TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JOHN TAPINIS...................................................................... CHAIR	10.00 .................	X	X
(2) ROBERT CUTRONA...................................................................... VICE CHAIR	3.00 .................	X	X
(3) ANTHONY DEFAZIO...................................................................... TREASURER	2.00 .................	X	X
(4) ELIZABETH PALAGIANO...................................................................... SECRETARY	1.00 .................	X	X
(5) MARY ELLEN BONGAILAS...................................................................... BOARD MEMBER	1.00 .................	X
(6) SHARDE P THOMAS...................................................................... BOARD MEMBER	1.00 .................	X
(7) AL LAMBERT...................................................................... BOARD MEMBER	1.00 .................	X
(8) DR CHRISTINE CEA...................................................................... BOARD MEMBER	1.00 .................	X
(9) ROBERT CONTI MBA...................................................................... BOARD MEMBER	2.00 .................	X
(10) VICTORIA DRUMBAKIS...................................................................... BOARD MEMBER	1.00 .................	X
(11) BERNADETTE PAULO...................................................................... BOARD MEMBER	1.00 .................	X
(12) RONALD GREGG ESQ...................................................................... BOARD MEMBER	1.00 .................	X
(13) JOHN HOGAN...................................................................... BOARD MEMBER	1.00 .................	X
(14) LAURA KENNEDY...................................................................... BOARD MEMBER	1.00 .................	X
(15) NANCY SHANAPHY...................................................................... BOARD MEMBER	1.00 .................	X
(16) DEEPTHA NEDUNCHEZIAN SITHIANMD...................................................................... BOARD MEMBER	1.00 .................	X
(17) ROBERTA VOGEL PHD...................................................................... BOARD MEMBER	1.00 .................	X

(A) Name and business address	(B) Description of services	(C) Compensation
COMMUNITY HEALTH ACTION OF SI 56 BAY STREET 4TH FLOOR STATEN ISLAND,NY10301	CONSULTING	672,459
DRISCOLL FOODS 174 DELAWANNA AVENUE CLIFTON,NJ07014	FOOD SERVICE	169,758
NERAL & COMPANY PA PO BOX 1727 WALL,NJ07719	AUDITING SERV	145,450
BROADVIEW NETWORKS PO BOX 9242 UNIONDALE,NY11555	COMMUNICATIONS	113,044

2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 4

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....	10,217,091	9,092,454	9,987,632	13,097,543	8,733,950	51,128,670
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3	10,217,091	9,092,454	9,987,632	13,097,543	8,733,950	51,128,670
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.						51,128,670

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..	10,217,091	9,092,454	9,987,632	13,097,543	8,733,950	51,128,670
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	-116,771	315,806	604,238	76,856	22,138	902,267
9	Net income from unrelated business activities, whether or not the business is regularly carried on..			26,520	56,783	64,084	147,387
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	43,360	37,967	35,927	147,070	240,607	504,931
11	Total support. Add lines 7 through 10.						52,683,255

Gross receipts from related activities, etc. (see instructions) ..................

7,521,865

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

97.050 %

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

96.860 %

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
PART II, LINE 10	OTHER INCOME 264,324

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization STATEN ISLAND MENTAL HEALTH SOCIETY INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization STATEN ISLAND MENTAL HEALTH SOCIETY INC		Employer identification number 13-5623279

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization STATEN ISLAND MENTAL HEALTH SOCIETY INC			Employer identification number 13-5623279
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	314,670		314,670
b	Buildings	2,898,496	2,646,452	252,044
c	Leasehold improvements	10,450,957	3,695,287	6,755,670
d	Equipment ...	316,291	271,466	44,825
e	Other ...	304,392	284,078	20,314
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				7,387,523

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
ACCOUNT PAYABLE OMH COPS/CSP	6,541,667
LIABILITY FOR PENSION BENEFITS	3,175,392
LINE OF CREDIT	600,000
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	10,317,059
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	16,696,167
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-214,633
b	Donated services and use of facilities .........	2b	335,721
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	114,839
e	Add lines 2a through 2d .....................			2e	235,927
3	Subtract line 2e from line 1..................			3	16,460,240
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	16,460,240

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	18,893,286
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	325,367
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	1,710,627
e	Add lines 2a through 2d....................			2e	2,035,994
3	Subtract line 2e from line 1...................			3	16,857,292
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	16,857,292

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PAGE 3, PART X	AS REQUIRED BY THE ACCOUNTING STANDARDS CODIFICATION, THE SOCIETY ADOPTED THE RECOGNITION REQUIREMENTS FOR UNCERTAIN INCOME TAX POSITIONS AS REQUIRED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA, WITH NO CUMULATIVE EFFECT ADJUSTMENT REQUIRED. INCOME TAX BENEFITS ARE RECOGNIZED FOR INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, ONLY WHEN IT IS DETERMINED THAT THE INCOME TAX POSITION WILL MORE-LIKELY-THAN-NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. THE SOCIETY HAS ANALYZED TAX POSITIONS TAKEN FOR FILING WITH THE INTERNAL REVENUE SERVICE AND NEW YORK STATE WHERE IT OPERATES. THE SOCIETY BELIEVES THAT INCOME TAX FILING POSITIONS WILL BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE AFFECT ON THE SOCIETYS FINANCIAL CONDITION, RESULTS OF OPERATIONS OR CASH FLOWS. ACCORDINGLY, THE SOCIETY HAS NOT RECORDED ANY RESERVES, OR RELATED ACCRUALS FOR INTEREST AND PENALTIES FOR UNCERTAIN INCOME TAX POSITIONS AT JUNE 30, 2016.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	SPECIAL EVENTS EXPENSES 89,056 EXPENSES RELATED TO RENTAL INCOME 25,783
SCHEDULE D, PAGE 4, PART XII, LINE 2D	SPECIAL EVENTS EXPENSES 89,056 EXPENSES RELATED TO RENTAL INCOME 25,783 ASC TOPIC 715-FASB 158 ADJUSTMT 1,595,788

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 ANNIVERSARY BAL (event type)	(b) Event #2 PHANTOM FUNDRAI (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	128,861	35,106	7,150	171,117
2	Less: Contributions . . . .	7,035			7,035
3	Gross income (line 1 minus line 2) . . . . . .	121,826	35,106	7,150	164,082

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	54,456	16,577	5,384	76,417
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				76,417
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				87,665

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .			23,436	23,436

2	Cash prizes . . . . .			11,500	11,500
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	54,456	16,577	5,384	76,417

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes100.000 %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

12,639

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

10,797

Enter the state(s) in which the organization conducts gaming activities: NY

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

R BELFINI

Address

669 CASTLETON AVE
STATEN ISLAND,NY10301

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1FERN ZAGOR LCSW ACSWPRESIDENT & CEO	(i) (ii)	288,720 -------------	-------------	-------------	3,787 -------------	-------------	292,507 -------------	-------------
2ELIZABETH A TRAYNORCHIEF CLINICAL OFFI	(i) (ii)	149,802 -------------	-------------	-------------	35,406 -------------	-------------	185,208 -------------	-------------
3ROSE MARIE BELFINICONTROLLER	(i) (ii)	137,842 -------------	-------------	-------------	35,321 -------------	-------------	173,163 -------------	-------------
4ARUNA AGNI MDPHYSICIAN	(i) (ii)	205,215 -------------	-------------	-------------	4,383 -------------	-------------	209,598 -------------	-------------
5MINI VERTER MDPHYSICIAN	(i) (ii)	172,060 -------------	-------------	-------------	14,273 -------------	-------------	186,333 -------------	-------------

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Return Reference	Explanation
FORM 990 - ORGANIZATION'S MISSION	THE SIMHS IS A NOT-FOR-PROFIT CHILDREN'S SERVICES PROVIDER AGENCY, FOUNDED IN 1895. OUR MISSION IS TO DIAGNOSE AND TREAT EMOTIONAL, BEHAVIORAL, ORGANIC, AND DEVELOPMENTAL PROBLEMS; TO CREATE AND SUPPORT PROGRAMS AND ENVIRONMENTS THAT REDUCE THE RISK OF DISABILITY AND ADVANCE THE OPTIMAL DEVELOPMENT OF CHILDREN; TO INCREASE OUR KNOWLEDGE OF THE CAUSES AND TREATMENTS OF MENTAL ILLNESS AND DEVELOPMENTAL IMPAIRMENT; AND TO PROMOTE PUBLIC AWARENESS OF, AND SUPPORT FOR, THE VALUE AND ABILITY OF OUR SERVICES. EACH YEAR WE SERVE ONE-IN-TEN STATEN ISLAND FAMILIES; WE TREAT OVER 5,000 INDIVIDUALS; WE CONDUCT 232,000 CHILD AND FAMILY EVALUATION AND TREATMENT SESSIONS; WE DELIVER SERVICES AT 21 SITES, BY 300 PROFESSIONAL AND SUPPORT STAFF; AND OUR VOLUNTEERS DONATE OVER 50,000 HOURS OF SERVICE.
FORM 990, PAGE 1, PART I, LINE 6	THERE ARE APPROXIMATELY 400 VOLUNTEERS COMPRISED OF THE BOARD OF DIRECTORS, WHO MAKE SIGNIFICANT CONTRIBUTIONS OF TIME RELATIVE TO GENERAL MANAGEMENT AND OPERATIONS, AND A SUBSTANTIAL NUMBER OF UNPAID VOLUNTEERS THAT HAVE MADE SIGNIFICANT CONTRIBUTIONS OF THEIR TIME FOR THE PURPOSE OF RAISING FUNDS ON BEHALF OF THE SOCIETY. THE HOURS CONTRIBUTED RELATE TO ATTENDING MEETINGS, COMMITTEES, ORGANIZING EVENTS, ETC.
FORM 990, PAGE 2, PART III, LINE 4D	GUN VIOLENCE: THE SOCIETY PROVIDES A FULL RANGE OF EVIDENCE-BASED MENTAL HEALTH AND RELATED SERVICES TO CHILDREN AND THEIR FAMILIES IMPACTED BY THE EPIDEMIC OF GUN VIOLENCE AND ACTIVELY PARTICIPATES IN THE CURE VIOLENCE COALITION OF PROVIDERS ASSEMBLED TO ADDRESS THE ISSUES AROUND GUN VIOLENCE. THE PROGRAM ENGAGES COALITION MEMBERS IN TRAINING AND EDUCATION AROUND STIGMA OF MENTAL HEALTH TREATMENT AND UNDERSTANDING THE CYCLE OF TRAUMA FOR CHILDREN, ADOLESCENTS AND FAMILY SYSTEMS. CHEMICAL DEPENDENCE: THE TEEN CENTER PROVIDES OUTPATIENT ALCOHOL/SUBSTANCE ABUSE TREATMENT PROGRAMS EXCLUSIVELY FOR TEENS AND YOUNG ADULTS, AGES 12 TO 21, INCLUDING FAMILY MEMBERS. THE TEEN CENTER PROGRAM SERVICES INCLUDE COUNSELING, TREATMENT, SUPPORT, AND TRAINING IN SOCIAL SKILLS, IN A NON-JUDGMENTAL ENVIRONMENT. CLIENTS RE-ACQUIRE THE LIFE SKILLS TO LEARN, WORK, PLAY AND INTERACT OPTIMALLY WITHOUT DEPENDENCE ON CHEMICAL SUBSTANCES, AND GAIN THE INSIGHT AND ABILITY TO GROW INTO RESPONSIBLE, PRODUCTIVE ADULTS. THE EARLY CHILDHOOD MENTAL HEALTH (UNDER 5) PROGRAM ENHANCES THE ABILITY OF THE SIMHS'S LICENSED CLINICAL STAFF IN THE AREA OF EARLY CHILDHOOD MENTAL HEALTH SERVICES BY DEVELOPING AND IMPLEMENTING AN INTENSIVE PROFESSIONAL TRAINING PROGRAM TO RECOGNIZE, ASSESS AND PROVIDE APPROPRIATE CLINICAL AND RELATIONSHIP-BASED INTERVENTIONS TO CHILDREN AGE FIVE AND UNDER AND THEIR FAMILIES WHO HAVE BEEN DIAGNOSED AS HAVING, OR ARE AT RISK OF DEVELOPING, A SOCIAL OR EMOTIONAL DISORDER. THE EARLY RECOGNITION PROGRAM IS AVAILABLE AT THE THREE MENTAL HEALTH CENTERS AND PROVIDES EMOTIONAL HEALTH SCREENING CONSISTING OF QUESTIONS REGARDING YOUR CHILD'S BEHAVIOR AT HOME AND IN SCHOOL. EARLY IDENTIFICATION AND TREATMENT OF EMOTIONAL/BEHAVIORAL PROBLEMS HELP CHILDREN AND TEENS SUCCEED IN SCHOOL AND DEVELOP POSITIVE SOCIAL RELATIONSHIPS AT HOME AND WITHIN THE COMMUNITY. THE INTEGRATED PROGRAM PROVIDES AN EDUCATIONAL SETTING FOR PRE-SCHOOL CHILDREN WHO HAVE BEEN IDENTIFIED WITH DEVELOPMENTAL DELAYS WITH TYPICALLY DEVELOPING CHILDREN. RELATED SERVICES ARE PROVIDED TO SPECIFIC STUDENTS IN ACCORDANCE WITH THEIR INDIVIDUAL EDUCATION PLAN(IEP). THE YOUTH ACHIEVING INDEPENDENCE, OR SAFETY.NET PROGRAM, WAS CREATED TO BRIDGE THE GAP BETWEEN ADOLESCENCE AND YOUNG ADULTHOOD. IT PROVIDES ASSISTANCE FOR INDIVIDUALS DIAGNOSED WITH SED AND SPMI WITH SERVICES INCLUDING VESID, CAREERS, GED PROGRAMS, JBFCS ADULT PSYCHOTHERAPY AND MEDICATION MANAGEMENT, NYC DOE, SUPPORTIVE EMPLOYMENT, JOB CORPS, FAMILY HEALTH PLUS, SECTION 8 AND OTHER HOUSING SUBSIDY PROGRAMS, AND MANY OTHERS. THE CO-LOCATOR PROGRAM IS A JOINT PROJECT WITH NEIGHBORING RICHMOND UNIVERSITY MEDICAL CENTER (RUMC) WITH SIMHS LENDING THEIR EXPERTISE TO PROVIDE MENTAL HEALTH SERVICES TO CHILDREN AND FAMILIES OF THE BOROUGH AT RUMC'S NEW PEDIATRIC SITE. THE COURT INVOLVED YOUTH INITIATIVE PROGRAM IS A GRANT TO PROVIDE BEHAVIORAL HEALTH (MENTAL HEALTH AND/OR SUBSTANCE ABUSE) SERVICES FOR YOUTHS WHO BECOME INVOLVED IN THE COURTS WITHIN THE JUSTICE SYSTEM IN ALL COMMUNITY BOARDS OF STATEN ISLAND. THE PROGRAM WILL IDENTIFY YOUTHS WITH MENTAL AND BEHAVIORAL HEALTH NEEDS AS CLOSE TO THE ARREST OR BEFORE AND, WHEN INDICATED, TO OFFER TREATMENT AND CONNECT/LINK THE YOUTH AND THEIR FAMILY TO TREATMENT, IF NOT OFFERED DIRECTLY BY THIS SERVICE. THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM PROMOTES COMMUNITY-LEVEL COLLABORATION AND FOCUSES ON SYSTEM REFORM. THE DSRIP GOAL IS TO ACHIEVE A 25 PERCENT REDUCTION IN AVOIDABLE HOSPITAL USE OVER FIVE YEARS. STATEN ISLAND MENTAL HEALTH SOCIETY IS PARTICIPATING AS A SAFETY NET PROVIDER, IN SEVERAL OF THE DSRIP PROJECTS FOCUSING ON SYSTEM TRANSFORMATION, CLINICAL IMPROVEMENT AND POPULATION HEALTH IMPROVEMENT. ALL DSRIP FUNDS ARE BASED ON PERFORMANCE LINKED TO ACHIEVEMENT OF PROJECT MILESTONES.
FORM 990, PAGE 6, PART VI, LINE 6	THE ORGANIZATION IS ORGANIZED WITH MEMBERS. THE ANNUAL MEMBERSHIP FEE IS CURRENTLY 50. MEMBERSHIP IN THE ORGANIZATION IS FOR ONE YEAR, INCLUDING ONE ANNUAL MEETING.
FORM 990, PAGE 6, PART VI, LINE 7A	NAMES OF POTENTIAL BOARD MEMBERS ARE FORWARDED TO THE NOMINATING COMMITTEE EACH YEAR BY CURRENT BOARD MEMBERS, STAFF OR OTHERS INTERESTED IN THE STATEN ISLAND MENTAL HEALTH SOCIETY, INC. (SIMHS). SUCH NOMINATIONS ARE REVIEWED BY THE SIMHS NOMINATING COMMITTEE (WHICH IS APPOINTED ANNUALLY). THE NOMINATIONS ARE THEN PRESENTED FOR ELECTION TO THE BOARD OF DIRECTORS DURING THE ANNUAL MEMBERS MEETING, WHICH TAKES PLACE ON THE THIRD THURSDAY IN JANUARY, IMMEDIATELY PRECEDING THE JANUARY BOARD OF DIRECTORS MEETING. IF THE INDIVIDUAL IS NOT ALREADY A MEMBER OF THE SIMHS, THEN HE/SHE MUST PROMPTLY PAY THE 50 DUES PRIOR TO HIS/HER ELECTION TO THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 11B	THE IRS FORM 990 IS PREPARED BY THE INDEPENDENT AUDITOR UTILIZING AUDIT WORK PAPERS AS WELL AS CLIENT PREPARED SUPPORTING SCHEDULES. THE FORM 990 IS REVIEWED IN DETAIL WITH THE CEO AND CONTROLLER. THE FORM 990 IS THEN PRESENTED TO THE FINANCE/AUDIT COMMITTEE WHO REVIEWS IT IN DETAIL. A PERIOD OF TIME IS ALLOTTED FOR QUESTIONS AND COMMENTS. DISCLOSURE IS MADE TO THE FULL BOARD OF DIRECTORS, THAT THE RETURN HAS BEEN REVIEWED AND APPROVED BY THE FINANCE/AUDIT COMMITTEE PRIOR TO FILING FORM 990 WITH THE IRS.
FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, EACH RESPONSIBLE PERSON SHALL BE REQUIRED TO REVIEW A COPY OF THE CONFLICT OF INTEREST AND DISCLOSURE OF CERTAIN INTERESTS POLICY. ANY INFORMATION REGARDING BUSINESS INTERESTS OF A RESPONSIBLE PERSON OR A FAMILY MEMBER SHALL BE TREATED AS CONFIDENTIAL AND SHALL GENERALLY BE MADE AVAILABLE ONLY TO THE CHAIR, THE PRESIDENT/CEO AND ANY COMMITTEE APPOINTED TO ADDRESS CONFLICTS OF INTEREST, EXCEPT TO THE EXTENT ADDITIONAL DISCLOSURE IS NECESSARY IN CONNECTION WITH THE IMPLEMENTATION OF THE POLICY. ANY CHANGES TO THE POLICY ARE COMMUNICATED IMMEDIATELY TO ALL RESPONSIBLE PERSONS. THE ANNUAL CONFLICT OF INTEREST POLICY PROVIDES A SECTION WHEREBY ANY POTENTIAL CONFLICTS AND AFFILIATIONS CAN BE LISTED. THE SIGNED FORMS ARE RETURNED AND A FILE IS MAINTAINED FOR EACH FISCAL YEAR. DURING BOARD AND COMMITTEE MEETINGS, MEMBERS HAVE THE OPPORTUNITY TO DECLARE A CONFLICT AND ABSTAIN FROM VOTING ON ANY ISSUE THAT RELATES TO THE ORGANIZATION WHERE A CONFLICT HAS BEEN DECLARED. ABSTENTIONS AND OBJECTIONS FOR ALL VOTES ARE NOTED IN THE OFFICIAL BOARD MEETING MINUTES.
FORM 990, PAGE 6, PART VI, LINE 15A	THE PROCESS FOR DETERMINING THE PRESIDENT'S (CEO) COMPENSATION INCLUDES REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE. THIS COMMITTEE IS MADE UP OF EIGHT BOARD MEMBERS WHICH INCLUDES THE CHAIR, VICE CHAIR, SECRETARY, TREASURER AND FOUR OTHER BOARD MEMBERS WHO ARE ALSO PREVIOUS BOARD CHAIRS. A REBUTTABLE PRESUMPTION CHECKLIST IS FOLLOWED AND DOCUMENTED WHICH INCLUDES THE FOLLOWING INFORMATION: 1) NAME OF THE DISQUALIFIED PERSON, 2) POSITION UNDER CONSIDERATION, 3) DURATION OF THE CONTRACT, 4) PROPOSED COMPENSATION, 5) DESCRIPTION OF TYPES OF COMPARABLE DATA RELIED UPON - COMMERCIALLY PREPARED SURVEY BY THE ECONOMIC RESEARCH INSTITUTE WITH THE MOST RECENT YEAR DATA, 6) SOURCES AND AMOUNTS OF THE COMPARABILITY DATA, 7) OFFICE WHERE THE COMPARABILITY DATA IS KEPT, 8) COMPENSATION PACKAGE APPROVED BY AUTHORIZED BODY, 9) DATE COMPENSATION APPROVED BY AUTHORIZED BODY, 10) NAMES OF THE AUTHORIZED BODY PRESENT FOR VOTE, 11) COMPARABILITY DATA RELIED UPON BY APPROVING BODY AND HOW DATA WAS OBTAINED, 12) NAMES OF AND ACTIONS BY MEMBERS OF AUTHORIZED BODY HAVING CONFLICT OF INTEREST, 13) DATE DOCUMENT PREPARED AND 14) DATE OF APPROVAL BY THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 15B	SALARIES FOR OTHER OFFICERS OR KEY EMPLOYEES ARE DETERMINED BY THE CEO, WITH THE KNOWLEDGE OF THE MEMBERS OF THE EXECUTIVE COMMITTEE.
FORM 990, PAGE 6, PART VI, LINE 19	COPIES OF MOST RECENT AUDITED FINANCIAL STATEMENTS AND IRS FORM 990, AS WELL AS THE NY CHARITIES REGISTRATION STATEMENT AND CONFLICT OF INTEREST POLICY SHALL BE MADE AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO SO REQUESTS. REQUESTS FOR COPIES SHALL BE MADE IN WRITING OR ELECTRONICALLY TO THE ORGANIZATION INDICATING THE NAME AND ADDRESS OF THE REQUESTOR.
FORM 990, PART XI, LINE 9	ASC TOPIC 715 -1,595,788 TOTAL -1,595,788

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE SIMHS IS A NOT-FOR-PROFIT CHILDREN'S SERVICES PROVIDER AGENCY, FOUNDED IN 1895. OUR MISSION IS TO DIAGNOSE AND TREAT EMOTIONAL, BEHAVIORAL, ORGANIC, AND DEVELOPMENTAL PROBLEMS; TO CREATE AND SUPPORT PROGRAMS AND ENVIRONMENTS THAT REDUCE THE RISK OF DISABILITY AND ADVANCE THE OPTIMAL DEVELOPMENT OF CHILDREN; TO INCREASE OUR KNOWLEDGE OF THE CAUSES AND TREATMENTS OF MENTAL ILLNESS AND DEVELOPMENTAL IMPAIRMENT; AND TO PROMOTE PUBLIC AWARENESS OF, AND SUPPORT FOR, THE VALUE AND ABILITY OF OUR SERVICES. EACH YEAR WE SERVE ONE-IN-TEN STATEN ISLAND FAMILIES; WE TREAT OVER 5,000 INDIVIDUALS; WE CONDUCT 232,000 CHILD AND FAMILY EVALUATION AND TREATMENT SESSIONS; WE DELIVER SERVICES AT 21 SITES, BY 300 PROFESSIONAL AND SUPPORT STAFF; AND OUR VOLUNTEERS DONATE OVER 50,000 HOURS OF SERVICE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	18
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	260
6	Total number of volunteers (estimate if necessary) .............	6	400
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	65,084
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	64,084

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	12,662,618	8,733,950
9	Program service revenue (Part VIII, line 2g) .........	4,896,191	7,280,000
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	205,137	-12,210
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	377,943	458,500
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	18,141,889	16,460,240
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	13,221,236	12,687,460
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 344,925
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	4,907,771	4,169,832
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	18,129,007	16,857,292
19	Revenue less expenses. Subtract line 18 from line 12.......	12,882	-397,052
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	14,246,481	13,228,163
21	Total liabilities (Part X, line 26).............	11,646,923	12,825,723
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,599,558	402,440

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 5,598,869 including grants of $ ) (Revenue $ 4,878,443 )
	MENTAL HEALTH SERVICES ARE PROVIDED TO STATEN ISLAND CHILDREN AND ADOLESCENTS AND THEIR FAMILIES AT TWO CLINIC LOCATIONS. THE ON-SITE MENTAL HEALTH PROGRAM PROVIDES SCHOOL-BASED THERAPEUTIC SERVICES FOR ELEMENTARY AND INTERMEDIATE SCHOOL STUDENTS WHO ARE IN NEED OF INDIVIDUAL SERVICES TO SUPPORT THEIR MAINSTREAM EDUCATIONAL GOALS.

4b	(Code: ) (Expenses $ 4,418,096 including grants of $ ) (Revenue $ )
	FOUR FULL-SERVICE HEAD START EARLYLEARN CENTERS SERVE MORE THAN 300 CHILDREN (AT ANY ONE TIME) BETWEEN 3-5 YEARS OLD EACH YEAR. THE PROGRAM GIVES EACH CHILD LEARNING AND PLAYING EXPERIENCES THAT PREPARE HIM OR HER FOR SCHOOL, ACADEMICALLY, EMOTIONALLY, AND SOCIALLY. CHILDREN AND FAMILIES ARE ALSO PROVIDED WITH A WIDE RANGE OF HEALTH AND SOCIAL SERVICES.

4c	(Code: ) (Expenses $ 1,470,545 including grants of $ ) (Revenue $ 800,800 )
	DIAGNOSIS & TREATMENT FOR DEVELOPMENTAL DISABILITIES - THE POUCH CENTER'S PROGRAMS AND SERVICES ASSIST PERSONS WHO HAVE DEVELOPMENTAL DISABILITIES, LEARNING DELAYS, NEUROLOGICAL IMPAIRMENTS, ATTENTION DEFICIT HYPERACTIVITY DISORDER, CEREBRAL PALSY, AUTISM, PERVASIVE DEVELOPMENTAL DISORDER, MENTAL RETARDATION, EPILEPSY, TRAUMATIC BRAIN INJURY, AND OTHER DEVELOPMENTAL CHALLENGES.

	(Code: ) (Expenses $ 3,839,414 including grants of $ ) (Revenue $ 1,600,757 )
	GUN VIOLENCE: THE SOCIETY PROVIDES A FULL RANGE OF EVIDENCE-BASED MENTAL HEALTH AND RELATED SERVICES TO CHILDREN AND THEIR FAMILIES IMPACTED BY THE EPIDEMIC OF GUN VIOLENCE AND ACTIVELY PARTICIPATES IN THE CURE VIOLENCE COALITION OF PROVIDERS ASSEMBLED TO ADDRESS THE ISSUES AROUND GUN VIOLENCE. THE PROGRAM ENGAGES COALITION MEMBERS IN TRAINING AND EDUCATION AROUND STIGMA OF MENTAL HEALTH TREATMENT AND UNDERSTANDING THE CYCLE OF TRAUMA FOR CHILDREN, ADOLESCENTS AND FAMILY SYSTEMS. CHEMICAL DEPENDENCE: THE TEEN CENTER PROVIDES OUTPATIENT ALCOHOL/SUBSTANCE ABUSE TREATMENT PROGRAMS EXCLUSIVELY FOR TEENS AND YOUNG ADULTS, AGES 12 TO 21, INCLUDING FAMILY MEMBERS. THE TEEN CENTER PROGRAM SERVICES INCLUDE COUNSELING, TREATMENT, SUPPORT, AND TRAINING IN SOCIAL SKILLS, IN A NON-JUDGMENTAL ENVIRONMENT. CLIENTS RE-ACQUIRE THE LIFE SKILLS TO LEARN, WORK, PLAY AND INTERACT OPTIMALLY WITHOUT DEPENDENCE ON CHEMICAL SUBSTANCES, AND GAIN THE INSIGHT AND ABILITY TO GROW INTO RESPONSIBLE, PRODUCTIVE ADULTS. THE EARLY CHILDHOOD MENTAL HEALTH (UNDER 5) PROGRAM ENHANCES THE ABILITY OF THE SIMHS'S LICENSED CLINICAL STAFF IN THE AREA OF EARLY CHILDHOOD MENTAL HEALTH SERVICES BY DEVELOPING AND IMPLEMENTING AN INTENSIVE PROFESSIONAL TRAINING PROGRAM TO RECOGNIZE, ASSESS AND PROVIDE APPROPRIATE CLINICAL AND RELATIONSHIP-BASED INTERVENTIONS TO CHILDREN AGE FIVE AND UNDER AND THEIR FAMILIES WHO HAVE BEEN DIAGNOSED AS HAVING, OR ARE AT RISK OF DEVELOPING, A SOCIAL OR EMOTIONAL DISORDER. THE EARLY RECOGNITION PROGRAM IS AVAILABLE AT THE THREE MENTAL HEALTH CENTERS AND PROVIDES EMOTIONAL HEALTH SCREENING CONSISTING OF QUESTIONS REGARDING YOUR CHILD'S BEHAVIOR AT HOME AND IN SCHOOL. EARLY IDENTIFICATION AND TREATMENT OF EMOTIONAL/BEHAVIORAL PROBLEMS HELP CHILDREN AND TEENS SUCCEED IN SCHOOL AND DEVELOP POSITIVE SOCIAL RELATIONSHIPS AT HOME AND WITHIN THE COMMUNITY. THE INTEGRATED PROGRAM PROVIDES AN EDUCATIONAL SETTING FOR PRE-SCHOOL CHILDREN WHO HAVE BEEN IDENTIFIED WITH DEVELOPMENTAL DELAYS WITH TYPICALLY DEVELOPING CHILDREN. RELATED SERVICES ARE PROVIDED TO SPECIFIC STUDENTS IN ACCORDANCE WITH THEIR INDIVIDUAL EDUCATION PLAN(IEP). THE YOUTH ACHIEVING INDEPENDENCE, OR SAFETY.NET PROGRAM, WAS CREATED TO BRIDGE THE GAP BETWEEN ADOLESCENCE AND YOUNG ADULTHOOD. IT PROVIDES ASSISTANCE FOR INDIVIDUALS DIAGNOSED WITH SED AND SPMI WITH SERVICES INCLUDING VESID, CAREERS, GED PROGRAMS, JBFCS ADULT PSYCHOTHERAPY AND MEDICATION MANAGEMENT, NYC DOE, SUPPORTIVE EMPLOYMENT, JOB CORPS, FAMILY HEALTH PLUS, SECTION 8 AND OTHER HOUSING SUBSIDY PROGRAMS, AND MANY OTHERS. THE CO-LOCATOR PROGRAM IS A JOINT PROJECT WITH NEIGHBORING RICHMOND UNIVERSITY MEDICAL CENTER (RUMC) WITH SIMHS LENDING THEIR EXPERTISE TO PROVIDE MENTAL HEALTH SERVICES TO CHILDREN AND FAMILIES OF THE BOROUGH AT RUMC'S NEW PEDIATRIC SITE. THE COURT INVOLVED YOUTH INITIATIVE PROGRAM IS A GRANT TO PROVIDE BEHAVIORAL HEALTH (MENTAL HEALTH AND/OR SUBSTANCE ABUSE) SERVICES FOR YOUTHS WHO BECOME INVOLVED IN THE COURTS WITHIN THE JUSTICE SYSTEM IN ALL COMMUNITY BOARDS OF STATEN ISLAND. THE PROGRAM WILL IDENTIFY YOUTHS WITH MENTAL AND BEHAVIORAL HEALTH NEEDS AS CLOSE TO THE ARREST OR BEFORE AND, WHEN INDICATED, TO OFFER TREATMENT AND CONNECT/LINK THE YOUTH AND THEIR FAMILY TO TREATMENT, IF NOT OFFERED DIRECTLY BY THIS SERVICE. THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM PROMOTES COMMUNITY-LEVEL COLLABORATION AND FOCUSES ON SYSTEM REFORM. THE DSRIP GOAL IS TO ACHIEVE A 25 PERCENT REDUCTION IN AVOIDABLE HOSPITAL USE OVER FIVE YEARS. STATEN ISLAND MENTAL HEALTH SOCIETY IS PARTICIPATING AS A SAFETY NET PROVIDER, IN SEVERAL OF THE DSRIP PROJECTS FOCUSING ON SYSTEM TRANSFORMATION, CLINICAL IMPROVEMENT AND POPULATION HEALTH IMPROVEMENT. ALL DSRIP FUNDS ARE BASED ON PERFORMANCE LINKED TO ACHIEVEMENT OF PROJECT MILESTONES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 3,839,414 including grants of $ ) (Revenue $ 1,600,757 )
4e	Total program service expenses15,326,924

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) LINDA WILSON........................................................................ BOARD MEMBER	1.00 .......................	X			0	0	0
(19) FERN ZAGOR LCSW ACSW........................................................................ PRESIDENT &	70.00 .......................		X		288,720	0	3,787
(20) ELIZABETH A TRAYNOR........................................................................ CHIEF CLINIC	60.00 .......................		X		149,802	0	35,406
(21) ROSE MARIE BELFINI........................................................................ CONTROLLER	70.00 .......................		X		137,842	0	35,321
(22) ARUNA AGNI MD........................................................................ PHYSICIAN	34.50 .......................			X	205,215	0	4,383
(23) MINI VERTER MD........................................................................ PHYSICIAN	32.00 .......................			X	172,060	0	14,273
(24) CARMEN CHISVETTE........................................................................ VP, FACILITI	40.00 .......................			X	115,630	0	21,989
(25) ROBIN SKLARIN........................................................................ PROGRAM DIRE	35.00 .......................			X	101,801	0	19,310
(26) YEZENIA ORTIZ........................................................................ PROGRAM DIRE	35.00 .......................			X	101,630	0	2,023

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,272,700	136,492

1a	Federated campaigns..		1a	23
b	Membership dues..		1b	8,408
c	Fundraising events..		1c	7,035
d	Related organizations		1d
e	Government grants (contributions)		1e	7,901,838

f	All other contributions, gifts, grants, and similar amounts not included above		1f	816,646

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		8,733,950

			Business Code
2a	MEDICARE/MEDICAID	621400	4,809,113	4,809,113
b	PARTICIPANT FEES	621400	2,470,887	2,470,887
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			7,280,000

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			22,138			22,138
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		99,216
b	Less: rental expenses		25,782
c	Rental income or (loss)		73,434
d	Net rental income or (loss)......			73,434	8,350	65,084
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		2,352,540
b	Less: cost or other basis and sales expenses		2,386,888
c	Gain or (loss)		-34,348
d	Net gain or (loss).....			-34,348	-34,348
8a	Gross income from fundraising events (not including $ 7,035of contributions reported on line 1c). See Part IV, line 18 ....
	a		164,082
b	Less: direct expenses ...b		76,417
c	Net income or (loss) from fundraising events..			87,665			87,665
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		23,436
b	Less: direct expenses ...b		12,639
c	Net income or (loss) from gaming activities..			10,797			10,797
10a	Gross sales of inventory, less returns and allowances ..
	a		53,089
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			53,089			53,089
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS INCOME			233,515	233,515
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			233,515
12	Total revenue. See Instructions......			16,460,240	7,487,517	65,084	173,689

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	678,117	413,125	131,776	133,216
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	8,621,348	8,138,067	418,178	65,103
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	708,119	652,198	42,160	13,761
9	Other employee benefits .......	2,003,564	1,857,641	112,168	33,755
10	Payroll taxes ...........	676,312	632,831	35,160	8,321
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	70,056	50,998	16,148	2,910
c	Accounting ...........	168,430	122,609	38,824	6,997
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	504,838	367,497	116,368	20,973
12	Advertising and promotion ....	29,228	24,137	1,273	3,818
13	Office expenses .......	338,632	317,875	12,387	8,370
14	Information technology ......	54,299	52,298	2,001
15	Royalties ..
16	Occupancy ...........	863,216	758,182	79,637	25,397
17	Travel ............	221,026	217,024	3,853	149
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	84,715	61,484	23,231
20	Interest ...........	20,918		20,918
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	286,094	260,346	25,748
23	Insurance ...	167,015	108,376	58,252	387
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	REPAIRS & MAINTENANCE	300,072	272,762	23,539	3,771
b	FOOD	254,068	248,201	2,568	3,299
c	BAD DEBT EXPENSE	241,712	241,712
d	SUBGRANTEE	240,228	240,228
e	All other expenses	325,285	289,333	21,254	14,698
25	Total functional expenses. Add lines 1 through 24e	16,857,292	15,326,924	1,185,443	344,925
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			800,867	1	1,221,164
2	Savings and temporary cash investments .........			589,383	2	495,584
3	Pledges and grants receivable, net ......			2,575,043	3	1,043,081
4	Accounts receivable, net .............			786,920	4	1,551,915
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........				8
9	Prepaid expenses and deferred charges ......			180,788	9	138,800
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	14,284,806
b	Less: accumulated depreciation	10b	6,897,283	7,673,611	10c	7,387,523
11	Investments—publicly traded securities .			1,607,277	11	1,320,281
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			32,592	15	69,815
16	Total assets. Add lines 1 through 15 (must equal line 34)...			14,246,481	16	13,228,163

17	Accounts payable and accrued expenses .....	2,523,755	17	2,451,072
18	Grants payable ...		18
19	Deferred revenue .........	328,470	19	57,592
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	8,794,698	25	10,317,059
26	Total liabilities. Add lines 17 through 25..	11,646,923	26	12,825,723

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	2,454,886	27	255,313
28	Temporarily restricted net assets ...........	134,672	28	137,127
29	Permanently restricted net assets	10,000	29	10,000
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	2,599,558	33	402,440
34	Total liabilities and net assets/fund balances ........	14,246,481	34	13,228,163