2018 ANNUAL STATEMENT
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 and the Certificate of Compliance 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 Department of Financial Services and Department of Health. A copy of the New York CONTINUING CARE RETIREMENT COMMUNITY Annual Statement and Instructions are available as indicated below.

The Department of Financial Services 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 Department of Financial Services 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 compressed zipped file; after downloading, unzip 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, Certificate of Compliance, and Interrogatories are Microsoft Office Word 2016 files. The Statement Blank is a Microsoft Office Excel 2016 file. The instructions and forms are set up to use standard 8.5" x 11" paper.

FORMS included for Download and/or Print:

  • JURAT (PAGES 1 AND 2 OF THE STATEMENT) 2018
  • STATEMENT BLANK 2018
  • INTERROGATORIES 2018
  • CERTIFICATE OF COMPLIANCE 2018
  • INSTRUCTIONS FOR COMPLETING THE ANNUAL STATEMENT MATERIAL 2018

DUE DATE & MAILING

The annual statement is required to be filed within four months of the close of the community's fiscal year (all statement filings are expected to be made timely).

It is recommended that an electronic copy of the jurat file, blank file, certificate of compliance, interrogatories file, audited financial statement, and any supporting material, be submitted to the Department of Financial Services (email Warren Youngs: [email protected]; and Mark Brandes, [email protected]; and Andre Blackman, [email protected]) and to the Department of Health (email Michael Heeran: [email protected]).

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

Page 1 of the Jurat and the Certificate of Compliance 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 Department of Financial Services and one paper copy to the Department of Health. One Jurat and Certificate of Compliance with ORIGINAL signatures must be sent to the Department of Financial Services.

New York State Department of Financial Services
One State Street
Health Bureau, 11th Floor
Attention: Warren Youngs, Supervising Examiner
New York, New York 10004-1511

Michael Heeran
CCRC Program Director
Center for Health Care Facility Licensure and Finance
New York State Department of Health
Room 1805, Corning Tower ESP
Albany, New York 12237

PROBLEMS AND QUESTIONS:
If you need help filling out your forms, contact: Health Bureau, Mr. Warren Youngs (212) 480-3883 or Mr. Andre Blackman (212) 709-7619, email to: [email protected] and [email protected].