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BESTSELF BEHAVIORAL HEALTH INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
BESTSELF BEHAVIORAL HEALTH INC (EIN 16-1004090)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-10-02
IRS object ID
201342759349300419
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-10-02T09:49:19-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN160929175EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DOPKINS & COMPANY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 INTERNATIONAL DRAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code142215794ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN161004090EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKE SHORE BEHAVIORAL HEALTH INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLAKENameControl
Phone7168420440Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1255 DELAWARE AVENUE NO 300AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14202ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHOWARD K HITZEL PSYDName
TitlePRESIDENTTitle
Phone7168420440Phone
Date Signed2013-09-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKAREN COSTAName
PTINP01448677PTIN
Phone7166348800Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonHOWARD K HITZEL PSYDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1255 DELAWARE AVENUE NO 300AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14202ZIPCode
FieldValueIRS element (for citing)
Gross Receipts15320365GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LAKE-SHORE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionLAKE SHORE BEHAVIORAL HEALTH, INC. PROVIDES A COMPREHENSIVE ARRAY OF TREATMENT AND REHABILITATION SERVICES FOR INDIVIDUALS WITH MENTAL ILLNESSES AND/OR CHEMICAL DEPENDENCY DISORDERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees314TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI-963TotalGrossUBI
Net Unrelated Business Txbl Income-963NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5208312ContributionsGrantsPriorYear
Contributions Grants Current Year5334082ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9329687ProgramServiceRevenuePriorYear
Program Service Revenue CY9956926ProgramServiceRevenueCY
Investment Income Prior Year5537InvestmentIncomePriorYear
Investment Income Current Year7152InvestmentIncomeCurrentYear
Other Revenue Prior Year-8112OtherRevenuePriorYear
Other Revenue Current Year-963OtherRevenueCurrentYear
Total Revenue Prior Year14535424TotalRevenuePriorYear
Total Revenue Current Year15297197TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9687921SalariesEtcPriorYear
Salaries Etc Current Year9984163SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5257052OtherExpensePriorYear
Other Expenses Current Year5509453OtherExpensesCurrentYear
Total Expenses Prior Year14944973TotalExpensesPriorYear
Total Expenses Current Year15493616TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-409549RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-196419RevenuesLessExpensesCY
Total Assets BOY6714059TotalAssetsBOY
Total Assets EOY6452237TotalAssetsEOY
Total Liabilities BOY2439952TotalLiabilitiesBOY
Total Liabilities EOY2368901TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4274107NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4083336NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionLAKE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6066786Expense
Revenue6386088Revenue
DescriptionMENTAL HEALTH TREATMENT: LAKE SHORE BEHAVIORAL HEALTH, INC. PROVIDES A RANGE OF OUTPATIENT TREATMENT AND REHABILITATION SERVICES TO INDIVIDUALS 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4125246Expense
Revenue2002004Revenue
DescriptionINTENSIVE 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.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3155112Expense
Revenue1233846Revenue
DescriptionCHEMICAL DEPENDENCY: LAKE SHORE BEHAVIORAL HEALTH, INC. OFFERS INDIVIDUAL, GROUP AND FAMILY COUNSELING TO ADULTS EXPERIENCING PROBLEMS RELATED TO THE USE OF ALCOHOL OR OTHER ADDICTIVE SUBSTANCES. A FAMILY/COMMUNITY BASED TREATMENT PROGRAM IS AVAILABLE TO TEENAGERS AGED 11 TO 17 YEARS OLD. LSBH ALSO OFFERS AN INTENSIVE RESIDENTIAL ADDICTIONS TREATMENT PROGRAM FOR PREGNANT OR PARENTING WOMEN.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense648610Expense
Revenue334988Revenue
DescriptionALL OTHER PROGRAM SERVICES.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp648610TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev334988TotalOfOtherProgramServiceRev
Total Program Service Expense13995754TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096170NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees314NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1FREDERICK GILLBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168420440TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1255 DELAWARE AVENUE SUITE 300AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14202ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
PETER C RUNFOLA
DIRECTOR1.00X000
JEFFREY LOWRY
DIRECTOR1.00X000
MARILYN WILSON
DIRECTOR1.00X000
MICHAEL A DE FREITAS ESQ
DIRECTOR1.00X000
KAREN E EDMOND LMSW
DIRECTOR1.00X000
PATRICK SILVER
DIRECTOR1.00X000
PATRICIA CARRINGTON ESQ
DIRECTOR1.00X000
HOWARD HITZEL
PRESIDENT35.00179876011123X
WILLIAM GAJEWSKI
CHAIR1.00000X
CHARLES SYMS MSW
VICE CHAIRPERSON1.00000X
ANGELA BENZEL CPA
TREASURER1.00000X
RICHARD J SCHECHTER EQP
VICE CHAIRPERSON1.00000X
CHRISTINE ELLINGTON-ROWE
SECRETARY1.00000X
FREDERICK GILL
CHIEF FINANCIAL OFFICER35.00115770012890X
CAROLYN YOUNG
ACT ASPIRE MD35.00166010010368X
FieldValueIRS element (for citing)
Total Reportable Comp From Org461656TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation34381TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SECURITAS SECURITY SERVICES USA INC
1195 SHERIDAN DRIVETONAWANDANY14150SECURITY SERVICES201434
DR DHAM GUPTA
260 MEADOWVIEW LANEWILLIAMSVILLENY14221CONSULTANT PSYCHIATRIST165522
HOUSING OPTIONS MADE EASY INC
75 JAMESTOWN STREETGOWANDANY14070SUBCONTRACTED PEER SERVICES158540
DR JEFFERY KASHIN
925 DELAWARE AVEBUFFALONY14209CONSULTANT PSYCHIATRIST153755
UNIVERSITY PSYCHIATRIC PRACTICE INC
462 GRIDER ST 11TH FLOORBUFFALONY14215CONSULTANT PSYCHIATRIST133275
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Government Grants5274927GovernmentGrants
All Other Contributions59155AllOtherContributions
Total Contributions5334082TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID62399067751996775199
THIRD PARTY PAYMENTS/MEDICARE62399016399341639934
CLIENT SERVICES/CONGREGATE623990623402623402
MEDICAID COPS623990421650421650
MEDICAID CSP623990349676349676

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column147065TotalRevenueColumn
Related Or Exempt Function Income147065RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9956926TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column19065TotalRevenueColumn
Exclusion$19,065ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real10292Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real11255Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-963Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-963TotalRevenueColumn
Unrelated Business Revenue-963UnrelatedBusinessRevenue

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other11913Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-11913Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-11913TotalRevenueColumn
Related Or Exempt Function Income-11913RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15297197TotalRevenueColumn
Related Or Exempt Function Income9945013RelatedOrExemptFunctionIncome
Unrelated Business Revenue-963UnrelatedBusinessRevenue
Exclusion$19,065ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total496035Total
Program Services176377ProgramServices
Management And General319658ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7517763Total
Program Services6990615ProgramServices
Management And General527148ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total231654Total
Program Services207764ProgramServices
Management And General23890ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total864698Total
Program Services796078ProgramServices
Management And General68620ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total874013Total
Program Services783880ProgramServices
Management And General90133ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total29291Total
Program Services23074ProgramServices
Management And General6217ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total56500Total
Management And General56500ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1538208Total
Program Services1506235ProgramServices
Management And General31973ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total276721Total
Program Services160816ProgramServices
Management And General115905ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total57426Total
Program Services49283ProgramServices
Management And General8143ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total871150Total
Program Services782578ProgramServices
Management And General88572ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total63944Total
Program Services57689ProgramServices
Management And General6255ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total290069Total
Program Services267781ProgramServices
Management And General22288ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total165109Total
Program Services85809ProgramServices
Management And General79300ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CLIENT INCIDENTALS15807761580776
TELEPHONE14704812712919919
VEHICLES104828989035925
PROGRAM SUPPLIES9691196911

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total231472Total
Program Services204056ProgramServices
Management And General27416ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15493616Total
Program Services13995754ProgramServices
Management And General1497862ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY958446BOY
EOY1710963EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY262275BOY
EOY87343EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2648887BOY
EOY1968619EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY63543BOY
EOY128029EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4751800LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2720064LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2251694BOY
EOY2031736EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY512614BOY
EOY525547EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY16600BOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6714059BOY
EOY6452237EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY843877BOY
EOY930002EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1596075BOY
EOY1438899EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2439952BOY
EOY2368901EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4274107BOY
EOY4083336EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4274107BOY
EOY4083336EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6714059BOY
EOY6452237EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-196419ReconcilationRevenueExpenses
Reconciliation Unrealized Invest5646ReconciliationUnrealizedInvest
Reconcilation Other Changes2ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5486563CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6884733CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5799305CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5208312CurrentTaxYearMinus1Year
Current Tax Year5334082CurrentTaxYear
Total28712995Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5486563CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6884733CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5799305CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5208312CurrentTaxYearMinus1Year
Current Tax Year5334082CurrentTaxYear
Total28712995Total
FieldValueIRS element (for citing)
Public Support Total17028712995PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5230CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10589CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13253CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17320CurrentTaxYearMinus1Year
Current Tax Year24713CurrentTaxYear
Total71105Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26510CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33338CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years52494CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year65169CurrentTaxYearMinus1Year
Total177511Total
FieldValueIRS element (for citing)
Total Support28961611TotalSupport
Gross Receipts From Admissions Etc35525758GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.99140PublicSupportPertcentage170
Public Support Pertcent Prior Year0.98780PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis110408OtherCostOrOtherBasis
Book Value110408BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1191979OtherCostOrOtherBasis
Depreciation218769Depreciation
Book Value973210BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1907781OtherCostOrOtherBasis
Depreciation1477510Depreciation
Book Value430271BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1413154OtherCostOrOtherBasis
Depreciation974574Depreciation
Book Value438580BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis128478OtherCostOrOtherBasis
Depreciation49211Depreciation
Book Value79267BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2031736TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
REFUNDABLE ADVANCES$73,376
DUE TO MEDICAID$1,365,523
FieldValueIRS element (for citing)
Total Of Amounts1438899TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt15326013TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments5646NetUnrealizedGainsInvestments
Other Revenues23170OtherRevenues
Revenue Not Rptd F99028816RevenueNotRptdF990
Revenue Subtotal15297197RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99015297197TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15516784TotExpensesEtcAuditedFinclStmt
Other Expenses Included23168OtherExpensesIncluded
Expenses Not Rptd F99023168ExpensesNotRptdF990
Expenses Subtotal15493616ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99015493616TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSETS 11,915. RENTAL EXPENSES NET WITH REVENUE 11,255.
PART XII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSETS 11,915. RENTAL EXPENSES NET WITH REVENUE 11,255. OTHER -2.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
HOWARD HITZEL
PRESIDENT178851000102509047020760190999000
CAROLYN YOUNG
ACT ASPIRE MD16551100049908376019920176378000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CIN ACCORDANCE WITH LAKE SHORE BEHAVIORAL HEALTH'S CONFLICT OF INTEREST POLICY, EACH OFFICER INCLUDING 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 15THE BOARD SUBCOMMITTEE HAS THE RESPONSIBILITY TO DETERMINE THE COMPENSATION OF KEY EMPLOYEES. 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 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 19THE 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.
FORM 990, PART XI, LINE 9:ROUNDING 2.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1LAKE SHORE COMMUNITY MENTAL HEALTH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1255 DELAWAREAddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14202ZIPCode
FieldValueIRS element (for citing)
EIN161450067EIN
Primary ActivitiesPROVIDE FINANCIAL ASSISTANCE TO LAKE SHORE BEHAVIORAL INC.PrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusCHARITABLEPublicCharityStatus
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg