2013-10-02T09:49:19-05:00 2012-12-31 160929175 DOPKINS & COMPANY LLP 200 INTERNATIONAL DR BUFFALO NY 142215794 990 2012-01-01 161004090 LAKE SHORE BEHAVIORAL HEALTH INC LAKE 7168420440 255 DELAWARE AVENUE NO 300 BUFFALO NY 14202 HOWARD K HITZEL PSYD 7168420440 2013-09-09 1 KAREN COSTA P01448677 7166348800 2012 2016-02-24 21:20:13Z HOWARD K HITZEL PSYD 255 DELAWARE AVENUE NO 300 BUFFALO NY 14202 15320365 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 12 314 12 -963 -963 5208312 5334082 9329687 9956926 5537 7152 -8112 -963 14535424 15297197 0 0 0 0 9687921 9984163 0 0 0 5257052 5509453 14944973 15493616 -409549 -196419 6714059 6452237 2439952 2368901 4274107 4083336 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 6066786 6386088 MENTAL 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. 4125246 2002004 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. 3155112 1233846 CHEMICAL 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. 648610 334988 ALL OTHER PROGRAM SERVICES. 648610 334988 13995754 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 1 170 0 1 314 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 1 0 NY X FREDERICK GILL 7168420440 255 DELAWARE AVENUE SUITE 300 BUFFALO NY 14202 PETER C RUNFOLA 1.00 X 0 0 0 JEFFREY LOWRY 1.00 X 0 0 0 MARILYN WILSON 1.00 X 0 0 0 MICHAEL A DE FREITAS ESQ 1.00 X 0 0 0 KAREN E EDMOND LMSW 1.00 X 0 0 0 PATRICK SILVER 1.00 X 0 0 0 PATRICIA CARRINGTON ESQ 1.00 X 0 0 0 HOWARD HITZEL 35.00 X 179876 0 11123 WILLIAM GAJEWSKI 1.00 X 0 0 0 CHARLES SYMS MSW 1.00 X 0 0 0 ANGELA BENZEL CPA 1.00 X 0 0 0 RICHARD J SCHECHTER EQP 1.00 X 0 0 0 CHRISTINE ELLINGTON-ROWE 1.00 X 0 0 0 FREDERICK GILL 35.00 X 115770 0 12890 CAROLYN YOUNG 35.00 X 166010 0 10368 461656 0 34381 3 0 1 0 SECURITAS SECURITY SERVICES USA INC 1195 SHERIDAN DRIVE TONAWANDA NY 14150 SECURITY SERVICES 201434 DR DHAM GUPTA 260 MEADOWVIEW LANE WILLIAMSVILLE NY 14221 CONSULTANT PSYCHIATRIST 165522 HOUSING OPTIONS MADE EASY INC 75 JAMESTOWN STREET GOWANDA NY 14070 SUBCONTRACTED PEER SERVICES 158540 DR JEFFERY KASHIN 925 DELAWARE AVE BUFFALO NY 14209 CONSULTANT PSYCHIATRIST 153755 UNIVERSITY PSYCHIATRIC PRACTICE INC 462 GRIDER ST 11TH FLOOR BUFFALO NY 14215 CONSULTANT PSYCHIATRIST 133275 6 5274927 59155 5334082 MEDICAID 623990 6775199 6775199 THIRD PARTY PAYMENTS/MEDICARE 623990 1639934 1639934 CLIENT SERVICES/CONGREGATE 623990 623402 623402 MEDICAID COPS 623990 421650 421650 MEDICAID CSP 623990 349676 349676 147065 147065 9956926 19065 19065 10292 11255 -963 -963 -963 11913 -11913 -11913 -11913 15297197 9945013 -963 19065 496035 176377 319658 7517763 6990615 527148 231654 207764 23890 864698 796078 68620 874013 783880 90133 29291 23074 6217 56500 56500 1538208 1506235 31973 276721 160816 115905 57426 49283 8143 871150 782578 88572 63944 57689 6255 290069 267781 22288 165109 85809 79300 CLIENT INCIDENTALS 1580776 1580776 TELEPHONE 147048 127129 19919 VEHICLES 104828 98903 5925 PROGRAM SUPPLIES 96911 96911 231472 204056 27416 15493616 13995754 1497862 0 958446 1710963 262275 87343 2648887 1968619 63543 128029 4751800 2720064 2251694 2031736 512614 525547 16600 6714059 6452237 843877 930002 1596075 1438899 2439952 2368901 X 4274107 4083336 4274107 4083336 6714059 6452237 X -196419 5646 2 X 0 1 X 1 1 1 X 5486563 6884733 5799305 5208312 5334082 28712995 5486563 6884733 5799305 5208312 5334082 28712995 28712995 5230 10589 13253 17320 24713 71105 26510 33338 52494 65169 177511 28961611 35525758 0.99140 0.98780 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 110408 110408 1191979 218769 973210 1907781 1477510 430271 1413154 974574 438580 128478 49211 79267 2031736 REFUNDABLE ADVANCES 73376 DUE TO MEDICAID 1365523 1438899 15326013 5646 23170 28816 15297197 0 15297197 15516784 23168 23168 15493616 0 15493616 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. X X X X 0 0 0 0 0 0 0 0 0 HOWARD HITZEL 178851 0 0 0 1025 0 9047 0 2076 0 190999 0 0 0 CAROLYN YOUNG 165511 0 0 0 499 0 8376 0 1992 0 176378 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 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 15 THE 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: ROUNDING 2. 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