990 SBH 2016 Public Disclosure PDF
990 SBH 2016 Public Disclosure PDF
990 SBH 2016 Public Disclosure PDF
990
OMB No. 1545-0047
Return of Organization Exempt From Income Tax
Form Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Department of the Treasury | Do not enter social security numbers on this form as it may be made public.
2016
Open to Public
Internal Revenue Service | Information about Form 990 and its instructions is at www.irs.gov/form990. Inspection
A For the 2016 calendar year, or tax year beginning and ending
B Check if C Name of organization D Employer identification number
applicable:
Address
change SBH COMMUNITY SERVICE NETWORK, INC.
Name
change Doing business as 23-7406410
Initial
return Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number
Final
return/ 425 KINGS HIGHWAY 718-787-1100
termin-
ated City or town, state or province, country, and ZIP or foreign postal code G Gross receipts $ 11,462,809.
X Amended
return BROOKLYN, NY 11223 H(a) Is this a group return
F Name and address of principal officer:JACK AINI Yes X No
Applica-
tion for subordinates? ~~
SAME AS C ABOVE
pending
H(b) Are all subordinates included? Yes No
I Tax-exempt status: X 501(c)(3) 501(c) ( ) § (insert no.) 4947(a)(1) or 527 If "No," attach a list. (see instructions)
J Website: | WWW.SBHONLINE.ORG H(c) Group exemption number |
K Form of organization: X Corporation Trust Association Other | L Year of formation: 1974 M State of legal domicile: NY
Part I Summary
1 Briefly describe the organization's mission or most significant activities: SEE SCHEDULE O
Activities & Governance
2 Check this box | if the organization discontinued its operations or disposed of more than 25% of its net assets.
3 Number of voting members of the governing body (Part VI, line 1a) ~~~~~~~~~~~~~~~~~~~~ 3 39
4 Number of independent voting members of the governing body (Part VI, line 1b) ~~~~~~~~~~~~~~ 4 39
5 Total number of individuals employed in calendar year 2016 (Part V, line 2a) ~~~~~~~~~~~~~~~~ 5 65
6 Total number of volunteers (estimate if necessary) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6 1450
7a Total unrelated business revenue from Part VIII, column (C), line 12 ~~~~~~~~~~~~~~~~~~~~ 7a 0.
b Net unrelated business taxable income from Form 990-T, line 34 •••••••••••••••••••••• 7b 0.
Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~ 7,371,179. 8,630,714.
Revenue
9 Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~ 1,533,094. 1,202,889.
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ~~~~~~~~~~~~~ 0. 6,558.
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~ 501,178. 344,373.
12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) ••• 9,405,451. 10,184,534.
13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) ~~~~~~~~~~~ 1,930,407. 1,922,066.
14 Benefits paid to or for members (Part IX, column (A), line 4) ~~~~~~~~~~~~~ 0. 0.
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ~~~ 3,780,162. 4,374,131.
Expenses
16a Professional fundraising fees (Part IX, column (A), line 11e)~~~~~~~~~~~~~~ 0. 0.
b Total fundraising expenses (Part IX, column (D), line 25) | 405,670.
17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) ~~~~~~~~~~~~~ 2,629,783. 2,915,866.
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ~~~~~~~ 8,340,352. 9,212,063.
19 Revenue less expenses. Subtract line 18 from line 12 •••••••••••••••• 1,065,099. 972,471.
Fund Balances
End of Year
20 Total assets (Part X, line 16) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11,334,326. 12,596,416.
21 Total liabilities (Part X, line 26) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 593,223. 882,842.
22 Net assets or fund balances. Subtract line 21 from line 20 •••••••••••••• 10,741,103. 11,713,574.
Part II Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
=
Here JACK AINI, PRESIDENT
Type or print name and title
Print/Type preparer's name Preparer's signature Date Check PTIN
if
AARON SHAPIRO P01333816
9 9
Paid self-employed
LOEB & TROPER LLP 13-1517563
9
Preparer Firm's name Firm's EIN
Use Only Firm's address 655 THIRD AVENUE, 12TH FLOOR
NEW YORK, NY 10017 Phone no.212-867-4000
May the IRS discuss this return with the preparer shown above? (see instructions) ••••••••••••••••••••• X Yes No
632001 11-11-16 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2016)
Form 990 (2016) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 2
Part III Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III •••••••••••••••••••••••••••• X
1 Briefly describe the organization's mission:
SEE SCHEDULE O
2 Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X No
If "Yes," describe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in how it conducts, any program services?~~~~~~ Yes X No
If "Yes," describe these changes on Schedule O.
4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
4a (Code: ) (Expenses $ 2,002,021. including grants of $ 20,019. ) (Revenue $ 1,092,923. )
NYS OFFICE OF MENTAL HEALTH LICENSED ARTICLE 31 CLINIC HAS OVER 500
CLIENTS. THE CLINIC PROVIDES CLINICAL THERAPEUTIC TREATMENT TO
INDIVIDUALS, COUPLES, FAMILIES, AND GROUPS. ITS COUNSELORS TREAT A
VARIETY OF ISSUES SUCH AS ANXIETY, DEPRESSION, OCD, PERSONALITY
DISORDERS, BEREAVEMENT, AND MARITAL THERAPY. ITS LICENSE WAS EXPANDED
SEVERAL YEARS AGO BY OMH TO INCLUDE CHILDREN AND ADOLESCENTS FIVE TO
EIGHTEEN YEARS OF AGE.
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Part IV Checklist of Required Schedules (continued)
Yes No
20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H ~~~~~~~~~~~~~~~~ 20a X
b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ~~~~~~~~~~ 20b
21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
domestic government on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II ~~~~~~~~~~~~~~ 21 X
22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III ~~~~~~~~~~~~~~~~~~~~~~~~~~ 22 X
23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete
Schedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 23 X
24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete
Schedule K. If "No", go to line 25a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 24a X
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? ~~~~~~~~~~~ 24b
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 24c
d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~ 24d
25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit
transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ~~~~~~~~~~~~~~~~ 25a X
b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete
Schedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 25b X
26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or
former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes,"
complete Schedule L, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 26 X
27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
of any of these persons? If "Yes," complete Schedule L, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 27 X
28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~~~~~~~~~~ 28a X
b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~ 28b X
c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV~~~~~~~~~~~~~~~~~~~~~ 28c X
29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M ~~~~~~~~~ 29 X
30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions? If "Yes," complete Schedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 30 X
31 Did the organization liquidate, terminate, or dissolve and cease operations?
If "Yes," complete Schedule N, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 31 X
32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete
Schedule N, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 32 X
33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ~~~~~~~~~~~~~~~~~~~~~~~~ 33 X
34 Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 34 X
35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~ 35a X
b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~ 35b X
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?
If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 36 X
37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI ~~~~~~~~ 37 X
38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?
Note. All Form 990 filers are required to complete Schedule O ••••••••••••••••••••••••••••••• 38 X
Form 990 (2016)
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Form 990 (2016) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 5
Part V Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V •••••••••••••••••••••••••••
Yes No
1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~ 1a 65
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~ 1b 0
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners? ••••••••••••••••••••••••••••••••••••••••••• 1c
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~ 2a 65
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?~~~~~~~~~~ 2b X
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions) ~~~~~~~~~~~
3a Did the organization have unrelated business gross income of $1,000 or more during the year? ~~~~~~~~~~~~~~ 3a X
b If "Yes," has it filed a Form 990-T for this year? If "No," to line 3b, provide an explanation in Schedule O ~~~~~~~~~~ 3b
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~ 4a X
b If "Yes," enter the name of the foreign country: J
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ~~~~~~~~~~~~ 5a X
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?~~~~~~~~~ 5b X
c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5c
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions? ~~~~~~~~~~~~~~~~~~~~~~~~ 6a X
b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a X
b If "Yes," did the organization notify the donor of the value of the goods or services provided? ~~~~~~~~~~~~~~~ 7b X
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282? •••••••••••••••••••••••••••••••••••••••••••••••••••• 7c X
d If "Yes," indicate the number of Forms 8282 filed during the year ~~~~~~~~~~~~~~~~ 7d
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~ 7e X
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~~~~~~~~~ 7f X
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?~ 7g
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 7h
8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the
sponsoring organization have excess business holdings at any time during the year? ~~~~~~~~~~~~~~~~~~~ 8
9 Sponsoring organizations maintaining donor advised funds.
a Did the sponsoring organization make any taxable distributions under section 4966? ~~~~~~~~~~~~~~~~~~~ 9a
b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~ 9b
10 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12 ~~~~~~~~~~~~~~~ 10a
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~ 10b
11 Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ 11a
b Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11b
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? 12a
b If "Yes," enter the amount of tax-exempt interest received or accrued during the year •••••• 12b
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state? ~~~~~~~~~~~~~~~~~~~~~ 13a
Note. See the instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans ~~~~~~~~~~~~~~~~~~~~~~ 13b
c Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13c
14a Did the organization receive any payments for indoor tanning services during the tax year? ~~~~~~~~~~~~~~~~ 14a X
b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O •••••••••• 14b
Form 990 (2016)
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Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ••••••••••••••••••••••••••• X
Section A. Governing Body and Management
Yes No
1a Enter the number of voting members of the governing body at the end of the tax year ~~~~~~ 1a 39
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b Enter the number of voting members included in line 1a, above, who are independent ~~~~~~ 1b 39
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 X
3 Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~ 3 X
4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ~~~~~ 4 X
5 Did the organization become aware during the year of a significant diversion of the organization's assets? ~~~~~~~~~ 5 X
6 Did the organization have members or stockholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6 X
7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a X
b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7b X
8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a The governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8a X
b Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~ 8b X
9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address? If "Yes," provide the names and addresses in Schedule O ••••••••••••••••• 9 X
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes No
10a Did the organization have local chapters, branches, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 10a X
b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes? ~~~~~~~~~~~~~ 10b
11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 11a X
b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
12a Did the organization have a written conflict of interest policy? If "No," go to line 13 ~~~~~~~~~~~~~~~~~~~~ 12a X
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ~~~~~~ 12b X
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe
in Schedule O how this was done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12c X
13 Did the organization have a written whistleblower policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 X
14 Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~ 14 X
15 Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a The organization's CEO, Executive Director, or top management official ~~~~~~~~~~~~~~~~~~~~~~~~~~ 15a X
b Other officers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 15b X
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 16a X
b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements? •••••••••••••••••••••••••••••••••••• 16b
Section C. Disclosure
17 List the states with which a copy of this Form 990 is required to be filed JNY,NJ
18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
Own website Another's website X Upon request Other (explain in Schedule O)
19 Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
20 State the name, address, and telephone number of the person who possesses the organization's books and records: |
DOUGLAS BALIN - 718-787-1100
425 KINGS HIGHWAY, BROOKLYN, NY 11223
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Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII •••••••••••••••••••••••••••
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
¥ List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.
Enter -0- in columns (D), (E), and (F) if no compensation was paid.
¥ List all of the organization's current key employees, if any. See instructions for definition of "key employee."
¥ List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received report-
able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.
¥ List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of
reportable compensation from the organization and any related organizations.
¥ List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization,
more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees;
and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A) (B) (C) (D) (E) (F)
Name and Title Average Position Reportable Reportable Estimated
(do not check more than one
hours per box, unless person is both an compensation compensation amount of
officer and a director/trustee)
week Individual trustee or director from from related other
(list any the organizations compensation
hours for organization (W-2/1099-MISC) from the
Highest compensated
Institutional trustee
employee
below organizations
Former
Officer
line)
(1) JACK AINI 0.50
PRESIDENT X X 0. 0. 0.
(2) CHUCK MAMIYE 0.50
VICE PRESIDENT X X 0. 0. 0.
(3) FORTUNE FAHAM 0.50
VICE PRESIDENT X X 0. 0. 0.
(4) STEVE BALASIANO 0.50
TREASURER 1.00 X X 0. 0. 0.
(5) BARBARA MATALON 0.50
LIFETIME MEMBER X 0. 0. 0.
(6) ELLIOT BIBI 0.50
LIFETIME MEMBER X 0. 0. 0.
(7) FRED BIJOU 0.50
LIFETIME MEMBER X 0. 0. 0.
(8) ROBERT MATALON, M.D. 0.50
LIFETIME MEMBER X 0. 0. 0.
(9) LEE M. COHEN, CPA 0.50
MEMBER X 0. 0. 0.
(10) AJ GINDI 0.50
MEMBER X 0. 0. 0.
(11) AL FALACK 0.50
MEMBER X 0. 0. 0.
(12) BRIGITTE BEYDA 0.50
MEMBER X 0. 0. 0.
(13) CHARLES DWECK 0.50
MEMBER X 0. 0. 0.
(14) DANIELLE MANDALAWI 0.50
MEMBER X 0. 0. 0.
(15) EDDIE RISHTY 0.50
MEMBER X 0. 0. 0.
(16) EDMOND HARARY 0.50
MEMBER X 0. 0. 0.
(17) EDWARD ADES 0.50
MEMBER X 0. 0. 0.
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Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A) (B) (C) (D) (E) (F)
Name and title Average Position Reportable Reportable Estimated
(do not check more than one
hours per box, unless person is both an compensation compensation amount of
officer and a director/trustee)
week from from related other
(list any
Highest compensated
related
Institutional trustee
(W-2/1099-MISC) organization
organizations and related
Key employee
below
employee
organizations
Former
Officer
line)
(18) EZRA ANTEBI 0.50
MEMBER X 0. 0. 0.
(19) GLADYS HAZEN 0.50
MEMBER X 0. 0. 0.
(20) HAROLD DWECK 0.50
MEMBER X 0. 0. 0.
(21) JOE A. FRANCO 0.50
MEMBER X 0. 0. 0.
(22) LIZA SHAMAH 0.50
MEMBER X 0. 0. 0.
(23) MARSHALL MIZRAHI 0.50
MEMBER X 0. 0. 0.
(24) MAX MIZRACHI 0.50
MEMBER X 0. 0. 0.
(25) MAYER CHEMTOB 0.50
MEMBER X 0. 0. 0.
(26) DAVID BEYDA 0.50
MEMBER X 0. 0. 0.
1b Sub-total ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | 0. 0. 0.
c Total from continuation sheets to Part VII, Section A ~~~~~~~~~~ | 523,737. 0. 39,370.
d Total (add lines 1b and 1c) •••••••••••••••••••••••• | 523,737. 0. 39,370.
2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization | 3
Yes No
3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on
line 1a? If "Yes," complete Schedule J for such individual ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 X
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual~~~~~~~~~~~~~ 4 X
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? If "Yes," complete Schedule J for such person •••••••••••••••••••••••• 5 X
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
(A) (B) (C)
Name and business address NONE Description of services Compensation
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 | 0
SEE PART VII, SECTION A CONTINUATION SHEETS Form 990 (2016)
632008 11-11-16
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10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Form 990 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A) (B) (C) (D) (E) (F)
Name and title Average Position Reportable Reportable Estimated
hours (check all that apply) compensation compensation amount of
per from from related other
week the organizations compensation
Institutional trustee
related and related
Key employee
organizations organizations
below
Former
Officer
line)
(27) MICHELE LEVY 0.50
MEMBER X 0. 0. 0.
(28) MICHELLE SASSON 0.50
MEMBER X 0. 0. 0.
(29) RACHEL HAZAN 0.50
MEMBER X 0. 0. 0.
(30) RENA ASHEAR 0.50
MEMBER X 0. 0. 0.
(31) ALYSSA SHWEKEY 0.50
MEMBER X 0. 0. 0.
(32) RICHARD SHWEKEY 0.50
MEMBER X 0. 0. 0.
(33) ABE SORCHER 0.50
MEMBER X 0. 0. 0.
(34) MICHAEL WAHBA 0.50
MEMBER X 0. 0. 0.
(35) MICHAEL BAYDA 0.50
MEMBER X 0. 0. 0.
(36) LISA ELO 0.50
MEMBER X 0. 0. 0.
(37) NEMO GINDI 0.50
MEMBER X 0. 0. 0.
(38) ISAAC MOSSERY 0.50
MEMBER X 0. 0. 0.
(39) SEYMOUR SAMMEL 0.50
MEMBER X 0. 0. 0.
(40) DOUGLAS BALIN, LMSW, MPA 35.00
EXECUTIVE DIRECTOR X 212,421. 0. 11,310.
(41) CHARLES ANTEBY 35.00
DIRECTOR OF DEVELOPMENT X 202,597. 0. 16,655.
(42) JOSEPH MATALON 35.00
DIRECTOR OF CLIENT'S DIVISION NY X 108,719. 0. 11,405.
632201
04-01-16
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Part VIII Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII •••••••••••••••••••••••••
(A) (B) (C) (D)
Total revenue Related or Unrelated Revenue excluded
exempt function business from tax under
sections
revenue revenue 512 - 514
Contributions, Gifts, Grants
and Other Similar Amounts
b
Revenue
c
d
e
f All other program service revenue ~~~~~
g Total. Add lines 2a-2f ••••••••••••••••• | 1,202,889.
3 Investment income (including dividends, interest, and
other similar amounts)~~~~~~~~~~~~~~~~~ | 6,558. 6,558.
4 Income from investment of tax-exempt bond proceeds |
5 Royalties ••••••••••••••••••••••• |
(i) Real (ii) Personal
6 a Gross rents ~~~~~~~ 92,469.
b Less: rental expenses ~~~ 62,186.
c Rental income or (loss) ~~ 30,283.
d Net rental income or (loss) •••••••••••••• | 30,283. 30,283.
7 a Gross amount from sales of (i) Securities (ii) Other
assets other than inventory
b Less: cost or other basis
and sales expenses ~~~
c Gain or (loss) ~~~~~~~
d Net gain or (loss) ••••••••••••••••••• |
8 a Gross income from fundraising events (not
Other Revenue
including $ 1,710,675. of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~~ a 1,333,900.
b Less: direct expenses~~~~~~~~~~ b 1,216,089.
c Net income or (loss) from fundraising events ••••• | 117,811. 117,811.
9 a Gross income from gaming activities. See
Part IV, line 19 ~~~~~~~~~~~~~ a
b Less: direct expenses ~~~~~~~~~ b
c Net income or (loss) from gaming activities •••••• |
10 a 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 •••••• |
Miscellaneous Revenue Business Code
11 a NY CANCER CENTER, INC-SBH SERVICE 900099 196,279. 196,279.
b
c
d All other revenue ~~~~~~~~~~~~~
e Total. Add lines 11a-11d ~~~~~~~~~~~~~~~ | 196,279.
12 Total revenue. See instructions. ••••••••••••• | 10,184,534. 1,202,889. 0. 350,931.
632009 11-11-16 Form 990 (2016)
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Form 990 (2016) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 10
Part IX Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Check if Schedule O contains a response or note to any line in this Part IX ••••••••••••••••••••••••••
Do not include amounts reported on lines 6b, (A) (B) (C) (D)
7b, 8b, 9b, and 10b of Part VIII. Total expenses Program service Management and Fundraising
expenses general expenses expenses
1 Grants and other assistance to domestic organizations
and domestic governments. See Part IV, line 21 ~ 30,000. 30,000.
2 Grants and other assistance to domestic
individuals. See Part IV, line 22 ~~~~~~~ 1,892,066. 1,892,066.
3 Grants and other assistance to foreign
organizations, foreign governments, and foreign
individuals. See Part IV, lines 15 and 16 ~~~
4 Benefits paid to or for members ~~~~~~~
5 Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~ 442,983. 442,983.
6 Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B) ~~~ 120,124. 120,124.
7 Other salaries and wages ~~~~~~~~~~ 3,321,348. 2,963,120. 170,997. 187,231.
8 Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
9 Other employee benefits ~~~~~~~~~~ 102,972. 91,536. 7,989. 3,447.
10 Payroll taxes ~~~~~~~~~~~~~~~~ 386,704. 321,996. 42,675. 22,033.
11 Fees for services (non-employees):
a Management ~~~~~~~~~~~~~~~~ 241,854. 75,758. 158,850. 7,246.
b Legal ~~~~~~~~~~~~~~~~~~~~
c Accounting ~~~~~~~~~~~~~~~~~
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 Sch O.) 915,919. 910,627. 1,038. 4,254.
12 Advertising and promotion ~~~~~~~~~ 31,537. 23,940. 1,658. 5,939.
13 Office expenses~~~~~~~~~~~~~~~ 664,929. 392,562. 182,735. 89,632.
14 Information technology ~~~~~~~~~~~
15 Royalties ~~~~~~~~~~~~~~~~~~
16 Occupancy ~~~~~~~~~~~~~~~~~ 250,292. 156,487. 34,142. 59,663.
17 Travel ~~~~~~~~~~~~~~~~~~~ 52,868. 47,579. 1,347. 3,942.
18 Payments of travel or entertainment expenses
for any federal, state, or local public officials
19 Conferences, conventions, and meetings ~~
20 Interest ~~~~~~~~~~~~~~~~~~
21 Payments to affiliates ~~~~~~~~~~~~
22 Depreciation, depletion, and amortization ~~ 374,432. 295,769. 59,627. 19,036.
23 Insurance ~~~~~~~~~~~~~~~~~ 66,680. 53,262. 10,171. 3,247.
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 BAD DEBT 317,355. 317,355.
b
c
d
e All other expenses
25 Total functional expenses. Add lines 1 through 24e 9,212,063. 7,374,826. 1,431,567. 405,670.
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)
632011 11-11-16
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Form 990 (2016) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 12
Part XI Reconciliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI •••••••••••••••••••••••••••
1 Total revenue (must equal Part VIII, column (A), line 12) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 10,184,534.
2 Total expenses (must equal Part IX, column (A), line 25) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 9,212,063.
3 Revenue less expenses. Subtract line 2 from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 972,471.
4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ~~~~~~~~~~ 4 10,741,103.
5 Net unrealized gains (losses) on investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5
6 Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6
7 Investment expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7
8 Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8
9 Other changes in net assets or fund balances (explain in Schedule O) ~~~~~~~~~~~~~~~~~~~ 9 0.
10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column (B)) ••••••••••••••••••••••••••••••••••••••••••••••• 10 11,713,574.
Part XII Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII ••••••••••••••••••••••••••• X
Yes No
1 Accounting method used to prepare the Form 990: Cash X Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
2a Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~ 2a X
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basis X Consolidated basis Both consolidated and separate basis
b Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~ 2b X
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basis X Consolidated basis Both consolidated and separate basis
c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~ 2c X
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3a X
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits •••••••••••••••• 3b
Form 990 (2016)
632012 11-11-16
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10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
SCHEDULE A OMB No. 1545-0047
Total
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 632021 09-21-16 Schedule A (Form 990 or 990-EZ) 2016
14
10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
SBH COMMUNITY SERVICE NETWORK, INC.
Schedule A (Form 990 or 990-EZ) 2016 23-7406410 Page 2
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization
fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) | (a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) 2016 (f) Total
1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~ 5,440,237. 6,354,082. 6,160,311. 7,371,179. 8,630,714. 33,956,523.
2 Tax revenues levied for the organ-
ization'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 ~~~ 5,440,237. 6,354,082. 6,160,311. 7,371,179. 8,630,714. 33,956,523.
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. 33,956,523.
Section B. Total Support
Calendar year (or fiscal year beginning in) | (a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) 2016 (f) Total
7 Amounts from line 4 ~~~~~~~ 5,440,237. 6,354,082. 6,160,311. 7,371,179. 8,630,714. 33,956,523.
8 Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~ 146,408. 159,539. 160,750. 154,328. 99,027. 720,052.
9 Net income from unrelated business
activities, whether or not the
business is regularly carried on ~ 214,920. 117,811. 332,731.
10 Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part VI.) ~~~~ 134,855. 193,095. 208,973. 230,876. 196,279. 964,078.
11 Total support. Add lines 7 through 10 35,973,384.
12 Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~ 12 3,786,673.
13 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 ••••••••••••••••••••••••••••••••••••••••••••• |
Section C. Computation of Public Support Percentage
14 Public support percentage for 2016 (line 6, column (f) divided by line 11, column (f)) ~~~~~~~~~~~~ 14 94.39 %
15 Public support percentage from 2015 Schedule A, Part II, line 14 ~~~~~~~~~~~~~~~~~~~~~ 15 94.08 %
16a 33 1/3% support test - 2016. 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | X
b 33 1/3% support test - 2015. 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
17a 10% -facts-and-circumstances test - 2016. 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 ~~~~~~~~~~~~~~~ |
b 10% -facts-and-circumstances test - 2015. 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 ~~~~~~~~ |
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ••• |
Schedule A (Form 990 or 990-EZ) 2016
632022 09-21-16
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SBH COMMUNITY SERVICE NETWORK, INC.
Schedule A (Form 990 or 990-EZ) 2016 23-7406410 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) 2012 (b) 2013 (c) 2014 (d) 2015 (e) 2016 (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 per-
formed, 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 bus-
iness under section 513 ~~~~~
4 Tax revenues levied for the organ-
ization'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 ~~~
7 a 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 ~~~~~~
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
7 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) 2016
632026 09-21-16
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SBH COMMUNITY SERVICE NETWORK, INC.
Schedule A (Form 990 or 990-EZ) 2016 23-7406410 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
7 Total 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 2016 from Section C, line 6
10 Line 8 amount divided by Line 9 amount
(i) (ii) (iii)
Excess Distributions Underdistributions Distributable
Section E - Distribution Allocations (see instructions) Pre-2016 Amount for 2016
632027 09-21-16
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SBH COMMUNITY SERVICE NETWORK, INC.
Schedule A (Form 990 or 990-EZ) 2016 23-7406410 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.)
MISCELLANEOUS
2016
| Attach to Form 990, Form 990-EZ, or Form 990-PF.
or 990-PF)
Department of the Treasury
| Information about Schedule B (Form 990, 990-EZ, or 990-PF) and
Internal Revenue Service its instructions is at www.irs.gov/form990 .
Name of the organization Employer identification number
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
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.
Special Rules
X For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% 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 ~~~~~~~~~~~~~~~ | $
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 990-PF, Part I, line 2, to
certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2016)
623451 10-18-16
Schedule B (Form 990, 990-EZ, or 990-PF) (2016) Page 2
Name of organization Employer identification number
Part I Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
1 Person X
Payroll
$ 462,958. Noncash
(Complete Part II for
noncash contributions.)
7 Person X
Payroll
$ 187,500. Noncash
(Complete Part II for
noncash contributions.)
2 Person X
Payroll
$ 183,736. Noncash
(Complete Part II for
noncash contributions.)
3 Person X
Payroll
$ 175,350. Noncash
(Complete Part II for
noncash contributions.)
4 Person X
Payroll
$ 175,000. Noncash
(Complete Part II for
noncash contributions.)
5 Person X
Payroll
$ 187,500. Noncash
(Complete Part II for
noncash contributions.)
623452 10-18-16 Schedule B (Form 990, 990-EZ, or 990-PF) (2016)
23
10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Schedule B (Form 990, 990-EZ, or 990-PF) (2016) Page 2
Name of organization Employer identification number
Part I Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
6 Person X
Payroll
$ 195,345. Noncash
(Complete Part II for
noncash contributions.)
Person
Payroll
$ Noncash
(Complete Part II for
noncash contributions.)
Person
Payroll
$ Noncash
(Complete Part II for
noncash contributions.)
Person
Payroll
$ Noncash
(Complete Part II for
noncash contributions.)
Person
Payroll
$ Noncash
(Complete Part II for
noncash contributions.)
Person
Payroll
$ Noncash
(Complete Part II for
noncash contributions.)
623452 10-18-16 Schedule B (Form 990, 990-EZ, or 990-PF) (2016)
24
10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Schedule B (Form 990, 990-EZ, or 990-PF) (2016) Page 3
Name of organization Employer identification number
Part II Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
(a)
(c)
No. (b) (d)
FMV (or estimate)
from Description of noncash property given Date received
(See instructions)
Part I
$
623453 10-18-16 Schedule B (Form 990, 990-EZ, or 990-PF) (2016)
25
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Schedule B (Form 990, 990-EZ, or 990-PF) (2016) Page 4
Name of organization Employer identification number
(a) No.
from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
Part I
(a) No.
from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
Part I
(a) No.
from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
Part I
632052 08-29-16
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10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Schedule D (Form 990) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 3
Part VII Investments - Other 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. (Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
Part VIII Investments - Program 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. (Col. (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) SECURITY DEPOSIT 1,500.
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.) ••••• | 1,500.
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 X
Schedule D (Form 990) 2016
632053 08-29-16
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Schedule D (Form 990) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 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
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments ~~~~~~~~~~~~~~~~~~ 2a
b Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ 2b
c Recoveries of prior year grants ~~~~~~~~~~~~~~~~~~~~~~~~~ 2c
d Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2d
e Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2e
3 Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3
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
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
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ 2a
b Prior year adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2b
c Other losses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2c
d Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2d
e Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2e
3 Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3
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
Part XIII Supplemental Information.
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, 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.
PART X, LINE 2:
SBH HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT
2016
Supplemental Information Regarding Fundraising or Gaming Activities
(Form 990 or 990-EZ)
Complete if the organization answered "Yes" on Form 990, Part IV, line 17, 18, or 19, or if the
organization entered more than $15,000 on Form 990-EZ, line 6a.
Department of the Treasury
| Attach to Form 990 or Form 990-EZ. Open to Public
Internal Revenue Service
| Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990. Inspection
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
Part I Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990-EZ filers are not
required to complete this part.
1 Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a Mail solicitations e Solicitation of non-government grants
b Internet and email solicitations f Solicitation of government grants
c Phone solicitations g Special fundraising events
d In-person solicitations
2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or
key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes No
b If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
Yes No
Total •••••••••••••••••••••••••••••••••••••• |
3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration
or licensing.
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule G (Form 990 or 990-EZ) 2016
632081 09-12-16
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Schedule G (Form 990 or 990-EZ) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 2
Part II Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000
of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1 (b) Event #2 (c) Other events
(d) Total events
(add col. (a) through
TEAM SBH AUCTION 5
col. (c))
(event type) (event type) (total number)
Revenue
3 Gross income (line 1 minus line 2) •••• 181,400. 918,395. 234,105. 1,333,900.
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ••••••••••••••••••••• |
10a Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year?~~~~~~~~~ Yes No
b If "Yes," explain:
32
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Schedule G (Form 990 or 990-EZ) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 3
11 Does the organization conduct gaming activities with nonmembers?~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No
12 Is the organization a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity formed
to administer charitable gaming? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No
13 Indicate the percentage of gaming activity conducted in:
a The organization's facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13a %
b An outside facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13b %
14 Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address |
15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? ~~~~~~ Yes No
b If "Yes," enter the amount of gaming revenue received by the organization | $ and the amount
of gaming revenue retained by the third party | $
c If "Yes," enter name and address of the third party:
Name |
Address |
Name |
17 Mandatory distributions:
a Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No
b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year | $
Part IV Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b,
15c, 16, and 17b, as applicable. Also provide any additional information. See instructions
2 Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | 2.
3 Enter total number of other organizations listed in the line 1 table •••••••••••••••••••••••••••••••••••••••••••••••••• | 0.
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (2016)
632101 11-01-16 35
Schedule I (Form 990) (2016) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 2
Part III Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of (c) Amount of (d) Amount of non- (e) Method of valuation (f) Description of noncash assistance
recipients cash grant cash assistance (book, FMV, appraisal, other)
PART I, LINE 2:
WHEN A CLIENT APPLIES FOR FUNDS FROM SBH THEY ARE ASSIGNED TO A
CAPTAIN). THE CAPTAIN AND SOCIAL WORKER MEET WITH THE CLIENT AND REVIEW
REDUCING EXPENSES THAT MAY INCLUDE SUCH MATTERS AS SEEKING LESS EXPENSIVE
632102 11-01-16 36 Schedule I (Form 990) (2016)
Schedule I (Form 990) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 2
Part III Continuation of Grants and Other Assistance to Individuals in the United States (Schedule I (Form 990), Part III.)
(a) Type of grant or assistance (b) Number of (c) Amount of (d) Amount of non- (e) Method of (f) Description of non-cash assistance
recipients cash grant cash assistance valuation (book, FMV,
appraisal, other)
632242
04-01-16 37
Schedule I (Form 990) SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 2
Part IV Supplemental Information
THE FUNDS ARE GIVEN TO SUPPORT THE FAMILY DURING THE TREATMENT PLAN. THE
CLIENTS OVERALL BUDGET AND MAY INCLUDE AWARDS TOWARDS RENT, UTILITY COSTS,
EXPENSES ARE BASED ON THE CLIENTS OVERALL BUDGET OF INCOME AND EXPENSES.
LEAST THREE BOARD MEMBERS OF SBH MUST APPROVE THE ALLOCATION OF FUNDS.
(Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
| Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
2016
Department of the Treasury | Attach to Form 990. Open to Public
Internal Revenue Service | Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990. Inspection
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
Part I Questions Regarding Compensation
Yes No
1a Check the appropriate 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 indemnification and gross-up payments Health or social club dues or initiation fees
Discretionary spending account Personal services (such as, maid, chauffeur, chef)
b If any of the boxes on 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 ~~~~~~~~~~~ 1b
2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors,
trustees, and officers, including the CEO/Executive Director, regarding the items checked on line 1a? ~~~~~~~~~~~~ 2
3 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 X Compensation survey or study
Form 990 of other organizations X Approval by the board or compensation committee
4 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:
a Receive a severance payment or change-of-control payment? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4a X
b Participate in, or receive payment from, a supplemental nonqualified retirement plan? ~~~~~~~~~~~~~~~~~~~~ 4b X
c Participate in, or receive payment from, an equity-based compensation arrangement?~~~~~~~~~~~~~~~~~~~~ 4c X
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5 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:
a The organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5a X
b Any related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5b X
If "Yes" on line 5a or 5b, describe in Part III.
6 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:
a The organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6a X
b Any related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6b X
If "Yes" on line 6a or 6b, describe in Part III.
7 For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed payments
not described on lines 5 and 6? If "Yes," describe in Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 X
8 Were any amounts reported on Form 990, Part VII, paid or accrued 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 ~~~~~~~~~~~ 8 X
9 If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in
Regulations section 53.4958-6(c)? ••••••••••••••••••••••••••••••••••••••••••••• 9
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2016
632111 09-09-16
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10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Schedule J (Form 990) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 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 aren't 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.
(B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and (D) Nontaxable (E) Total of columns (F) Compensation
other deferred benefits (B)(i)-(D) in column (B)
(i) Base (ii) Bonus & (iii) Other compensation reported as deferred
(A) Name and Title compensation incentive reportable on prior Form 990
compensation compensation
632113 09-09-16 41
SCHEDULE L Transactions With Interested Persons OMB No. 1545-0047
(Form 990 or 990-EZ) | Complete if the organization answered "Yes" on Form 990, Part IV, line 25a, 25b, 26, 27, 28a,
28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b. 2016
Department of the Treasury | Attach to Form 990 or Form 990-EZ. Open To Public
Internal Revenue Service | Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990. Inspection
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
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 (b) Relationship between disqualified (d) Corrected?
(a) Name of disqualified person person and organization (c) Description of transaction
Yes No
2 Enter the amount of tax incurred by the organization managers or disqualified persons during the year under
section 4958 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ~~~~~~~~~~~~~~~~ | $
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 (c) Amount of (d) Type of (e) Purpose of
interested person and assistance assistance assistance
the organization
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule L (Form 990 or 990-EZ) 2016
632131 10-24-16
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10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
SBH COMMUNITY SERVICE NETWORK, INC.
Schedule L (Form 990 or 990-EZ) 2016 23-7406410 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 (c) Amount of (d) Description of (e) Sharing of
organization's
person and the organization transaction transaction revenues?
Yes No
JOSEPH MATALON SON OF BOARD MEMBER 108,719.SALARY X
(Form 990)
J Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
2016
Department of the Treasury J Attach to Form 990. Open To Public
Internal Revenue Service
J Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990. Inspection
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
Part I Types of Property
(a) (b) (c) (d)
Check if Number of Noncash contribution Method of determining
applicable contributions or amounts reported on noncash contribution amounts
items contributed Form 990, Part VIII, line 1g
1 Art - Works of art ~~~~~~~~~~~~~
2 Art - Historical treasures ~~~~~~~~~
3 Art - Fractional interests ~~~~~~~~~~
4 Books and publications ~~~~~~~~~~
5 Clothing and household goods ~~~~~~ X 64,475.FAIR MARKET VALUE
6 Cars and other vehicles ~~~~~~~~~~
7 Boats and planes ~~~~~~~~~~~~~
8 Intellectual property ~~~~~~~~~~~
9 Securities - Publicly traded ~~~~~~~~
10 Securities - Closely held stock ~~~~~~~
11 Securities - Partnership, LLC, or
trust interests ~~~~~~~~~~~~~~
12 Securities - Miscellaneous ~~~~~~~~
13 Qualified conservation contribution -
Historic structures ~~~~~~~~~~~~
14 Qualified conservation contribution - Other~
15 Real estate - Residential ~~~~~~~~~
16 Real estate - Commercial ~~~~~~~~~
17 Real estate - Other ~~~~~~~~~~~~
18 Collectibles ~~~~~~~~~~~~~~~~
19 Food inventory ~~~~~~~~~~~~~~
20 Drugs and medical supplies ~~~~~~~~
21 Taxidermy ~~~~~~~~~~~~~~~~
22 Historical artifacts ~~~~~~~~~~~~
23 Scientific specimens ~~~~~~~~~~~
24 Archeological artifacts ~~~~~~~~~~
25 Other J ( )
26 Other J ( )
27 Other J ( )
28 Other J ( )
29 Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ~~~~ 29
Yes No
30a During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it
must hold for at least three years from the date of the initial contribution, and which isn't required to be used for
exempt purposes for the entire holding period? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 30a X
b If "Yes," describe the arrangement in Part II.
31 Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions? ~~~~~~ 31 X
32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 32a X
b If "Yes," describe in Part II.
33 If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule M (Form 990) (2016)
632141 08-23-16
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SBH COMMUNITY SERVICE NETWORK, INC.
Schedule M (Form 990) (2016) 23-7406410 Page 2
Part II Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization
is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete
this part for any additional information.
45
10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
OMB No. 1545-0047
Supplemental Information to Form 990 or 990-EZ
2016
SCHEDULE O
(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.
Department of the Treasury | Attach to Form 990 or 990-EZ. Open to Public
Internal Revenue Service | Information about Schedule O (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990. Inspection
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
2) THE REACH FOR THE STARS SUNDAY PROGRAM PROVIDES A WEEKLY FULL-DAY
OVER 350 INDIVIDUALS AND FAMILIES MONTHLY. MUCH OF ITS THRUST IS THE
FAMILY.
6)THE SENIOR DIVISION PROVIDES A BROAD ARRAY OF PROGRAMS FOR THE OLDER
COUNSELING, SOCIAL AND MENTAL HEALTH SEMINARS AND PROGRAMS, CLUBS, ETC.
VARIETY OF SUBJECTS.
RELATIONSHIP.
THE FORM 990 IS REVIEWED BY SEVERAL BOARD MEMBERS PRIOR TO FILING WITH THE
IRS, INCLUDING THE PRESIDENT, TREASURER, AND THE AUDIT COMMITTEE. THE FORM
990 IS ALSO REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE EXECUTIVE
DIRECTOR. ANY QUESTIONS OR ISSUES ARE REVIEWED WITH THE ACCOUNTANT FOR
(A) THE INDIVIDUAL IN QUESTION MAY TAKE NO PART IN SBH DECISIONS TO WHICH
THE TRUSTEE:
(I) SHALL DISCLOSE SUCH INTEREST TO THE OTHER MEMBERS OF THE BOARD OR
COMMITTEE; AND
632212 08-25-16 Schedule O (Form 990 or 990-EZ) (2016)
48
10130119 733030 1556A 2016.05020 SBH COMMUNITY SERVICE NETWO 1556A__2
Schedule O (Form 990 or 990-EZ) (2016) Page 2
Name of the organization Employer identification number
SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410
SUCH DISCLOSURE AND THE FACT THAT THE TRUSTEE DID NOT VOTE OR PARTICIPATE
EACH YEAR THE BOARD OF DIRECTORS ARE ASKED TO REVIEW THE CONFLICT OF
SBH OFFICERS AND INDEPENDENT BOARD MEMBERS USE COMPARABLE COMPENSATION FROM
FROM WEBSITES SUCH AS, BUT NOT LIMITED TO, CHARITY NAVIGATOR ARE USED IN
POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SBH
OF THE AUDITED FINANCIAL STATEMENTS HAS NOT CHANGED FROM THAT OF THE
PRIOR YEAR.
THE 2016 990 IS BEING AMENDED DUE TO THE COMPLETION OF THE AUDITED
FINANCIAL STATEMENTS. THE FOLLOWING ITEMS WERE AMENDED: FORM 990 PARTS
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt
Part II
organizations during the tax year.
(a) (b) (c) (d) (e) (f) (g)
Section 512(b)(13)
Name, address, and EIN Primary activity Legal domicile (state or Exempt Code Public charity Direct controlling controlled
of related organization foreign country) section status (if section entity entity?
501(c)(3)) Yes No
THE SEPHARDIC BIKUR HOLIM FUND IN MEMORY OF SBH COMMUNITY
JOSEPH D. BEYDA, INC. - 47-14841, 425 KINGS SERVICE NETWORK,
HIGHWAY, BROOKLYN, NY 11223 SUPPORT SBH NEW YORK 501(C)(3) LINE 12A, I INC. X
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule R (Form 990) 2016
Part III Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related
organizations treated as a partnership during the tax year.
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)
Legal
Name, address, and EIN Primary activity domicile Direct controlling Predominant income Share of total Share of Disproportionate Code V-UBI General or Percentage
of related organization (state or entity (related, unrelated, income end-of-year allocations?
amount in box managing ownership
foreign excluded from tax under assets 20 of Schedule partner?
country) sections 512-514) Yes No K-1 (Form 1065) Yes No
Part IV Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related
organizations treated as a corporation or trust during the tax year.
(a) (b) (c) (d) (e) (f) (g) (h) (i)
Section
Name, address, and EIN Primary activity Legal domicile Direct controlling Type of entity Share of total Share of Percentage 512(b)(13)
of related organization (state or entity (C corp, S corp, income end-of-year ownership controlled
foreign entity?
country) or trust) assets
Yes No
Part V Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note: Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule. Yes No
1 During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1a X
b Gift, grant, or capital contribution to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1b X
c Gift, grant, or capital contribution from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1c X
d Loans or loan guarantees to or for related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1d X
e Loans or loan guarantees by related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1e X
(2)
(3)
(4)
(5)
(6)
632163 09-06-16 53 Schedule R (Form 990) 2016
Schedule R (Form 990) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 4
Part VI Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue)
that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)
Are all
Name, address, and EIN Primary activity Legal domicile Predominant income partners sec. Share of Share of Dispropor-Code V-UBI General or Percentage
of entity (state or foreign (related, unrelated, 501(c)(3)
total end-of-year amount in box 20 managing ownership
tionate
excluded from tax under orgs.? of Schedule K-1 partner?
allocations?
country) sections 512-514) Yes No income assets Yes No (Form 1065) Yes No
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Schedule R (Form 990) 2016 SBH COMMUNITY SERVICE NETWORK, INC. 23-7406410 Page 5
Part VII Supplemental Information.
Provide additional information for responses to questions on Schedule R. See instructions.