STATEN ISLAND MENTAL HEALTH: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- STATEN ISLAND MENTAL HEALTH (EIN 13-5623279)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-03-16
- IRS object ID
- 201330759349300703
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-16T13:41:46-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NERAL & COMPANY PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1727 | AddressLine1 |
| City | WALL | City |
| State | NJ | State |
| ZIP Code | 07719 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 135623279 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STATEN ISLAND MENTAL HEALTH | BusinessNameLine1 |
| Business Name Line2 | SOCIETY INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STAT | NameControl |
| Phone | 7184422225 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 669 CASTLETON AVENUE | AddressLine1 |
| City | STATEN ISLAND | City |
| State | NY | State |
| ZIP Code | 103012028 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | FERN ZAGOR LCSW ACSW | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 7184422225 | Phone |
| Date Signed | 2013-02-01 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS NERAL CPA | Name |
| Phone | 7326814595 | Phone |
| Date Prepared | 2013-03-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | FERN ZAGOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 669 CASTLETON AVE | AddressLine1 |
| City | STATEN ISLAND | City |
| State | NY | State |
| ZIP Code | 103012028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 23597642 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SIMHS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1954 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | THE SIMHS IS A NOT-FOR-PROFIT CHILDREN'S SERVICES AGENCY. 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. WE SERVE ONE IN TEN STATEN ISLAND FAMILIES. EACH YEAR: WE SERVE ONE-IN-TEN STATEN ISLAND FAMILIES; WE TREAT OVER 5,000 INDIVIDUALS; WE CONDUCT 161,000 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 25 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 25 | NbrIndependentVotingMembers |
| Total Nbr Employees | 273 | TotalNbrEmployees |
| Total Nbr Volunteers | 500 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 7695426 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 9425797 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11358013 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 10219465 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 195559 | InvestmentIncomePriorYear |
| Investment Income Current Year | 26944 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 219569 | OtherRevenuePriorYear |
| Other Revenue Current Year | 258862 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 19468567 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19931068 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 15444865 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14634050 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 466769 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4559907 | OtherExpensePriorYear |
| Other Expenses Current Year | 4477267 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20004772 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19111317 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -536205 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 819751 | RevenuesLessExpensesCY |
| Total Assets BOY | 16207072 | TotalAssetsBOY |
| Total Assets EOY | 14374938 | TotalAssetsEOY |
| Total Liabilities BOY | 12007180 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10308751 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4199892 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4066187 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE SIMHS IS A NOT-FOR-PROFIT CHILDREN'S SERVICES AGENCY. 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. WE SERVE ONE IN TEN STATEN ISLAND FAMILIES. EACH YEAR: WE SERVE ONE-IN-TEN STATEN ISLAND FAMILIES; WE TREAT OVER 5,000 INDIVIDUALS; WE CONDUCT 161,000 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 9914557 | Expense |
| Revenue | 9009945 | Revenue |
| Description | MENTAL HEALTH SERVICES FOR CHILDREN OFFERS MENTAL HEALTH AND RELATED SERVICES TO STATEN ISLAND CHILDREN AND ADOLESCENTS AND THEIR FAMILIES. ON-SITE MENTAL HEALTH PROGRAM PROVIDES SCHOOL-BASED THERAPEUTIC SERVICES FOR ELEMENTARY AND INTERMEDIATE SCHOOL STUDENTS WHO ARE IN DANGER OF BEING PLACED INTO SPECIAL EDUCATION CLASSES BECAUSE OF BEHAVIORAL OR PSYCHOLOGICAL CHALLENGES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3929815 | Expense |
| Description | THREE FULL-SERVICE HEAD START 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. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1489444 | Expense |
| Revenue | 872132 | Revenue |
| Description | 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. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2909170 | Expense |
| Revenue | 263977 | Revenue |
| Description | 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-JUDGEMENTAL 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. DAY CARE CENTER - PORT RICHMOND DAY NURSERY HAS PROVIDED A CARING AND STIMULATING PRESCHOOL ENVIRONMENT FOR 3,4,AND 5 YEAR OLDS WHOSE PARENTS ARE WORKING, TRAINING FOR, OR SEEKING EMPLOYMENT OR ARE INCAPACITATED. TO BE ACCEPTED INTO THIS PROGRAM, A FAMILY'S INCOME MUST BE WITHIN GUIDELINES SET BY NEW YORK CITY. THIS PROGRAM CLOSED SUBSEQUENT TO YEAR END DUE TO NOTIFICATION FROM THE NYC AGENCY FOR CHILDREN'S SERVICES OF IT'S INTENT TO ELIMINATE CHILD CARE FUNDING. EARLY CHILDHOOD MENTAL HEALTH (UNDER 5) PROGRAM - THIS PROGRAM ENHANCES THE ABILITY OF THE SIMHS'S LICENSED CLINICAL STAFF IN THE AREA OF EARLY CHILDHOOD MENTAL HEALTH SERVICES BY DEVELOPING AND IMPLEMENTING AN INTENSIVE PROFESSIONAL TRAINING PROGRAM TO RECOGNIZE, ASSESS AND PROVIDE APPROPRIATE CLINICAL AND RELATIONSHIP-BASED INTERVENTIONS TO CHILDREN AGE FIVE AND UNDER AND THEIR FAMILIES WHO HAVE BEEN DIAGNOSED AS HAVING, OR ARE AT RISK OF DEVELOPING, A SOCIAL OR EMOTIONAL DISORDER. CLINIC PLUS - THIS PROGRAM PROVIDES MENTAL HEALTH SCREENING TO CHILDREN AND ADOLESCENTS ENROLLED IN INTERMEDIATE AND HIGH SCHOOLS; CONDUCTING COMPREHENSIVE ASSESSMENTS WITH CHILDREN AND FAMILIES WHO INDICATE A NEED VIA INSTRUMENT SCORE; AND PROVIDING EVIDENCE-BASED MENTAL HEALTH SERVICES TO CHILDREN AND FAMILIES IN NATURAL SETTINGS SUCH AS SCHOOLS AND HOMES. THIS PROGRAM CLOSED DECEMBER 31, 2012. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 2909170 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 263977 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 18242986 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | true | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 33 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 3 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 273 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 25 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 25 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | R BELFINI | NamePerson |
| Telephone Number | 7184422225 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 669 CASTLETON AVE | AddressLine1 |
| City | STATEN ISLAND | City |
| State | NY | State |
| ZIP Code | 10301 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (34 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| JOHN TAPINIS | ||||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| LORI KARELAS | ||||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| ANTHONY DEFAZIO | ||||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| ELIZABETH PALAGIANO | ||||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | ||
| MICHAEL BEHAR | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| NANCY MYERS BENBOW | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DR CHRISTINE CEA | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT CONTI MBA | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| VICTORIA DRUMBAKIS | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| SAMIR FARAG | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MARGUERITE FIORE ESQ | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RONALD GREGG ESQ | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JOHN HOGAN CPA | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| NELLI KEMEVOR RNMPH | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT CUTRONA ESQ | ||||||||
| BOAD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| LAURA KENNEDY | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| KAREN LACAVA | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RONNA LASHER | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JOSEPH LIBASSI | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DONNA LONG | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| GRACELYN SANTOS DDS | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| NANCY SHANAPHY | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DEEPTHA NEDUNCHEZIAN SITHIANMD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| ROBERTA VOGEL PHD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| LINDA WILSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| KENNETH POPLER PH D MBA | ||||||||
| PRES & CEO | 70.00 | X | 540127 | 0 | 53087 | |||
| PATRICIA FINKELSTEIN | ||||||||
| CFO | 55.00 | X | 158467 | 0 | 52538 | |||
| FERN ZAGOR LCSW ACSW | ||||||||
| COO | 70.00 | X | 149882 | 0 | 28627 | |||
| ARUNA AGNI MD | ||||||||
| PHYSICIAN | 34.50 | 207120 | 0 | 16309 | X | |||
| MINI VERTER MD | ||||||||
| PHYSICIAN | 32.00 | 169461 | 0 | 47858 | X | |||
| AMARJIT KAUR MD | ||||||||
| PHYSICIAN | 30.00 | 150232 | 0 | 71961 | X | |||
| BERYL CLARK | ||||||||
| VP,EARLY CH | 123502 | 0 | 15684 | X | ||||
| CARMEN CHISVETTE | ||||||||
| VP, FACILITI | 40.00 | 110958 | 0 | 37278 | X | |||
| NATHALIE WEEKS LMSW MBA | ||||||||
| DIRECTOR MH | 35.00 | 138571 | 0 | 31346 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1748320 | TotalReportableCompFromOrg |
| Total Other Compensation | 354688 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CLJ BUILDING ENTERPRISES INC | |||||
| 124 MCCLEAN AVENUE | STATEN ISLAND | NY | 10305 | CONTRACTOR | 2468348 |
| GREENBERG TRAURIG LLP | |||||
| 54 STATE STREET 6TH FLOOR | ALBANY | NY | 12207 | LEGAL SERVICES | 462115 |
| NERAL & COMPANY PA | |||||
| PO BOX 1727 | WALL | NJ | 07719 | AUDITING SERV | 152375 |
| BROADVIEW NETWORKS | |||||
| PO BOX 9242 | UNIONDALE | NY | 11555 | COMMUNICATIONS | 109759 |
| PROJECT -ONE SERVICES INC | |||||
| 899 MANOR ROAD | STATEN ISLAND | NY | 10314 | CLEANING SERVIC | 101897 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Federated Campaigns | 3783 | FederatedCampaigns |
| Fundraising Events | 3520 | FundraisingEvents |
| Government Grants | 8053473 | GovernmentGrants |
| All Other Contributions | 1365021 | AllOtherContributions |
| Total Contributions | 9425797 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID | 621400 | 9423428 | 9423428 |
| PARTICIPANT FEES | 621400 | 796037 | 796037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 10219465 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28195 | TotalRevenueColumn |
| Exclusion | $28,195 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3358769 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3360020 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -1251 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1251 | TotalRevenueColumn |
| Related Or Exempt Function Income | -1251 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 429389 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 3520 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 293599 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 135790 | TotalRevenueColumn |
| Exclusion | $135,790 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 24805 | GrossIncomeGaming |
| Gaming Direct Expenses | 12955 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11850 | TotalRevenueColumn |
| Exclusion | $11,850 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 67861 | GrossSalesOfInventory |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 67861 | TotalRevenueColumn |
| Exclusion | $67,861 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS INCOME | Description |
| Total Revenue Column | 43361 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43361 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 43361 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19931068 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10261575 | RelatedOrExemptFunctionIncome |
| Exclusion | $243,696 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 976856 | Total |
| Program Services | 753549 | ProgramServices |
| Management And General | 80264 | ManagementAndGeneral |
| Fundraising | 143043 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9988687 | Total |
| Program Services | 9735720 | ProgramServices |
| Management And General | 164529 | ManagementAndGeneral |
| Fundraising | 88438 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 897225 | Total |
| Program Services | 873682 | ProgramServices |
| Management And General | 16785 | ManagementAndGeneral |
| Fundraising | 6758 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1988665 | Total |
| Program Services | 1909303 | ProgramServices |
| Management And General | 47150 | ManagementAndGeneral |
| Fundraising | 32212 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 782617 | Total |
| Program Services | 759068 | ProgramServices |
| Management And General | 14265 | ManagementAndGeneral |
| Fundraising | 9284 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208338 | Total |
| Program Services | 195008 | ProgramServices |
| Management And General | 4405 | ManagementAndGeneral |
| Fundraising | 8925 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 162579 | Total |
| Program Services | 152177 | ProgramServices |
| Management And General | 3437 | ManagementAndGeneral |
| Fundraising | 6965 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 410571 | Total |
| Program Services | 384303 | ProgramServices |
| Management And General | 8680 | ManagementAndGeneral |
| Fundraising | 17588 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26761 | Total |
| Program Services | 16538 | ProgramServices |
| Management And General | 281 | ManagementAndGeneral |
| Fundraising | 9942 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 408437 | Total |
| Program Services | 400293 | ProgramServices |
| Management And General | 4175 | ManagementAndGeneral |
| Fundraising | 3969 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36540 | Total |
| Program Services | 34848 | ProgramServices |
| Management And General | 996 | ManagementAndGeneral |
| Fundraising | 696 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 883241 | Total |
| Program Services | 824722 | ProgramServices |
| Management And General | 15650 | ManagementAndGeneral |
| Fundraising | 42869 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 350028 | Total |
| Program Services | 339050 | ProgramServices |
| Management And General | 6533 | ManagementAndGeneral |
| Fundraising | 4445 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69852 | Total |
| Program Services | 42238 | ProgramServices |
| Management And General | 1038 | ManagementAndGeneral |
| Fundraising | 26576 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 480938 | Total |
| Program Services | 467284 | ProgramServices |
| Management And General | 7756 | ManagementAndGeneral |
| Fundraising | 5898 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140348 | Total |
| Program Services | 134564 | ProgramServices |
| Management And General | 3447 | ManagementAndGeneral |
| Fundraising | 2337 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT EXPENSE | 503714 | 484904 | 11165 | 7645 |
| REPAIRS & MAINTENANCE | 291748 | 282487 | 5611 | 3650 |
| FOOD | 216704 | 209694 | 1440 | 5570 |
| MISCELLANEOUS | 131111 | 105033 | 1657 | 24421 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156357 | Total |
| Program Services | 138521 | ProgramServices |
| Management And General | 2298 | ManagementAndGeneral |
| Fundraising | 15538 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19111317 | Total |
| Program Services | 18242986 | ProgramServices |
| Management And General | 401562 | ManagementAndGeneral |
| Fundraising | 466769 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5335430 | BOY |
| EOY | 2221801 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 242506 | BOY |
| EOY | 192821 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 290056 | BOY |
| EOY | 823812 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1201315 | BOY |
| EOY | 1051143 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 237876 | BOY |
| EOY | 195752 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14028898 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5585264 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7198768 | BOY |
| EOY | 8443634 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1665929 | BOY |
| EOY | 1413383 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35192 | BOY |
| EOY | 32592 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16207072 | BOY |
| EOY | 14374938 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10036739 | BOY |
| EOY | 7477526 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64630 | BOY |
| EOY | 115674 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1905811 | BOY |
| EOY | 2715551 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12007180 | BOY |
| EOY | 10308751 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4056403 | BOY |
| EOY | 3917441 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 133489 | BOY |
| EOY | 138746 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10000 | BOY |
| EOY | 10000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4199892 | BOY |
| EOY | 4066187 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16207072 | BOY |
| EOY | 14374938 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 819751 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -953456 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9594947 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 10045620 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8772214 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 8482587 | CurrentTaxYearMinus1Year |
| Current Tax Year | 10217091 | CurrentTaxYear |
| Total | 47112459 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9594947 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 10045620 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8772214 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 8482587 | CurrentTaxYearMinus1Year |
| Current Tax Year | 10217091 | CurrentTaxYear |
| Total | 47112459 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 47112459 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 68813 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | -332274 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 312197 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 420038 | CurrentTaxYearMinus1Year |
| Current Tax Year | -116771 | CurrentTaxYear |
| Total | 352003 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 317489 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 53494 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 30517 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3271 | CurrentTaxYearMinus1Year |
| Current Tax Year | 43360 | CurrentTaxYear |
| Total | 448131 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 47912593 | TotalSupport |
| Gross Receipts From Admissions Etc | 10262826 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.98330 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.97410 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 314670 | OtherCostOrOtherBasis |
| Book Value | 314670 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2898496 | OtherCostOrOtherBasis |
| Depreciation | 2444784 | Depreciation |
| Book Value | 453712 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10262730 | OtherCostOrOtherBasis |
| Depreciation | 2687463 | Depreciation |
| Book Value | 7575267 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 249469 | OtherCostOrOtherBasis |
| Depreciation | 248589 | Depreciation |
| Book Value | 880 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 303536 | OtherCostOrOtherBasis |
| Depreciation | 204435 | Depreciation |
| Book Value | 99101 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8443630 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LIABILITY FOR PENSION BENEFITS | Description |
| Amount | $2,715,551 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2715551 | TotalOfAmounts |
| Total Revenue | 19931068 | TotalRevenue |
| Total Expenses | 19111317 | TotalExpenses |
| Excess Or Deficit For Year | 819751 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -143717 | NetUnrealizedGLOnInvestments |
| Other | -$809,739 | OtherAmount |
| Total Adjustments | -953456 | TotalAdjustments |
| Excess Or Deficit Per FS | -133705 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 20431006 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -143717 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 337102 | DonatedSrvcAndUseOfFacilities |
| Other Revenues | 306553 | OtherRevenues |
| Revenue Not Rptd F990 | 499938 | RevenueNotRptdF990 |
| Revenue Subtotal | 19931068 | RevenueSubtotal |
| Total Revenue Per Form990 | 19931068 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20564711 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 337102 | DonatedServicesUseOfFacilities |
| Other Expenses Included | 1116292 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1453394 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19111317 | ExpensesSubtotal |
| Total Expenses Per Form990 | 19111317 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| LIABILITY UNDER FIN 48 FOOTNOTE | SCHEDULE D, PAGE 3, PART X | AS REQUIRED BY THE ACCOUNTING STANDARDS CODIFICATION, THE SOCIETY ADOPTED THE RECOGNITION REQUIREMENTS FOR UNCERTAIN INCOME TAX POSITIONS AS REQUIRED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA, WITH NO CUMULATIVE EFFECT ADJUSTMENT REQUIRED. INCOME TAX BENEFITS ARE RECOGNIZED FOR INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, ONLY WHEN IT IS DETERMINED THAT THE INCOME TAX POSITION WILL MORE-LIKELY-THAN-NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. THE SOCIETY HAS ANALYZED TAX POSITIONS TAKEN FOR FILING WITH THE INTERNAL REVENUE SERVICE AND NEW YORK STATE WHERE IT OPERATES. THE SOCIETY BELIEVES THAT INCOME TAX FILING POSITIONS WILL BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE AFFECT ON THE SOCIETYS FINANCIAL CONDITION, RESULTS OF OPERATIONS OR CASH FLOWS. ACCORDINGLY, THE SOCIETY HAS NOT RECORDED ANY RESERVES, OR RELATED ACCRUALS FOR INTEREST AND PENALTIES FOR UNCERTAIN INCOME TAX POSITIONS AT JUNE 30, 2012. THE SOCIETY BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION FOR YEARS PRIOR TO 2009. |
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | SPECIAL EVENTS EXPENSES 306,553 SPECIAL EVENTS EXPENSES -306,553 FASB 158 ADJUSTMENT -809,739 |
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | SPECIAL EVENTS EXPENSES 306,553 |
| EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 2D | SPECIAL EVENTS EXPENSES 306,553 FASB 158 ADJUSTMENT 809,739 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CHILDREN'S THEA | NameOfEvent1 |
| Gross Receipts Event1 | 187615 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 187615 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 178607 | OtherDirectExpensesEvent1 |
| Name Of Event2 | ANNIVERSARY BAL | NameOfEvent2 |
| Gross Receipts Event2 | 180625 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 3520 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 177105 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 69074 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 64669 | GrossReceiptsOtherEvents |
| Gross Revenue Other Events | 64669 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 45918 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 432909 | GrossReceiptsTotal |
| Charitable Contributions Total | 3520 | CharitableContributionsTotal |
| Gross Revenue Total Events | 429389 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 293599 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 293599 | DirectExpenseSummaryEvents |
| Net Income Summary | 135790 | NetIncomeSummary |
Gaming Information GamingInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteer Labor Bingo | false | VolunteerLaborBingo |
| Volunteer Labor Pull Tabs | false | VolunteerLaborPullTabs |
| Gross Revenue Other Gaming | 24805 | GrossRevenueOtherGaming |
| Cash Prizes Other Gaming | 11750 | CashPrizesOtherGaming |
| Other Direct Expenses Other Gaming | 1205 | OtherDirectExpensesOtherGaming |
| Volunteer Labor Other Gaming | false | VolunteerLaborOtherGaming |
| Gross Revenue Total Gaming | 24805 | GrossRevenueTotalGaming |
| Cash Prizes Total Gaming | 11750 | CashPrizesTotalGaming |
| Other Direct Expenses Total Gaming | 1205 | OtherDirectExpensesTotalGaming |
| Direct Expense Summary Gaming | 12955 | DirectExpenseSummaryGaming |
| Net Gaming Income Summary | 11850 | NetGamingIncomeSummary |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | NY | StatesWhereGamingConducted |
| Licensed | true | Licensed |
| License Suspended Etc | false | LicenseSuspendedEtc |
| Gaming With Nonmembers | true | GamingWithNonmembers |
| Member Of Other Entity | false | MemberOfOtherEntity |
| Name Of Gaming Rec Keeper Person | R BELFINI | NameOfGamingRecKeeperPerson |
Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 669 CASTLETON AVE | AddressLine1 |
| City | STATEN ISLAND | City |
| State | NY | State |
| ZIP Code | 10301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contract With3rd Party For Gam Rev | false | ContractWith3rdPartyForGamRev |
| Charitable Distrib Required | false | CharitableDistribRequired |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|
| KENNETH POPLER PH D MBA | |||
| 540127 | 5000 | 48087 | 593214 |
| PATRICIA FINKELSTEIN | |||
| 158467 | 3200 | 49338 | 211005 |
| FERN ZAGOR LCSW ACSW | |||
| 149882 | 3121 | 25506 | 178509 |
| ARUNA AGNI MD | |||
| 207120 | 4115 | 12194 | 223429 |
| MINI VERTER MD | |||
| 169461 | 3416 | 44442 | 217319 |
| AMARJIT KAUR MD | |||
| 150232 | 3031 | 68930 | 222193 |
| NATHALIE WEEKS LMSW MBA | |||
| 138571 | 31346 | 169917 | |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT S CUTRONA SR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | FATHER, BRDMBR | Relationship |
| Amount Of Transaction | 98083 | AmountOfTransaction |
| Description Of Transaction | OWNER, CLEANING FIRM | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | ROBERT S CUTRONA SR OWNER AND PRESIDENT OF PROJECTONE SERVICES INC IS THE FATHER OF BOARD MEMBER ROBERT CUTRONA ESQ | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | THE SIMHS IS A NOT-FOR-PROFIT CHILDREN'S SERVICES AGENCY. 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. WE SERVE ONE IN TEN STATEN ISLAND FAMILIES. EACH YEAR: WE SERVE ONE-IN-TEN STATEN ISLAND FAMILIES; WE TREAT OVER 5,000 INDIVIDUALS; WE CONDUCT 161,000 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. |
| EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS | FORM 990, PAGE 1, PART I, LINE 6 | THE BOARD OF DIRECTORS IS COMPRISED OF VOLUNTEERS AND MAKES SIGNIFICANT CONTRIBUTIONS OF TIME RELATIVE TO GENERAL MANAGEMENT AND OPERATIONS OF THE SOCIETY. IN ADDITION,A SUBSTANTIAL NUMBER OF UNPAID VOLUNTEERS (APPROX 500) HAVE MADE SIGNIFICANT CONTRIBUTIONS OF THEIR TIME FOR THE PURPOSE OF RAISING FUNDS ON BEHALF OF THE SOCIETY. THE HOURS CONTRIBUTED INCLUDE HOURS RELATED TO ATTENDING MEETINGS, COMMITTEES, ORGANIZING EVENTS, ETC. |
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | 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-JUDGEMENTAL 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. DAY CARE CENTER - PORT RICHMOND DAY NURSERY HAS PROVIDED A CARING AND STIMULATING PRESCHOOL ENVIRONMENT FOR 3,4,AND 5 YEAR OLDS WHOSE PARENTS ARE WORKING, TRAINING FOR, OR SEEKING EMPLOYMENT OR ARE INCAPACITATED. TO BE ACCEPTED INTO THIS PROGRAM, A FAMILY'S INCOME MUST BE WITHIN GUIDELINES SET BY NEW YORK CITY. THIS PROGRAM CLOSED SUBSEQUENT TO YEAR END DUE TO NOTIFICATION FROM THE NYC AGENCY FOR CHILDREN'S SERVICES OF IT'S INTENT TO ELIMINATE CHILD CARE FUNDING. EARLY CHILDHOOD MENTAL HEALTH (UNDER 5) PROGRAM - THIS PROGRAM ENHANCES THE ABILITY OF THE SIMHS'S LICENSED CLINICAL STAFF IN THE AREA OF EARLY CHILDHOOD MENTAL HEALTH SERVICES BY DEVELOPING AND IMPLEMENTING AN INTENSIVE PROFESSIONAL TRAINING PROGRAM TO RECOGNIZE, ASSESS AND PROVIDE APPROPRIATE CLINICAL AND RELATIONSHIP-BASED INTERVENTIONS TO CHILDREN AGE FIVE AND UNDER AND THEIR FAMILIES WHO HAVE BEEN DIAGNOSED AS HAVING, OR ARE AT RISK OF DEVELOPING, A SOCIAL OR EMOTIONAL DISORDER. CLINIC PLUS - THIS PROGRAM PROVIDES MENTAL HEALTH SCREENING TO CHILDREN AND ADOLESCENTS ENROLLED IN INTERMEDIATE AND HIGH SCHOOLS; CONDUCTING COMPREHENSIVE ASSESSMENTS WITH CHILDREN AND FAMILIES WHO INDICATE A NEED VIA INSTRUMENT SCORE; AND PROVIDING EVIDENCE-BASED MENTAL HEALTH SERVICES TO CHILDREN AND FAMILIES IN NATURAL SETTINGS SUCH AS SCHOOLS AND HOMES. THIS PROGRAM CLOSED DECEMBER 31, 2012. |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION IS ORGANIZED WITH MEMBERS. THE ANNUAL MEMBERSHIP FEE IS CURRENTLY 50. MEMBERSHIP IN THE ORGANIZATION IS FOR ONE YEAR, INCLUDING ONE ANNUAL MEETING. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | 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. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE IRS FORM 990 IS PREPARED BY THE INDEPENDENT AUDITOR UTILIZING AUDIT WORK PAPERS AS WELL AS CLIENT PREPARED SUPPORTING SCHEDULES. THE FORM 990 IS REVIEWED IN DETAIL WITH THE CEO AND CONTROLLER. THE FORM 990 IS THEN PRESENTED TO THE FINANCE/AUDIT COMMITTEE WHO REVIEWS IT IN DETAIL. A PERIOD OF TIME IS ALLOTTED FOR QUESTIONS AND COMMENTS. DISCLOSURE IS MADE TO THE FULL BOARD OF DIRECTORS, THAT THE RETURN HAS BEEN REVIEWED AND APPROVED BY THE FINANCE/AUDIT COMMITTEE PRIOR TO FILING FORM 990 WITH THE IRS. |
| ENFORCEMENT OF CONFLICTS POLICY | 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. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | 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. |
| COMPENSATION PROCESS FOR OFFICERS | 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. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | 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. |
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