Continuing Care Retirement Community Annual Statement
General Filing Instructions
This annual statement is for use by Continuing Care Retirement Communities authorized pursuant to Article 46 of the Public Health Law filing the New York Continuing Care Retirement Community Annual Statement with the Department of Financial Services and Department of Health can be found below.
Each Continuing Care Retirement Community may submit an electronic version of page 1 of the Jurat and the Certificate of Compliance which must contain original signatures of the officers and a notary.
The Department of Financial Services recommends that each Continuing Care Retirement Community download the forms packet and return the annual statement material via email. A Continuing Care Retirement Community may also contact DFS to request a hard copy of the annual statement filing material.
Specific Filing Information
The Continuing Care Retirement Community Filing Instructions and Forms packet is a compressed zipped file. The Jurat, Certificate of Compliance, and Interrogatories are Microsoft Word files. The Statement Blank is a Microsoft Excel file. The instructions and forms are set to standard 8.5" x 11" paper size.
- Download the Continuing Care Retirement Community Filing Instructions and Forms packet (.zip)
After downloading, unzip the file to obtain the following:
- General Filing Instructions (MS Word)
- Jurat (pages 1 and 2 of the Statement) (MS Word)
- Statement Blank (MS Excel)
- Interrogatories (MS Word)
- Certificate of Compliance (MS Word)
- Instructions for completing the Annual Statement (PDF)
Due Date and Mailing
The annual statement is required to be filed within four months of the closing of the Community's fiscal year (all statement filings are expected to be made timely).
All required documents with a copy of the jurat file, blank file, certificate of compliance, interrogatories file, audited financial statement, and any supporting material, when submitted by email, must be submitted to DFS to the following email addresses:
- Ergys Shanaj at [email protected]
- Andre Blackman at [email protected]
- Sylvia Lawson at [email protected]
- Mark Brandes at [email protected]
- DFS Regulatory Inbox at [email protected]
- Mike Heeran at the Department of Health at [email protected]
When requested in hard copy, an original version of a filing document can be sent by mail to the addresses indicated below, with two paper copies submitted to DFS and one paper copy to the Department of Health. The Jurat and Certificate of Compliance must be provided with ORIGINAL signatures when submitted to the Department of Financial Services.
| New York State Department of Financial Services One State Street Plaza Health Bureau, 11th Floor New York, New York 10004-1511 Attn: Andre Blackman | New York State Department of Health 875 Central Avenue Albany, New York 12206 Attn: Michael Heeran, CCRC Program Lead |
Questions?
If you need help filling out your forms, contact Ergys Shanaj (212) 480-3878 or Andre Blackman (212) 709-7619, or email [email protected] and [email protected].