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BESTSELF BEHAVIORAL HEALTH INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
BESTSELF BEHAVIORAL HEALTH INC (EIN 16-1004090)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-04
IRS object ID
201232789349300308
Schema version
2011v1.2
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)
Timestamp2012-10-04T09:06:03-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 Date2011-01-01TaxPeriodBeginDate

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 Signed2012-09-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD J PFENTNERName
PTINP00658696PTIN
Phone7166348800Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
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 Receipts14563996GrossReceipts
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 Employees322TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI-8112TotalGrossUBI
Net Unrelated Business Txbl Income-8112NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5799305ContributionsGrantsPriorYear
Contributions Grants Current Year5208312ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9266430ProgramServiceRevenuePriorYear
Program Service Revenue CY9329687ProgramServiceRevenueCY
Investment Income Prior Year11647InvestmentIncomePriorYear
Investment Income Current Year5537InvestmentIncomeCurrentYear
Other Revenue Prior Year39908OtherRevenuePriorYear
Other Revenue Current Year-8112OtherRevenueCurrentYear
Total Revenue Prior Year15117290TotalRevenuePriorYear
Total Revenue Current Year14535424TotalRevenueCurrentYear
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 Year9785894SalariesEtcPriorYear
Salaries Etc Current Year9687921SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5449465OtherExpensePriorYear
Other Expenses Current Year5257052OtherExpensesCurrentYear
Total Expenses Prior Year15235359TotalExpensesPriorYear
Total Expenses Current Year14944973TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-118069RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-409549RevenuesLessExpensesCY
Total Assets BOY8096708TotalAssetsBOY
Total Assets EOY6714059TotalAssetsEOY
Total Liabilities BOY3416747TotalLiabilitiesBOY
Total Liabilities EOY2439952TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4679961NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4274107NetAssetsOrFundBalancesEOY
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
Expense5401799Expense
Revenue5717284Revenue
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)
Expense2332963Expense
Revenue2357131Revenue
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)
Expense2863955Expense
Revenue1056229Revenue
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)
Expense2802689Expense
Revenue199043Revenue
DescriptionALL OTHER PROGRAM SERVICES.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp2802689TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev199043TotalOfOtherProgramServiceRev
Total Program Service Expense13401406TotalProgramServiceExpense
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 Securities1ReportInvestOthSecurities
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096184NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees322NumberOfEmployees
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
Other WebsiteXOtherWebsite
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
WILLIAM GAJEWSKI
CHAIR1.00X000X
JEFFREY LOWRY
DIRECTOR1.00X000
CHARLES SYMS MSW
DIRECTOR1.00X000
MARILYN WILSON
DIRECTOR1.00X000
ANGELA BENZEL CPA
TREASURER1.00X000X
MICHAEL A DE FREITAS ESQ
DIRECTOR1.00X000
KAREN E EDMUND LMSW
VICE CHAIRPERSON1.00X000X
RICHARD J SCHECHTER EQP
VICE CHAIRPERSON1.00X000X
PATRICK SILVER
DIRECTOR1.00X000
CHRISTINE ELLINGTON-ROWE
SECRETARY1.00X000X
PATRICIA CARRINGTON ESQ
DIRECTOR1.00X000
HOWARD HITZEL
PRESIDENT35.00171082010816X
FREDERICK GILL
CHIEF FINANCIAL OFFICER35.00111993013145X
CAROLYN YOUNG
ACT ASPIRE MD35.0016960501637X
FieldValueIRS element (for citing)
Total Reportable Comp From Org452680TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation25598TotalOtherCompensation
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 SERVICES207495
DR DHAM GUPTA
260 MEADOWVIEW LANEWILLIAMSVILLENY14221CONSULTANT PSYCHIATRIST177840
DR JEFFERY KASHIN
925 DELAWARE AVEBUFFALONY14209CONSULTANT PSYCHIATRIST160995
HOUSING OPTIONS MADE EASY INC
75 JAMESTOWN STREETGOWANDANY14070SUBCONTRACTED PEER SERVICES123802
DR HONG RAE CHOE
250 WELLINGWOODE AMHERSTNY14051CONSULTANT PSYCHIATRIST103270
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants4903971GovernmentGrants
All Other Contributions304341AllOtherContributions
Total Contributions5208312TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID62399056445645644564
THIRD PARTY PAYMENTS62399016474961647496
MEDICAID COPS62399013178761317876
CLIENT SERVICES623990333653333653
MEDICAID CSP623990312817312817

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column73281TotalRevenueColumn
Related Or Exempt Function Income73281RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9329687TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column21248TotalRevenueColumn
Exclusion$21,248ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real4749Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real12861Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-8112Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-8112TotalRevenueColumn
Unrelated Business Revenue-8112UnrelatedBusinessRevenue

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other15711Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-15711Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-15711TotalRevenueColumn
Related Or Exempt Function Income-15711RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14535424TotalRevenueColumn
Related Or Exempt Function Income9313976RelatedOrExemptFunctionIncome
Unrelated Business Revenue-8112UnrelatedBusinessRevenue
Exclusion$21,248ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total478278Total
Program Services171242ProgramServices
Management And General307036ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7163574Total
Program Services6626625ProgramServices
Management And General536949ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total234540Total
Program Services222137ProgramServices
Management And General12403ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1723148Total
Program Services1619993ProgramServices
Management And General103155ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total88381Total
Program Services1335ProgramServices
Management And General87046ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1465Total
Management And General1465ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total100010Total
Program Services43510ProgramServices
Management And General56500ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1380143Total
Program Services1360033ProgramServices
Management And General20110ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total404626Total
Program Services277551ProgramServices
Management And General127075ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total43401Total
Program Services35404ProgramServices
Management And General7997ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total890059Total
Program Services799246ProgramServices
Management And General90813ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total68843Total
Program Services57616ProgramServices
Management And General11227ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total352816Total
Program Services325093ProgramServices
Management And General27723ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total170890Total
Program Services83503ProgramServices
Management And General87387ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CLIENT INCIDENTALS945311945311
FOOD286769286769
MISCELLANEOUS28431725060633711
VEHICLES1361011287167385

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total192301Total
Program Services166716ProgramServices
Management And General25585ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total14944973Total
Program Services13401406ProgramServices
Management And General1543567ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1487750BOY
EOY958446EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY262248BOY
EOY262275EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3042368BOY
EOY2648887EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY295116BOY
EOY63543EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4806544LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2554850LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2489041BOY
EOY2251694EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY509253BOY
EOY512614EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10932BOY
EOY16600EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8096708BOY
EOY6714059EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1039219BOY
EOY843877EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2377528BOY
EOY1596075EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3416747BOY
EOY2439952EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4679961BOY
EOY4274107EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4679961BOY
EOY4274107EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8096708BOY
EOY6714059EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-409549ReconcilationRevenueExpenses
Reconcilation Other Changes3695ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years4891764CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5486563CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6884733CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5799305CurrentTaxYearMinus1Year
Current Tax Year5208312CurrentTaxYear
Total28270677Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4891764CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5486563CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6884733CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5799305CurrentTaxYearMinus1Year
Current Tax Year5208312CurrentTaxYear
Total28270677Total
FieldValueIRS element (for citing)
Public Support Total17028270677PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years76358CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5230CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10589CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13253CurrentTaxYearMinus1Year
Current Tax Year17320CurrentTaxYear
Total122750Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years50113CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years26510CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years33338CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52494CurrentTaxYearMinus1Year
Current Tax Year65169CurrentTaxYear
Total227624Total
FieldValueIRS element (for citing)
Total Support28621051TotalSupport
Gross Receipts From Admissions Etc42681661GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.98780PublicSupportPertcentage170
Public Support Pertcent Prior Year0.98710PublicSupportPertcentPriorYear
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
Depreciation168542Depreciation
Book Value1023437BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1860585OtherCostOrOtherBasis
Depreciation1378272Depreciation
Book Value482313BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1514079OtherCostOrOtherBasis
Depreciation972211Depreciation
Book Value541868BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis129493OtherCostOrOtherBasis
Depreciation35825Depreciation
Book Value93668BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2251694TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionMUTUAL FUNDSDescription
Book Value512614BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities512614TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
REFUNDABLE ADVANCES$63,614
DUE TO MEDICAID$1,532,461
FieldValueIRS element (for citing)
Total Of Amounts1596075TotalOfAmounts
Total Revenue14535424TotalRevenue
Total Expenses14944973TotalExpenses
Excess Or Deficit For Year-409549ExcessOrDeficitForYear
Net Unrealized GL On Investments-3928NetUnrealizedGLOnInvestments
Donated Services And Facilities7623DonatedServicesAndFacilities
Total Adjustments3695TotalAdjustments
Excess Or Deficit Per FS-405854ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt14554830TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-3928NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities7623DonatedSrvcAndUseOfFacilities
Other Revenues15711OtherRevenues
Revenue Not Rptd F99019406RevenueNotRptdF990
Revenue Subtotal14535424RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99014535424TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt14960684TotExpensesEtcAuditedFinclStmt
Other Expenses Included15711OtherExpensesIncluded
Expenses Not Rptd F99015711ExpensesNotRptdF990
Expenses Subtotal14944973ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99014944973TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSETS 15,711.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:LOSS ON DISPOSAL OF ASSETS 15,711.

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)

Base 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
17011200097008616022000181898000
CAROLYN YOUNG
16932900027600016370171242000

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 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 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 5:NET UNREALIZED LOSSES ON INVESTMENTS: -3,928. DONATED SERVICES AND USE OF FACILITIES: 7,623. TOTAL TO FORM 990, PART XI, LINE 5: 3,695.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
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