TY 2018 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...................................................................... CHAIRMAN	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) SARA BARAHONA...................................................................... BOARD MEMBER	1.00 .................	X
(6) MARY ELLEN BONGAILAS...................................................................... BOARD MEMBER	1.00 .................	X
(7) DR CHRISTINE CEA...................................................................... BOARD MEMBER	1.00 .................	X
(8) ROBERT CONTI MBA...................................................................... BOARD MEMBER	1.00 .................	X
(9) VICTORIA DRUMBAKIS...................................................................... BOARD MEMBER	1.00 .................	X
(10) BERNADETTE PAULO...................................................................... BOARD MEMBER	1.00 .................	X
(11) RONALD GREGG ESQ...................................................................... BOARD MEMBER	1.00 .................	X
(12) JOHN HOGAN...................................................................... BOARD MEMBER	1.00 .................	X
(13) LAURA KENNEDY...................................................................... BOARD MEMBER	1.00 .................	X
(14) NANCY SHANAPHY...................................................................... BOARD MEMBER	1.00 .................	X
(15) DEEPTHA NEDUNCHEZIAN SITHIANMD...................................................................... BOARD MEMBER	1.00 .................	X
(16) ROBERTA VOGEL PHD...................................................................... BOARD MEMBER	1.00 .................	X
(17) LINDA WILSON...................................................................... BOARD MEMBER	1.00 .................	X

(A) Name and business address	(B) Description of services	(C) Compensation
FUND FOR THE ADVMNT OF MENTAL HEALTH C/O 669 CASTLETON AVENUE STATEN ISLAND,NY10301	RENT	292,831
ACE ENDICO 80 INTERNATIONAL BLVD BREWSTER,NY10509	FOOD SERVICE	179,268
NERAL & COMPANY PA PO BOX 1727 WALL,NJ07719	AUDITING SERV	153,350
BROADVIEW NETWORKS PO BOX 9242 UNIONDALE,NY11555	COMMUNICATIONS	119,249

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	13,097,543	8,733,950	9,430,713	8,751,767	3,920,889	43,934,862
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	13,097,543	8,733,950	9,430,713	8,751,767	3,920,889	43,934,862
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.						43,934,862

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..	13,097,543	8,733,950	9,430,713	8,751,767	3,920,889	43,934,862
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	76,856	22,138	28,456	37,192	13,519	178,161
9	Net income from unrelated business activities, whether or not the business is regularly carried on..	56,783	67,684	57,499	37,279	21,822	241,067
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	147,070	240,607	72,204	63,560		523,441
11	Total support. Add lines 7 through 10						44,877,531

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

31,760,257

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 2018 (line 6, column (f) divided by line 11, column (f)) .........

97.900 %

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

96.950 %

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

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 (explain in Part VI). 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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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 523,441

Schedule A (Form 990 or 990-EZ) 2018

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

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) (2018)

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

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 7/25/06, 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) 2018

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 .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..

Schedule D (Form 990) 2018

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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2018

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	7,365,055
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-508
b	Donated services and use of facilities .........	2b	117,709
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	21,720
e	Add lines 2a through 2d .....................			2e	138,921
3	Subtract line 2e from line 1..................			3	7,226,134
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	7,226,134

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	9,818,924
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	117,709
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	1,425,672
e	Add lines 2a through 2d....................			2e	1,543,381
3	Subtract line 2e from line 1...................			3	8,275,543
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	8,275,543

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 DECEMBER 31, 2018.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	EXPENSES RELATED TO RENTAL INCOME 21,720
SCHEDULE D, PAGE 4, PART XII, LINE 2D	EXPENSES RELATED TO RENTAL INCOME 21,720 ASC TOPIC 715-FASB 158 ADJUSTMT 1,403,952

Schedule D (Form 990) 2018

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

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 nonfixed
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) 2018

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 ACSW PRESIDENT & CEO	(i) (ii)	286,139 -------------	-------------	-------------	-------------	-------------	286,139 -------------	-------------
2ELIZABETH A TRAYNOR CHIEF CLINICAL OFFI	(i) (ii)	145,258 -------------	-------------	-------------	17,482 -------------	-------------	162,740 -------------	-------------
3ROSE MARIE BELFINI SENIOR V.P./ CAO	(i) (ii)	133,200 -------------	-------------	-------------	16,984 -------------	-------------	150,184 -------------	-------------
4ARUNA AGNI MD PHYSICIAN	(i) (ii)	193,223 -------------	-------------	-------------	-------------	-------------	193,223 -------------	-------------
5MINI VERTER MD PHYSICIAN	(i) (ii)	173,155 -------------	-------------	-------------	5,553 -------------	-------------	178,708 -------------	-------------

Schedule J (Form 990) 2018

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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number

13-5623279

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ROBERT S CUTRONA SR	FATHER OF BD	42,738	OWNER, CLEANING FIRM		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART V	ROBERT S. CUTRONA, SR., OWNER AND PRESIDENT OF PROJECT-ONE SERVICES, INC., IS THE FATHER OF BOARD MEMBER ROBERT CUTRONA, ESQ.

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets
bullet

Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
STATEN ISLAND MENTAL HEALTH
SOCIETY INC

Employer identification number
13-5623279

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 31, or Form 990-EZ, line 36. Part I can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2018)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III .............

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? ......

If "Yes," did the organization provide such notice? .....................

Did the organization discharge or pay all of its liabilities in accordance with state laws? .....................

Did the organization have any tax-exempt bonds outstanding during the year? .....................

If "Yes" on line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" on line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
CASH & CASH EQUIVALENT	01-01-2019	1,315,060	BANK BAL.	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3
INVESTMENTS	01-01-2019	13,529	BROKER STM	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3
RECEIVABLES	01-01-2019	2,569,205	BOOK	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3
SECURITY DEPOSITS	01-01-2019	17,770	BOOK	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3
OTHER ASSETS	01-01-2019	84,586	BOOK	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3
P,P & E	01-01-2019	6,792,040	BOOK	74-3177454	RICHMOND MEDICAL CENTER 355 BARD AVENUE STATEN ISLAND,NY10310	501 (C) 3

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? .........................

Become an employee of, or independent contractor for, a successor or transferee organization? .....................

Become a direct or indirect owner of a successor or transferee organization? .....................

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? ........

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

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

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2018)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation

SCHEDULE N, PART II, PAGE 2, LINE 2E

ON APRIL 5, 2016, THE SOCIETY AND RICHMOND UNIVERSITY MEDICAL CENTER ("RUMC"), ANNOUNCED THAT THE TWO ORGANIZATIONS SIGNED AN AGREEMENT TO MERGE THAT, UPON CLOSING, WILL ALLOW AN INTEGRATION OF THE SOCIETY'S BROAD RANGE OF BEHAVIORAL HEALTH SERVICES INTO RUMC'S EXISTING MEDICAL AND BEHAVIORAL HEALTH SERVICES, RESULTING IN A COMPREHENSIVE NETWORK ACROSS STATEN ISLAND. IT IS THE INTENT OF THE MERGER TO PRESERVE THE SOCIETYS BRAND VISIBILITY AND COMMUNITY GOODWILL IN THE STATEN ISLAND COMMUNITY. UPON MERGER THE SEPARATE EXISTENCE OF THE SOCIETY SHALL CEASE, AND RUMC SHALL BE THE SURVIVING CORPORATION. ALSO IN APRIL OF 2016, THE SOCIETY TRANSFERRED THE MENTAL HEALTH CLINIC LICENSES TO RUMC. DURING FISCAL 2018, AS NEW GRANT OPPORTUNITIES EXPANDED, NEW MENTAL HEALTH CLINICS WERE ESTABLISHED AT DIFFERENT SCHOOL LOCATIONS ACROSS STATEN ISLAND, UNDER RUMC'S AUSPICES. IN NOVEMBER 2018 THE SOCIETY TRANSFERRED IT'S OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES (OASAS) LICENSE AND CONTRACT TO RUMC AS WELL. SERVICES CONTINUE TO BE PROVIDED BY THE SOCIETY'S CLINICAL STAFF THROUGH A MANAGEMENT SERVICES AGREEMENT. BOTH THE SOCIETY AND RUMC HAVE WORKED WITH STATE AND CITY REPRESENTATIVES ON TRANSFERRING THE REMAINING LICENSED PROGRAMS AND CONTRACT SPONSORSHIPS IN PREPARATION OF THE MERGER CLOSING. THE MERGER WAS EXECUTED ON JANUARY 1, 2019. ALL ASSETS AND LIABILITIES OF THE SOCIETY WERE TRANSFERRED AND CONVEYED TO RUMC AT THAT TIME. DOCUMENTATION OF NOTIFICATION TO THE ATTORNEY GENERAL, SUPREME COURT OF THE STATE OF NEW YORK AND THE NEW YORK STATE DEPARTMENT OF HEALTH AND APPROVAL OF THE CERTIFICATE OF MERGER ARE ATTACHED TO THIS FILING. THE CHAIRMAN OF THE BOARD OF STATEN ISLAND MENTAL HEALTH SOCIETY, INC., JOHN TAPINAS, HAS TAKEN A POSITION ON THE RICHMOND MEDICAL CENTER BOARD OF DIRECTORS EFFECTIVE 1/1/19. FERN ZAGOR - CEO, ELIZABETH TRAINOR - COO & ROSEMARIE BELFINI - CAO, ALL KEY EMPLOYEES OF STATEN ISLAND MENTAL HEALTH SOCIETY, INC., TOOK ROLES IN THE SUCCESSOR ORGANIZATION FOR A PERIOD OF TIME.

Schedule N (Form 990 or 990-EZ) (2018)

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

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 300 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. THE HOURS CONTRIBUTED RELATE TO ATTENDING MEETINGS, COMMITTEES,ETC.
FORM 990, PAGE 2, PART III, LINE 4D	THE 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 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. THE HEALTH HOMES AT RISK PROGRAM - OR FOR STATEN ISLAND SICARES, IS A DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP) INITIATIVE IMPLEMENTED BY NYS AS PART OF THE MEDICAID REDESIGN TO REDUCE AVOIDABLE EMERGENCY ROOM VISITS. SIMHS WAS ENGAGED BY CBC AS ONE OF SIX CARE MANAGEMENT AGENCIES (CMA) TO PROVIDE CARE MANAGEMENT FOR THIS INITIATIVE. THIS PROGRAM PROVIDES CARE SERVICES IN THE SAME VAIN AS HEALTH HOMES WITH CERTAIN EXCEPTIONS; ONE IS ELIGIBILITY REQUIREMENT OF WITH ONE CHRONIC CONDITION, AND THE SECOND IS THE LONGEVITY OR CARE IS 3 MONTHS. THE HEALTH HOMES PROGRAM - CBC IS THE RECOGNIZED HEALTH HOME AND SIMHS WAS ENGAGED TO PROVIDE THE CARE MANAGEMENT. THE SERVICES ARE PROVIDED TO CLIENTS THAT HAVE 2 CHRONIC MEDICAL CONDITIONS. THE INTENSITY OF SERVICES IS BASED ON AN ASSESSMENT COMPLETED FOR EACH CLIENT. THE ASSESSMENT IS USED TO DETERMINE A CLIENT'S KNOWLEDGE AND INCLINATION TO ASSESS MEDICAL SERVICES. A CLIENT CAN REMAIN IN THE PROGRAM AND ASSESSMENTS ARE REQUIRED PERIODICALLY. THE DEVELOPMENTAL DISABILITIES CLINIC SERVICES PROGRAM SUPPORTS THE PROVISION OF ARTICLE 16 SERVICES OF THE POUCH CENTER TO 137 ELIGIBLE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, AS WELL AS TO THEIR CAREGIVERS. THIS WILL BE DONE BY PROVIDING ELIGIBLE INDIVIDUALS OUTPATIENT CLINIC SERVICES MEETING THE AFOREMENTIONED CRITERIA AND WHO ARE DEVELOPMENTALLY DISABLED IN NYC. INDIVIDUALS WILL BE SCREENED TO DETERMINE ELIGIBILITY BUT MAY BE SELF-REFERRED, REFERRED BY PARENT, GUARDIAN OR OTHER CAREGIVER OR BY A SERVICE PROVIDER/AGENCY. ELIGIBLE INDIVIDUALS MUST RANGE FROM AGE 2 TO ADULTHOOD AND AT LEAST 75% MUST RESIDE IN STATEN ISLAND. IF ELIGIBLE, INDIVIDUALS WILL RECEIVE ONGOING THERAPY AND MEDICATION MANAGEMENT SERVICES AS RECOMMENDED BY THE EVALUATING CLINICIAN OR AS REQUESTED BY THE CLIENT/REFERRAL SOURCE. ONGOING SERVICES INCLUDE INDIVIDUAL, GROUP AND FAMILY PSYCHOTHERAPY, MEDICATION MANAGEMENT, SPEECH, PHYSICAL AND OCCUPATIONAL THERAPIES. THE EARLY CHILDHOOD MENTAL HEALTH SERVICIES PROGRAM PROVIDES TREATMENT TO ALL CHILDREN AGE FIVE AND UNDER WITH MENTAL HEALTH CONDITIONS. CHILDREN CAN BE REFERRALS FROM UPK, EARLYLEARN SITES OR THE COMMUNITY AT LARGE. EACH CHILD WILL BE ASSESSED AND ENGAGED IN TREATMENT FOR SOCIAL, EMOTIONAL, MENTAL HEALTH, TRAUMA AND BEHAVIORAL CHALLENGES. SOCIAL WORKERS WILL PROVIDE SERVICES AT THE CURRENTLY LICENSED ARTICLE 31 CLINICS DURING HOURS OF CLINIC OPERATION TO SUPPORT TREATMENT FOR UPK AND COMMUNITY REFERRALS. THE CHILD TRAUMATIC STRESS CENTER - TO DEVELOP THE STATEN ISLAND CHILDREN'S TRAUMA CENTER (SICTC), AN INITIATIVE THAT WILL EXPAND AND ENHANCE SIMHS'S CONTINUUM OF EVIDENCE BASED TRAUMA SUPPORT AND TREATMENT FOR STATEN ISLAND'S CHILDREN AND YOUTH WHO HAVE BEEN AND CONTINUE TO BE AFFECTED BY AN ARRAY OF COMPOUNDING TRAUMATIC EVENTS. SICTC IS A MULTI-PRONGED INITIATIVE THAT WILL SUPPORT CHILDREN AND YOUTH WHO HAVE EXPERIENCED TRAUMA, AGES 5-21 YEARS OLD, AND THEIR CAREGIVERS (BOTH FAMILIES AND CROSS-SECTOR PROVIDERS) ACROSS THE SYSTEMS OF CARE. OVER THE FIVE YEAR PROGRAM, SICTC WILL PROVIDE TRAUMA PSYCHOEDUCATION AND YOUTH WITHIN 10 SCHOOL-BASED CLINIC AND DAY TREATMENT SETTINGS. SIMHS WILL SCREEN YOUTH AGES 5-21 YEARS OLD FOR TRAUMA OVER THE LIFETIME OF THE GRANT, AND CHILDREN AND YOUTH IDENTIFIED AS BEING ADVERSELY AFFECTED BY TRAUMA WILL BE REFERRED TO SICTC'S TRAUMA TREATMENT SERVICES THAT WILL BE TAILORED TO THEIR NEEDS AND EXPERIENCES. SIMHS WILL OFFER YOUTH AGES 10-15 SCHOOL-BASED GROUP TREATMENT ONE-ON-ONE CLINIC- OR SCHOOL-BASED SERVICES YOUTH WITH MORE ACUTE NEEDS AND/OR THOSE OUTSIDE OF THE TARGET AGE RANGE. FINALLY, SIMHS WILL PROVIDE NON-CLINICAL COMMUNITY BASED PROVIDERS WITH TRAUMA 101 PSYCHOEDUCATION AND 40 ADDITIONAL COMMUNITY BASED CLINICIANS AND TRAUMA SCREENING TOOLS, THEREBY INFUSING THE ENTIRE STATEN ISLAND SYSTEM OF CARE WITH A TRAUMA INFORMED LENS. SICTC WILL IMPROVE THE PROCESS FOR IDENTIFYING CHILDREN AND YOUTH ADVERSELY AFFECTED BY TRAUMA, INCREASE ACCESS TO TRAUMA TREATMENT AND SUPPORT AND IMPROVE OUTCOMES FOR STATEN ISLAND'S CHILDREN, YOUTH, AND FAMILIES AFFECTED BY TRAUMA, AND ENHANCE THE STATEN ISLAND CHILD AND YOUTH SERVICES SYSTEM THROUGH TRAUMA-FOCUSED TRAININGS AND EDUCATION. 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.
FORM 990, PAGE 6, PART VI, LINE 6	THE ORGANIZATION IS ORGANIZED WITH MEMBERS. 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 CHAIRMAN. THE FORM 990 IS THEN MADE AVAILABLE TO THE FINANCE/AUDIT COMMITTEE FOR REVIEW. 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 AND THE FORM 990 IS FILED.
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	TRNSFR NET ASSETS AT MERGER 1,054,754 EFFECT OF ASC TOPIC 715 -1,403,952 TOTAL -349,198

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

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	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	17
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	244
6	Total number of volunteers (estimate if necessary) .............	6	300
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	22,822
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	21,822

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	8,751,767	3,920,889
9	Program service revenue (Part VIII, line 2g) .........	8,147,375	3,521,895
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	129,732	-285,652
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	224,768	69,002
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	17,253,642	7,226,134
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)	13,479,042	6,458,645
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	4,215,842	1,816,898
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	17,694,884	8,275,543
19	Revenue less expenses. Subtract line 18 from line 12.......	-441,242	-1,049,409
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	12,783,575	0
21	Total liabilities (Part X, line 26).............	11,384,460	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,399,115	0

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 3,002,557 including grants of $ ) (Revenue $ 2,092,348 )
	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 $ 2,073,746 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 $ 815,020 including grants of $ ) (Revenue $ 438,388 )
	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 $ 1,579,796 including grants of $ ) (Revenue $ 991,159 )
	THE 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 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. THE HEALTH HOMES AT RISK PROGRAM - OR FOR STATEN ISLAND SICARES, IS A DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP) INITIATIVE IMPLEMENTED BY NYS AS PART OF THE MEDICAID REDESIGN TO REDUCE AVOIDABLE EMERGENCY ROOM VISITS. SIMHS WAS ENGAGED BY CBC AS ONE OF SIX CARE MANAGEMENT AGENCIES (CMA) TO PROVIDE CARE MANAGEMENT FOR THIS INITIATIVE. THIS PROGRAM PROVIDES CARE SERVICES IN THE SAME VAIN AS HEALTH HOMES WITH CERTAIN EXCEPTIONS; ONE IS ELIGIBILITY REQUIREMENT OF WITH ONE CHRONIC CONDITION, AND THE SECOND IS THE LONGEVITY OR CARE IS 3 MONTHS. THE HEALTH HOMES PROGRAM - CBC IS THE RECOGNIZED HEALTH HOME AND SIMHS WAS ENGAGED TO PROVIDE THE CARE MANAGEMENT. THE SERVICES ARE PROVIDED TO CLIENTS THAT HAVE 2 CHRONIC MEDICAL CONDITIONS. THE INTENSITY OF SERVICES IS BASED ON AN ASSESSMENT COMPLETED FOR EACH CLIENT. THE ASSESSMENT IS USED TO DETERMINE A CLIENT'S KNOWLEDGE AND INCLINATION TO ASSESS MEDICAL SERVICES. A CLIENT CAN REMAIN IN THE PROGRAM AND ASSESSMENTS ARE REQUIRED PERIODICALLY. THE DEVELOPMENTAL DISABILITIES CLINIC SERVICES PROGRAM SUPPORTS THE PROVISION OF ARTICLE 16 SERVICES OF THE POUCH CENTER TO 137 ELIGIBLE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, AS WELL AS TO THEIR CAREGIVERS. THIS WILL BE DONE BY PROVIDING ELIGIBLE INDIVIDUALS OUTPATIENT CLINIC SERVICES MEETING THE AFOREMENTIONED CRITERIA AND WHO ARE DEVELOPMENTALLY DISABLED IN NYC. INDIVIDUALS WILL BE SCREENED TO DETERMINE ELIGIBILITY BUT MAY BE SELF-REFERRED, REFERRED BY PARENT, GUARDIAN OR OTHER CAREGIVER OR BY A SERVICE PROVIDER/AGENCY. ELIGIBLE INDIVIDUALS MUST RANGE FROM AGE 2 TO ADULTHOOD AND AT LEAST 75% MUST RESIDE IN STATEN ISLAND. IF ELIGIBLE, INDIVIDUALS WILL RECEIVE ONGOING THERAPY AND MEDICATION MANAGEMENT SERVICES AS RECOMMENDED BY THE EVALUATING CLINICIAN OR AS REQUESTED BY THE CLIENT/REFERRAL SOURCE. ONGOING SERVICES INCLUDE INDIVIDUAL, GROUP AND FAMILY PSYCHOTHERAPY, MEDICATION MANAGEMENT, SPEECH, PHYSICAL AND OCCUPATIONAL THERAPIES. THE EARLY CHILDHOOD MENTAL HEALTH SERVICIES PROGRAM PROVIDES TREATMENT TO ALL CHILDREN AGE FIVE AND UNDER WITH MENTAL HEALTH CONDITIONS. CHILDREN CAN BE REFERRALS FROM UPK, EARLYLEARN SITES OR THE COMMUNITY AT LARGE. EACH CHILD WILL BE ASSESSED AND ENGAGED IN TREATMENT FOR SOCIAL, EMOTIONAL, MENTAL HEALTH, TRAUMA AND BEHAVIORAL CHALLENGES. SOCIAL WORKERS WILL PROVIDE SERVICES AT THE CURRENTLY LICENSED ARTICLE 31 CLINICS DURING HOURS OF CLINIC OPERATION TO SUPPORT TREATMENT FOR UPK AND COMMUNITY REFERRALS. THE CHILD TRAUMATIC STRESS CENTER - TO DEVELOP THE STATEN ISLAND CHILDREN'S TRAUMA CENTER (SICTC), AN INITIATIVE THAT WILL EXPAND AND ENHANCE SIMHS'S CONTINUUM OF EVIDENCE BASED TRAUMA SUPPORT AND TREATMENT FOR STATEN ISLAND'S CHILDREN AND YOUTH WHO HAVE BEEN AND CONTINUE TO BE AFFECTED BY AN ARRAY OF COMPOUNDING TRAUMATIC EVENTS. SICTC IS A MULTI-PRONGED INITIATIVE THAT WILL SUPPORT CHILDREN AND YOUTH WHO HAVE EXPERIENCED TRAUMA, AGES 5-21 YEARS OLD, AND THEIR CAREGIVERS (BOTH FAMILIES AND CROSS-SECTOR PROVIDERS) ACROSS THE SYSTEMS OF CARE. OVER THE FIVE YEAR PROGRAM, SICTC WILL PROVIDE TRAUMA PSYCHOEDUCATION AND YOUTH WITHIN 10 SCHOOL-BASED CLINIC AND DAY TREATMENT SETTINGS. SIMHS WILL SCREEN YOUTH AGES 5-21 YEARS OLD FOR TRAUMA OVER THE LIFETIME OF THE GRANT, AND CHILDREN AND YOUTH IDENTIFIED AS BEING ADVERSELY AFFECTED BY TRAUMA WILL BE REFERRED TO SICTC'S TRAUMA TREATMENT SERVICES THAT WILL BE TAILORED TO THEIR NEEDS AND EXPERIENCES. SIMHS WILL OFFER YOUTH AGES 10-15 SCHOOL-BASED GROUP TREATMENT ONE-ON-ONE CLINIC- OR SCHOOL-BASED SERVICES YOUTH WITH MORE ACUTE NEEDS AND/OR THOSE OUTSIDE OF THE TARGET AGE RANGE. FINALLY, SIMHS WILL PROVIDE NON-CLINICAL COMMUNITY BASED PROVIDERS WITH TRAUMA 101 PSYCHOEDUCATION AND 40 ADDITIONAL COMMUNITY BASED CLINICIANS AND TRAUMA SCREENING TOOLS, THEREBY INFUSING THE ENTIRE STATEN ISLAND SYSTEM OF CARE WITH A TRAUMA INFORMED LENS. SICTC WILL IMPROVE THE PROCESS FOR IDENTIFYING CHILDREN AND YOUTH ADVERSELY AFFECTED BY TRAUMA, INCREASE ACCESS TO TRAUMA TREATMENT AND SUPPORT AND IMPROVE OUTCOMES FOR STATEN ISLAND'S CHILDREN, YOUTH, AND FAMILIES AFFECTED BY TRAUMA, AND ENHANCE THE STATEN ISLAND CHILD AND YOUTH SERVICES SYSTEM THROUGH TRAUMA-FOCUSED TRAININGS AND EDUCATION. 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.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,579,796 including grants of $ ) (Revenue $ 991,159 )
4e	Total program service expenses7,471,119

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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) FERN ZAGOR LCSW ACSW........................................................................ PRESIDENT &	70.00 .......................	X		286,139	0	0
(19) ELIZABETH A TRAYNOR........................................................................ CHIEF CLINIC	60.00 .......................	X		145,258	0	17,482
(20) ROSE MARIE BELFINI........................................................................ SENIOR V.P./	70.00 .......................	X		133,200	0	16,984
(21) ARUNA AGNI MD........................................................................ PHYSICIAN	.......................		X	193,223	0	0
(22) MINI VERTER MD........................................................................ PHYSICIAN	.......................		X	173,155	0	5,553
(23) OTMAINE BENASSOU........................................................................ PSYCHIATRIC	.......................		X	123,541	0	5,553
(24) BARBARA CULVER........................................................................ PSYCHIATRIC	.......................		X	123,126	0	5,553
(25) CARMEN CHISVETTE........................................................................ VP, FACILITI	.......................		X	119,478	0	5,553

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,297,120	56,678

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	3,740,090

f	All other contributions, gifts, grants, and similar amounts not included above		1f	180,799

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		3,920,889

		Business Code
2a	PARTICIPANT FEES	621400	1,983,988	1,983,988
b	MEDICARE/MEDICAID	621400	1,342,741	1,342,741
c	VITAL ACCESS PROVIDER (VAP)	621400	195,166	195,166
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		3,521,895

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-285,652			-285,652
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		44,543
b	Less: rental expenses		21,721
c	Rental income or (loss)		22,822
d	Net rental income or (loss)......			22,822		22,822
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS INCOME			46,180	46,180
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			46,180
12	Total revenue. See Instructions......			7,226,134	3,568,075	22,822	-285,652

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	387,575	229,255	158,320
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	4,282,609	4,047,918	234,691
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	460,956	427,110	33,846
9	Other employee benefits .......	1,003,958	946,230	57,728
10	Payroll taxes ...........	323,547	308,514	15,033
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	2,962	2,193	769
c	Accounting ...........	151,875	112,457	39,418
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)	179,880	133,193	46,687
12	Advertising and promotion ....	500	500
13	Office expenses .......	135,009	117,509	17,500
14	Information technology ......	29,124	28,735	389
15	Royalties ..
16	Occupancy ...........	399,299	371,405	27,894
17	Travel ............	71,691	70,202	1,489
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	38,944	27,720	11,224
20	Interest ...........	55,726		55,726
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	141,752	127,618	14,134
23	Insurance ...	94,349	64,061	30,288
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	188,493	161,327	27,166
b	FOOD	131,577	129,432	2,145
c	BAD DEBT EXPENSE	104,315	104,315
d	MISCELLANEOUS	73,063	39,045	34,018
e	All other expenses	18,339	22,380	-4,041
25	Total functional expenses. Add lines 1 through 24e	8,275,543	7,471,119	804,424	0
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 ........		474,016	1
2	Savings and temporary cash investments .........		510,748	2
3	Pledges and grants receivable, net ......		1,030,944	3
4	Accounts receivable, net .............		1,922,385	4
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 ......		130,153	9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b	6,833,118	10c
11	Investments—publicly traded securities .		1,756,121	11
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 ...........		126,090	15
16	Total assets. Add lines 1 through 15 (must equal line 34)...		12,783,575	16	0

17	Accounts payable and accrued expenses .....	2,850,394	17
18	Grants payable ...		18
19	Deferred revenue .........	33,622	19
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	8,500,444	25
26	Total liabilities. Add lines 17 through 25..	11,384,460	26	0

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,252,261	27
28	Temporarily restricted net assets ...........	136,854	28
29	Permanently restricted net assets	10,000	29
	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 ...........	1,399,115	33	0
34	Total liabilities and net assets/fund balances ........	12,783,575	34	0