2014-11-04T07:53:16-06:00 2013-12-31 160929175 DOPKINS & COMPANY LLP 200 INTERNATIONAL DR BUFFALO NY 142215794 990 2013-01-01 161004090 LAKE SHORE BEHAVIORAL HEALTH INC LAKE 7168420440 255 DELAWARE AVENUE NO 300 BUFFALO NY 14202 HOWARD K HITZEL PSYD PRESIDENT 7168420440 2014-10-28 1 KAREN COSTA P01448677 7166348800 2013 2015-11-30 17:44:51Z HOWARD K HITZEL PSYD 255 DELAWARE AVENUE NO 300 BUFFALO NY 14202 16925382 0 X WWW.LAKE-SHORE.ORG X 1971 NY LAKE SHORE BEHAVIORAL HEALTH, INC. PROVIDES A COMPREHENSIVE ARRAY OF TREATMENT AND REHABILITATION SERVICES FOR INDIVIDUALS WITH MENTAL ILLNESSES AND/OR CHEMICAL DEPENDENCY DISORDERS. 12 12 330 0 -12 -12 5334082 5494040 9956926 11407396 7152 9817 -963 -12 15297197 16911241 0 0 0 0 9984163 10958954 0 0 0 5509453 6041101 15493616 17000055 -196419 -88814 6452237 5609346 2368901 1614824 4083336 3994522 X LAKE SHORE BEHAVIORAL HEALTH, INC. PROMOTES SELF-SUFFICIENCY, WELLNESS AND RECOVERY, AND AN ENHANCED QUALITY OF LIFE FOR ALL INDIVIDUALS WITH MENTAL ILLNESSES AND ADDICTIVE DISORDERS BY PROVIDING EFFECTIVE, ACCESSIBLE, AND CULTURALLY-SENSITIVE SERVICES. 0 0 6807609 7324857 MENTAL HEALTH TREATMENT: LAKE SHORE BEHAVIORAL HEALTH, INC. PROVIDES A RANGE OF OUTPATIENT TREATMENT AND REHABILITATION SERVICES TO ADULTS AND ADOLESCENTS DIAGNOSED WITH MENTAL ILLNESSES INCLUDING DEPRESSION, ANXIETY, SCHIZOPHRENIA, AND BIPOLAR DISORDER, AMONG OTHERS. SERVICES INCLUDE INDIVIDUAL, GROUP AND FAMILY COUNSELING; PSYCHIATRIC EVALUATION; MEDICATION THERAPY; INDIVIDUALIZED RECOVERY PLANNING; SYMPTOM MONITORING; CRISIS INTERVENTION; BASIC LIVING SKILLS TRAINING; HEALTH ASSESSMENT; AND RELAPSE PREVENTION, AMONG OTHERS. 4469853 2331922 INTENSIVE MENTAL HEALTH SERVICES: INTENSIVE SERVICES ARE COMPRISED OF THE ASSERTIVE COMMUNITY TREATMENT TEAMS (ACT), THE HOMELESS SERVICES PROGRAM AND THE CASE MANAGEMENT PROGRAM. LSBH OFFERS ASSERTIVE COMMUNITY TREATMENT (ACT) TO INDIVIDUALS WITH SERIOUS MENTAL ILLNESSES WHO HAVE PREVIOUSLY NOT BENEFITTED FROM TRADITIONAL OUTPATIENT MENTAL HEALTH SERVICES. ACT CONSISTS OF A MOBILE MENTAL HEALTH TEAM THAT PROVIDES COMPREHENSIVE, INDIVIDUALIZED PSYCHIATRIC TREATMENT TO PEOPLE IN THE COMMUNITY. THE HOMELESS SERVICES PROGRAM PROVIDES HOUSING AND SUPPORT SERVICES FOR INDIVIDUALS WHO ARE HOMELESS AND WHO SUFFER FROM A MENTAL ILLNESS. THE CASE MANAGEMENT PROGRAM OFFERS PLANNING, LINKING, ADVOCACY, AND MONITORING SERVICES TO INDIVIDUALS WITH SERIOUS MENTAL ILLNESSES. "HEALTH HOME SERVICES-LSBH PROVIDES CARE COORDINATION TO MEDICAID RECIPIENTS TO HELP MAKE SURE AN INDIVIDUAL'S MEDICAL, MENTAL HEALTH, SUBSTANCE ABUSE SERVICES AS WELL AS THEIR SOCIAL NEEDS ARE BEING MET." 3178300 1551177 SUBSTANCE USE DISORDER TREATMENT: LAKE SHORE BEHAVIORAL HEALTH, INC. OFFERS INDIVIDUAL, GROUP AND FAMILY COUNSELING TO ADULTS AND ADOLESCENTS EXPERIENCING PROBLEMS RELATED TO THE USE OF ALCOHOL OR OTHER ADDICTIVE SUBSTANCES. CLINICS ALSO OFFER INTEGRATED TREATMENT FOR INDIVIDUALS WHO ARE DUALLY DIAGNOSED WITH MENTAL HEALTH DISORDERS, MEDICATION ASSISTED TREATMENT IS ALSO OFFERED. LSBH ALSO OFFERS AN INTENSIVE RESIDENTIAL ADDICTIONS TREATMENT PROGRAM FOR PREGNANT OR PARENTING WOMEN. 862242 199440 ALL OTHER PROGRAM SERVICES. 862242 199440 15318004 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 156 0 1 330 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NY X HOWARD HITZEL PSY D 7168420440 255 DELAWARE AVENUE SUITE 300 BUFFALO NY 14202 PETER C RUNFOLA DIRECTOR 1.00 X 0 0 0 JEFFREY LOWRY DIRECTOR 1.00 X 0 0 0 MARILYN WILSON DIRECTOR 1.00 X 0 0 0 MICHAEL A DE FREITAS ESQ DIRECTOR 1.00 X 0 0 0 KAREN E EDMUND LMSW DIRECTOR 1.00 X 0 0 0 PATRICK SILVER DIRECTOR 1.00 X 0 0 0 PATRICIA CARRINGTON ESQ DIRECTOR 1.00 X 0 0 0 HOWARD HITZEL PRESIDENT 35.00 X 188361 0 10995 WILLIAM GAJEWSKI CHAIR 1.00 X 0 0 0 CHARLES SYMS MSW VICE CHAIRPERSON 1.00 X 0 0 0 ANGELA BENZEL CPA TREASURER 1.00 X 0 0 0 RICHARD J SCHECHTER EQP VICE CHAIRPERSON 1.00 X 0 0 0 CHRISTINE ELLINGTON-ROWE SECRETARY 1.00 X 0 0 0 FREDERICK GILL CHIEF FINANCIAL OFFICER 35.00 X 110078 0 13434 CAROLYN YOUNG ACT ASPIRE MD 35.00 X 147891 0 9722 JAROD MASCI PSYCIATRIST 35.00 X 201729 0 14969 648059 0 49120 4 0 1 0 SECURITAS SECURITY SERVICES USA INC 1195 SHERIDAN DRIVE TONAWANDA NY 14150 SECURITY SERVICES 200532 DR JEFFERY KASHIN 925 DELAWARE AVE BUFFALO NY 14209 CONSULTANT PSYCHIATRIST 178220 DR HERMAN SZYMANSKI 340 BRANTWOOD ROAD AMHERST NY 14226 CONSULTANT PSYCHIATRIST 112153 3 5416540 77500 5494040 MEDICAID 623990 7530798 7530798 THIRD PARTY PAYMENTS/MEDICARE 623990 2689861 2689861 MEDICAID CSP 623990 346191 346191 MISCELLANEOUS 623990 332830 332830 CLIENT SERVICES/CONGREGATE 623990 315744 315744 191972 191972 11407396 9817 9817 14129 14141 -12 -12 -12 16911241 11407396 -12 9817 697179 374311 322868 8000235 7421327 578908 296650 277885 18765 1964890 1770795 194095 2499 2499 46950 46950 1533269 1514630 18639 206729 111668 95061 762914 678913 84001 86207 76050 10157 329034 305105 23929 214751 94177 120574 CLIENT INCIDENTALS 1000316 1000316 RESIDENT FOOD 313636 313636 OTHER 295027 245960 49067 MINOR EQUIPMENT 203067 196355 6712 1046702 936876 109826 17000055 15318004 1682051 0 1710963 1268105 87343 1968619 1728313 128029 107725 4948600 2969545 2031736 1979055 525547 526148 6452237 5609346 930002 1252928 1438899 361896 2368901 1614824 X 4083336 3994522 4083336 3994522 6452237 5609346 -88814 0 X 0 1 X 1 1 1 X 6884733 5799305 5208312 5334082 5494040 28720472 6884733 5799305 5208312 5334082 5494040 28720472 28720472 10589 13253 17320 24713 9817 75692 33338 52494 65169 151001 28947165 47687121 0.99220 0.99140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 110408 110408 1195907 311677 884230 1923816 1583761 340055 1538745 999890 538855 179724 74217 105507 1979055 AMOUNTS DUE TO 3RD PARTY PAYORS 361896 361896 X X X X 0 0 0 0 0 0 0 0 0 HOWARD HITZEL PRESIDENT 188361 0 0 0 0 0 9418 0 1577 0 199356 0 0 0 CAROLYN YOUNG ACT ASPIRE MD 145174 0 2717 0 0 0 7395 0 2327 0 157613 0 0 0 JAROD MASCI PSYCIATRIST 200162 0 1567 0 0 0 10086 0 4883 0 216698 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED IN DRAFT FORM TO MEMBERS OF THE BOARD OF LAKE SHORE BEHAVIORAL HEALTH, INC. FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C IN ACCORDANCE WITH LAKE SHORE BEHAVIORAL HEALTH'S CONFLICT OF INTEREST POLICY, EACH OFFICER INCLUDES ANY NON-DIRECTOR SERVING ON ANY COMMITTEE OF THE BOARD OF DIRECTORS AND DIRECTORS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, D. UNDERSTANDS THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES, AND E. IS NOT AWARE THAT HE OR SHE HAS ANY FINANCIAL INTEREST OR, IF HE OR SHE IS AWARE OF ANY FINANCIAL INTEREST, A DESCRIPTION OF THE MATERIAL FACTS CONCERNING IT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD SUBCOMMITTEE HAS THE RESPONSIBILITY TO DETERMINE THE COMPENSATION OF THE PRESIDENT OF THE AGENCY. THE PURPOSE OF THE COMMITTEE IS TO APPROVE ANNUAL PERFORMANCE STANDARDS AND TO DETERMINE APPROPRIATE PERFORMANCE MEASURES AND ESTABLISH CRITERIA FOR ANY INCENTIVE BASED COMPENSATION. IT ALSO ANNUALLY REVIEWS AND APPROVES ANY CHANGES TO THE TOTAL COMPENSATION OF THE PRESIDENT. THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED BY THE PRESIDENT. THE PRESIDENT APPROVES ANNUAL PERFORMANCE STANDARDS AND DETERMINES APPROPRIATE PERFORMANCE MEASURES AND ESTABLISHES CRITERIA FOR ANY INCENTIVE BASED COMPENSATION FOR KEY EMPLOYEES. THE COMMITTEE DETERMINES IF THE COMPENSATION IS REASONABLE. TO ACCOMPLISH THIS, THE COMMITTEE WILL OBTAIN COMPARABLE COMPENSATION DATA FOR EXECUTIVES OF OTHER NON PROFIT ORGANIZATIONS OF SIMILAR SIZE IN THE WESTERN NEW YORK AREA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE. COPIES CAN BE PROVIDED UPON REQUEST BY PHONE, IN WRITING, OR VIA E-MAIL. LAKE SHORE COMMUNITY MENTAL HEALTH FOUNDATION 255 DELAWARE BUFFALO NY 14202 161450067 PROVIDE FINANCIAL ASSISTANCE TO LAKE SHORE BEHAVIORAL INC. NY 501(C)(3) CHARITABLE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0