health Bureau
25 Beaver Street
Attention: Gary Teitel, Assistant Chief Actuary
New York, New York 10004

New York State Department of Health
Bureau of Continuing Care Initiatives
Office of Managed Care
Empire State Plaza, Corning Tower, Room 2084
Attention: Linda Gowdy, Director
Albany, New York 12237

If you need help filling out your forms, contact: Health Bureau, Mr. Gary Teitel (212) 480-7709, mailto:


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