Continuing Care Retirement Community 2020 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.

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.

Instructions for filing the New York Continuing Care Retirement Community Annual Statement with the Department of Financial Services and Department of Health can be found below. A copy of the Annual Statement and Instructions are available below.

The Department of Financial Services recommends that each Continuing Care Retirement Community download the forms packet and return the annual statement material via email (or on a compact disc). A Continuing Care Retirement Community may also contact the Department of Financial Services as indicated below to request a hard copy of the annual statement 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.

After downloading, unzip the file to obtain the following files:

  • Jurat (pages 1 and 2 of the Statement) 2020 (MS Word)
  • Statement Blank 2020 (MS Excel)
  • Interrogatories 2020 (MS Word)
  • Certificate of Compliance 2020 (MS Word)
  • Instructions for completing the Annual Statement 2020 (PDF)

Due Date and 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 a copy of the jurat file, blank file, certificate of compliance, interrogatories file, audited financial statement, and any supporting material, be submitted via email 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 via email to Michael Heeran: [email protected]).

Material saved to compact disc may 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 via email, may 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

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

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].