401k Plan data: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN plan

LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN
Plan identification number	002

LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BESTSELF BEHAVIORAL HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: BESTSELF BEHAVIORAL HEALTH, INC.

Employer identification number (EIN): 161004090

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Additional information about BESTSELF BEHAVIORAL HEALTH, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1972-12-27

Company Identification Number: 249829

Legal Registered Office Address: 255 DELAWARE AVENUE
SUITE 300
BUFFALO
United States of America (USA)
14202

More information about BESTSELF BEHAVIORAL HEALTH, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 HOWARD HITZEL HOWARD HITZEL 2018-10-15
002 2016-01-01 HOWARD HITZEL
002 2015-01-01 HOWARD HITZEL
002 2014-01-01 HOWARD HITZEL
002 2013-01-01 HOWARD HITZEL
002 2012-01-01 HOWARD HITZEL
002 2011-01-01 HOWARD HITZEL HOWARD HITZEL 2012-10-11
002 2010-01-01 HOWARD HITZEL HOWARD HITZEL 2011-10-12
002 2009-01-01 HOWARD HITZEL HOWARD HITZEL 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	HOWARD HITZEL	HOWARD HITZEL	2018-10-15
002	2016-01-01	HOWARD HITZEL
002	2015-01-01	HOWARD HITZEL
002	2014-01-01	HOWARD HITZEL
002	2013-01-01	HOWARD HITZEL
002	2012-01-01	HOWARD HITZEL
002	2011-01-01	HOWARD HITZEL	HOWARD HITZEL	2012-10-11
002	2010-01-01	HOWARD HITZEL	HOWARD HITZEL	2011-10-12
002	2009-01-01	HOWARD HITZEL	HOWARD HITZEL	2010-10-14

Plan Statistics for LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN

Measure Date Value
2023: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 1,513
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 1,188
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 285
Total of all active and inactive participants 2023-01-01 1,473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 1,473
Number of participants with account balances 2023-01-01 1,194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 139
2022: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,350
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,265
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 222
Total of all active and inactive participants 2022-01-01 1,487
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 1,487
Number of participants with account balances 2022-01-01 1,198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 91
2021: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,230
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,143
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 173
Total of all active and inactive participants 2021-01-01 1,316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 1,316
Number of participants with account balances 2021-01-01 1,091
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 60
2020: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,126
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,095
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 118
Total of all active and inactive participants 2020-01-01 1,214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 1,214
Number of participants with account balances 2020-01-01 1,034
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 34
2019: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 986
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 999
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 110
Total of all active and inactive participants 2019-01-01 1,109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 1,109
Number of participants with account balances 2019-01-01 920
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 29
2018: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 820
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 859
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 107
Total of all active and inactive participants 2018-01-01 966
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 967
Number of participants with account balances 2018-01-01 614
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 36
2017: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 493
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 737
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 111
Total of all active and inactive participants 2017-01-01 848
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 848
Number of participants with account balances 2017-01-01 504
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 30
2016: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 230
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 249
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 15
Total of all active and inactive participants 2016-01-01 264
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 264
Number of participants with account balances 2016-01-01 254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 205
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 25
Total of all active and inactive participants 2015-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 230
Number of participants with account balances 2015-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 10
2014: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 215
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 17
Total of all active and inactive participants 2014-01-01 232
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 232
Number of participants with account balances 2014-01-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 18
2013: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 190
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 142
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 35
Total of all active and inactive participants 2013-01-01 177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 177
Number of participants with account balances 2013-01-01 174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 17
2012: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 162
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 27
Total of all active and inactive participants 2012-01-01 189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 190
Number of participants with account balances 2012-01-01 186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 255
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 162
Number of other retired or separated participants entitled to future benefits 2011-01-01 87
Total of all active and inactive participants 2011-01-01 249
Total participants 2011-01-01 249
Number of participants with account balances 2011-01-01 249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 29
2010: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 163
Number of other retired or separated participants entitled to future benefits 2010-01-01 92
Total of all active and inactive participants 2010-01-01 255
Total participants 2010-01-01 255
Number of participants with account balances 2010-01-01 255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 18
2009: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 162
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 97
Total of all active and inactive participants 2009-01-01 259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 259
Number of participants with account balances 2009-01-01 269
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 8

Measure	Date	Value
2023: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	1,513
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	1,188
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	285
Total of all active and inactive participants	2023-01-01	1,473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	1,473
Number of participants with account balances	2023-01-01	1,194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	139
2022: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,350
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,265
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	222
Total of all active and inactive participants	2022-01-01	1,487
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	1,487
Number of participants with account balances	2022-01-01	1,198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	91
2021: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,230
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,143
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	173
Total of all active and inactive participants	2021-01-01	1,316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	1,316
Number of participants with account balances	2021-01-01	1,091
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	60
2020: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,126
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,095
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	118
Total of all active and inactive participants	2020-01-01	1,214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	1,214
Number of participants with account balances	2020-01-01	1,034
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	34
2019: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	986
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	999
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	110
Total of all active and inactive participants	2019-01-01	1,109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	1,109
Number of participants with account balances	2019-01-01	920
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	29
2018: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	820
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	859
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	107
Total of all active and inactive participants	2018-01-01	966
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	967
Number of participants with account balances	2018-01-01	614
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	36
2017: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	493
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	737
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	111
Total of all active and inactive participants	2017-01-01	848
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	848
Number of participants with account balances	2017-01-01	504
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	30
2016: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	230
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	249
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	15
Total of all active and inactive participants	2016-01-01	264
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	264
Number of participants with account balances	2016-01-01	254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	205
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	25
Total of all active and inactive participants	2015-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	230
Number of participants with account balances	2015-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	10
2014: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	215
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	17
Total of all active and inactive participants	2014-01-01	232
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	232
Number of participants with account balances	2014-01-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	18
2013: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	190
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	142
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	35
Total of all active and inactive participants	2013-01-01	177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	177
Number of participants with account balances	2013-01-01	174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	17
2012: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	162
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	27
Total of all active and inactive participants	2012-01-01	189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	190
Number of participants with account balances	2012-01-01	186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	255
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	162
Number of other retired or separated participants entitled to future benefits	2011-01-01	87
Total of all active and inactive participants	2011-01-01	249
Total participants	2011-01-01	249
Number of participants with account balances	2011-01-01	249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	29
2010: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	163
Number of other retired or separated participants entitled to future benefits	2010-01-01	92
Total of all active and inactive participants	2010-01-01	255
Total participants	2010-01-01	255
Number of participants with account balances	2010-01-01	255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	18
2009: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	162
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	97
Total of all active and inactive participants	2009-01-01	259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	259
Number of participants with account balances	2009-01-01	269
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	8

Financial Data on LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN

Measure	Date	Value
2023 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2023-12-31	$-75
Total unrealized appreciation/depreciation of assets	2023-12-31	$-75
Total income from all sources (including contributions)	2023-12-31	$8,639,685
Total of all expenses incurred	2023-12-31	$4,064,303
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$3,931,326
Value of total corrective distributions	2023-12-31	$2,933
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$4,363,404
Value of total assets at end of year	2023-12-31	$28,037,075
Value of total assets at beginning of year	2023-12-31	$23,461,693
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$130,044
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$61,793
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-12-31	$61,793
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$2,865,651
Participant contributions at end of year	2023-12-31	$246
Participant contributions at beginning of year	2023-12-31	$1,932
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$213,086
Value of other receiveables (less allowance for doubtful accounts) at end of year	2023-12-31	$662
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2023-12-31	$47
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$4,575,382
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$28,037,075
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$23,461,693
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Investment advisory and management fees	2023-12-31	$30,147
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$4,203,969
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$3,891,972
Value of interest in pooled separate accounts at end of year	2023-12-31	$990,642
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$746,674
Value of interest in common/collective trusts at end of year	2023-12-31	$22,776,544
Value of interest in common/collective trusts at beginning of year	2023-12-31	$18,786,635
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$711,432
Net investment gain/loss from pooled separate accounts	2023-12-31	$206,614
Net investment gain or loss from common/collective trusts	2023-12-31	$3,296,517
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$1,284,667
Employer contributions (assets) at end of year	2023-12-31	$65,012
Employer contributions (assets) at beginning of year	2023-12-31	$34,433
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$3,931,326
Contract administrator fees	2023-12-31	$99,897
Did the plan have assets held for investment	2023-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2023-12-31	160929175
2022 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$97,776
Total of all expenses incurred	2022-12-31	$4,214,783
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$4,089,177
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$4,631,281
Value of total assets at end of year	2022-12-31	$23,461,693
Value of total assets at beginning of year	2022-12-31	$27,578,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$125,606
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$66,016
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$66,016
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$2,958,922
Participant contributions at end of year	2022-12-31	$1,932
Participant contributions at beginning of year	2022-12-31	$44
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$457,136
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$47
Other income not declared elsewhere	2022-12-31	$-831,693
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-4,117,007
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$23,461,693
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$27,578,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$29,828
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,891,972
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,820,697
Value of interest in pooled separate accounts at end of year	2022-12-31	$746,674
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$1,233,711
Value of interest in common/collective trusts at end of year	2022-12-31	$18,786,635
Value of interest in common/collective trusts at beginning of year	2022-12-31	$20,770,925
Net investment gain/loss from pooled separate accounts	2022-12-31	$-302,331
Net investment gain or loss from common/collective trusts	2022-12-31	$-3,465,497
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,215,223
Employer contributions (assets) at end of year	2022-12-31	$34,433
Employer contributions (assets) at beginning of year	2022-12-31	$753,323
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$4,089,177
Contract administrator fees	2022-12-31	$95,778
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2022-12-31	160929175
2021 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$8,056,445
Total of all expenses incurred	2021-12-31	$4,116,343
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,974,872
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$4,647,683
Value of total assets at end of year	2021-12-31	$27,578,700
Value of total assets at beginning of year	2021-12-31	$23,638,598
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$141,471
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$55,207
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$55,207
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$2,549,557
Participant contributions at end of year	2021-12-31	$44
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$265,289
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$328
Other income not declared elsewhere	2021-12-31	$419
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$3,940,102
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$27,578,700
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$23,638,598
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,820,697
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,389,345
Value of interest in pooled separate accounts at end of year	2021-12-31	$1,233,711
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$1,269,709
Value of interest in common/collective trusts at end of year	2021-12-31	$20,770,925
Value of interest in common/collective trusts at beginning of year	2021-12-31	$17,917,822
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$523,636
Net investment gain/loss from pooled separate accounts	2021-12-31	$172,281
Net investment gain or loss from common/collective trusts	2021-12-31	$2,657,219
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,832,837
Employer contributions (assets) at end of year	2021-12-31	$753,323
Employer contributions (assets) at beginning of year	2021-12-31	$1,061,394
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,974,872
Contract administrator fees	2021-12-31	$141,471
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2021-12-31	160929175
2020 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$7,463,920
Total of all expenses incurred	2020-12-31	$1,077,431
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$966,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$4,338,132
Value of total assets at end of year	2020-12-31	$23,638,598
Value of total assets at beginning of year	2020-12-31	$17,252,109
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$111,253
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$38,609
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$38,609
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$2,158,693
Participant contributions at beginning of year	2020-12-31	$443
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$133,459
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$328
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$722
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$6,386,489
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$23,638,598
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$17,252,109
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$29,981
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,389,345
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,399,957
Value of interest in pooled separate accounts at end of year	2020-12-31	$1,269,709
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$691,416
Value of interest in common/collective trusts at end of year	2020-12-31	$17,917,822
Value of interest in common/collective trusts at beginning of year	2020-12-31	$12,146,496
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$590,354
Net investment gain/loss from pooled separate accounts	2020-12-31	$216,237
Net investment gain or loss from common/collective trusts	2020-12-31	$2,280,588
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$2,045,980
Employer contributions (assets) at end of year	2020-12-31	$1,061,394
Employer contributions (assets) at beginning of year	2020-12-31	$1,013,075
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$966,178
Contract administrator fees	2020-12-31	$81,272
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2020-12-31	160929175
2019 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$6,284,180
Total of all expenses incurred	2019-12-31	$1,386,148
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,294,687
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$3,584,754
Value of total assets at end of year	2019-12-31	$17,252,109
Value of total assets at beginning of year	2019-12-31	$12,354,077
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$91,461
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$52,352
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$52,352
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,670,817
Participant contributions at end of year	2019-12-31	$443
Participant contributions at beginning of year	2019-12-31	$2,246
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$186,035
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$722
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$1,860
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$4,898,032
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$17,252,109
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$12,354,077
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$19,983
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$3,399,957
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,525,854
Value of interest in pooled separate accounts at end of year	2019-12-31	$691,416
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$702,203
Value of interest in common/collective trusts at end of year	2019-12-31	$12,146,496
Value of interest in common/collective trusts at beginning of year	2019-12-31	$8,398,616
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$694,545
Net investment gain/loss from pooled separate accounts	2019-12-31	$155,719
Net investment gain or loss from common/collective trusts	2019-12-31	$1,796,810
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$1,727,902
Employer contributions (assets) at end of year	2019-12-31	$1,013,075
Employer contributions (assets) at beginning of year	2019-12-31	$723,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,294,687
Contract administrator fees	2019-12-31	$71,478
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2019-12-31	160929175
2018 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$1,664,986
Total of all expenses incurred	2018-12-31	$1,501,425
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,400,728
Value of total corrective distributions	2018-12-31	$9,857
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$2,471,297
Value of total assets at end of year	2018-12-31	$12,354,077
Value of total assets at beginning of year	2018-12-31	$12,190,516
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$90,840
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$37,837
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$37,837
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$949,845
Participant contributions at end of year	2018-12-31	$2,246
Participant contributions at beginning of year	2018-12-31	$22,346
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$274,013
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$1,860
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$1,860
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$163,561
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$12,354,077
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$12,190,516
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,525,854
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,451,979
Value of interest in pooled separate accounts at end of year	2018-12-31	$702,203
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,724,407
Value of interest in common/collective trusts at end of year	2018-12-31	$8,398,616
Value of interest in common/collective trusts at beginning of year	2018-12-31	$7,624,812
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-233,400
Net investment gain/loss from pooled separate accounts	2018-12-31	$-34,546
Net investment gain or loss from common/collective trusts	2018-12-31	$-576,202
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$1,247,439
Employer contributions (assets) at end of year	2018-12-31	$723,298
Employer contributions (assets) at beginning of year	2018-12-31	$365,112
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,400,728
Contract administrator fees	2018-12-31	$90,840
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2018-12-31	160929175
2017 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2017 401k financial data
Total transfer of assets to this plan	2017-12-31	$4,529,889
Total income from all sources (including contributions)	2017-12-31	$4,179,169
Total of all expenses incurred	2017-12-31	$452,171
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$404,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$2,928,891
Value of total assets at end of year	2017-12-31	$12,190,516
Value of total assets at beginning of year	2017-12-31	$3,933,629
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$47,983
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$82,183
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$82,183
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$482,096
Participant contributions at end of year	2017-12-31	$22,346
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$1,733,381
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$1,860
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$3,726,998
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$12,190,516
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,933,629
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,451,979
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,645,403
Value of interest in pooled separate accounts at end of year	2017-12-31	$1,724,407
Value of interest in common/collective trusts at end of year	2017-12-31	$7,624,812
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$11,542
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$11,542
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,168,095
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$713,414
Employer contributions (assets) at end of year	2017-12-31	$365,112
Employer contributions (assets) at beginning of year	2017-12-31	$276,684
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$404,188
Contract administrator fees	2017-12-31	$47,983
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	Yes
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2017-12-31	160929175
2016 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$0
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Expenses. Interest paid	2016-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$781,279
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$74,262
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$74,237
Expenses. Certain deemed distributions of participant loans	2016-12-31	$0
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$554,771
Value of total assets at end of year	2016-12-31	$3,933,629
Value of total assets at beginning of year	2016-12-31	$3,226,612
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$25
Total income from rents	2016-12-31	$0
Total interest from all sources	2016-12-31	$1
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$144,244
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$144,244
Assets. Real estate other than employer real property at end of year	2016-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2016-12-31	$0
Administrative expenses professional fees incurred	2016-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2016-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$5,023
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Assets. Loans (other than to participants) at end of year	2016-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$25
Liabilities. Value of operating payables at end of year	2016-12-31	$0
Liabilities. Value of operating payables at beginning of year	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Income. Non cash contributions	2016-12-31	$0
Value of net income/loss	2016-12-31	$707,017
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,933,629
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,226,612
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Assets. partnership/joint venture interests at end of year	2016-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2016-12-31	$0
Investment advisory and management fees	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$3,645,403
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$3,019,637
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$0
Income. Interest from loans (other than to participants)	2016-12-31	$0
Interest earned on other investments	2016-12-31	$0
Income. Interest from US Government securities	2016-12-31	$0
Income. Interest from corporate debt instruments	2016-12-31	$0
Value of interest in master investment trust accounts at end of year	2016-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2016-12-31	$0
Value of interest in common/collective trusts at end of year	2016-12-31	$0
Value of interest in common/collective trusts at beginning of year	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$11,542
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$6,749
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$6,749
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1
Assets. Value of investments in 103.12 investment entities at end of year	2016-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2016-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Asset value of US Government securities at end of year	2016-12-31	$0
Asset value of US Government securities at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$82,263
Net investment gain/loss from pooled separate accounts	2016-12-31	$0
Net investment gain or loss from common/collective trusts	2016-12-31	$0
Net gain/loss from 103.12 investment entities	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Assets. Invements in employer securities at end of year	2016-12-31	$0
Assets. Invements in employer securities at beginning of year	2016-12-31	$0
Assets. Value of employer real property at end of year	2016-12-31	$0
Assets. Value of employer real property at beginning of year	2016-12-31	$0
Contributions received in cash from employer	2016-12-31	$549,748
Employer contributions (assets) at end of year	2016-12-31	$276,684
Employer contributions (assets) at beginning of year	2016-12-31	$200,226
Income. Dividends from preferred stock	2016-12-31	$0
Income. Dividends from common stock	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$74,237
Asset. Corporate debt instrument preferred debt at end of year	2016-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2016-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2016-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2016-12-31	$0
Contract administrator fees	2016-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2016-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2016-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-12-31	$0
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2016-12-31	160929175
2015 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$399,605
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$362,139
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$362,089
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$427,408
Value of total assets at end of year	2015-12-31	$3,226,612
Value of total assets at beginning of year	2015-12-31	$3,189,146
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$50
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$19
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$153,943
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$153,943
Assets. Real estate other than employer real property at end of year	2015-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$16,654
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Assets. Loans (other than to participants) at end of year	2015-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$50
Liabilities. Value of operating payables at end of year	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$37,466
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,226,612
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,189,146
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Assets. partnership/joint venture interests at end of year	2015-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,019,637
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$3,047,141
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$0
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$0
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Value of interest in master investment trust accounts at end of year	2015-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$0
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$6,749
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$19
Assets. Value of investments in 103.12 investment entities at end of year	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2015-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Asset value of US Government securities at end of year	2015-12-31	$0
Asset value of US Government securities at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-181,765
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Assets. Value of employer real property at end of year	2015-12-31	$0
Assets. Value of employer real property at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$410,754
Employer contributions (assets) at end of year	2015-12-31	$200,226
Employer contributions (assets) at beginning of year	2015-12-31	$142,005
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$362,089
Asset. Corporate debt instrument preferred debt at end of year	2015-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$0
Contract administrator fees	2015-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2015-12-31	160929175
2014 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Expenses. Interest paid	2014-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$473,971
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$264,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$264,273
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$325,797
Value of total assets at end of year	2014-12-31	$3,189,146
Value of total assets at beginning of year	2014-12-31	$2,979,448
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$2
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$197,663
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$197,663
Assets. Real estate other than employer real property at end of year	2014-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$300,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Assets. Loans (other than to participants) at end of year	2014-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$0
Liabilities. Value of operating payables at end of year	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Income. Non cash contributions	2014-12-31	$0
Value of net income/loss	2014-12-31	$209,698
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,189,146
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,979,448
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Assets. partnership/joint venture interests at end of year	2014-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$3,047,141
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,797,347
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$0
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$0
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Value of interest in master investment trust accounts at end of year	2014-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$0
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$24,971
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$24,971
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$2
Assets. Value of investments in 103.12 investment entities at end of year	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2014-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Asset value of US Government securities at end of year	2014-12-31	$0
Asset value of US Government securities at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-49,491
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Assets. Value of employer real property at end of year	2014-12-31	$0
Assets. Value of employer real property at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$325,797
Employer contributions (assets) at end of year	2014-12-31	$142,005
Employer contributions (assets) at beginning of year	2014-12-31	$157,130
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$264,273
Asset. Corporate debt instrument preferred debt at end of year	2014-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$0
Contract administrator fees	2014-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	DOPKINS & COMPANY, LLP
Accountancy firm EIN	2014-12-31	160929175
2013 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Expenses. Interest paid	2013-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$730,995
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$358,880
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$358,342
Expenses. Certain deemed distributions of participant loans	2013-12-31	$0
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$350,624
Value of total assets at end of year	2013-12-31	$2,979,448
Value of total assets at beginning of year	2013-12-31	$2,607,333
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$538
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$2
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$151,014
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$151,014
Assets. Real estate other than employer real property at end of year	2013-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2013-12-31	$0
Administrative expenses professional fees incurred	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$0
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$21,572
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Assets. Loans (other than to participants) at end of year	2013-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$538
Liabilities. Value of operating payables at end of year	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$372,115
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,979,448
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,607,333
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Assets. partnership/joint venture interests at end of year	2013-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,797,347
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,450,911
Value of interest in pooled separate accounts at end of year	2013-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$0
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$0
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Value of interest in master investment trust accounts at end of year	2013-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2013-12-31	$0
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest in common/collective trusts at beginning of year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$24,971
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$77,561
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$77,561
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$2
Assets. Value of investments in 103.12 investment entities at end of year	2013-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Asset value of US Government securities at end of year	2013-12-31	$0
Asset value of US Government securities at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$229,355
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Assets. Value of employer real property at end of year	2013-12-31	$0
Assets. Value of employer real property at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$329,052
Employer contributions (assets) at end of year	2013-12-31	$157,130
Employer contributions (assets) at beginning of year	2013-12-31	$78,861
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$358,342
Asset. Corporate debt instrument preferred debt at end of year	2013-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-12-31	$0
Contract administrator fees	2013-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$0
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	FEDERSPIEL, PFEIFER & KUBICKI, CPA
Accountancy firm EIN	2013-12-31	161492835
2012 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Expenses. Interest paid	2012-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$528,449
Total loss/gain on sale of assets	2012-12-31	$87,087
Total of all expenses incurred	2012-12-31	$628,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$624,461
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$231,654
Value of total assets at end of year	2012-12-31	$2,607,333
Value of total assets at beginning of year	2012-12-31	$2,707,157
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$3,812
Total income from rents	2012-12-31	$0
Total interest from all sources	2012-12-31	$4
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$52,224
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$52,224
Assets. Real estate other than employer real property at end of year	2012-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2012-12-31	$0
Administrative expenses professional fees incurred	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$300,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$0
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Assets. Loans (other than to participants) at end of year	2012-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$699
Liabilities. Value of operating payables at end of year	2012-12-31	$0
Liabilities. Value of operating payables at beginning of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$0
Total non interest bearing cash at beginning of year	2012-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Income. Non cash contributions	2012-12-31	$0
Value of net income/loss	2012-12-31	$-99,824
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,607,333
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,707,157
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Assets. partnership/joint venture interests at end of year	2012-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2012-12-31	$0
Investment advisory and management fees	2012-12-31	$3,113
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,450,911
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,603,652
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$0
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned on other investments	2012-12-31	$0
Income. Interest from US Government securities	2012-12-31	$0
Income. Interest from corporate debt instruments	2012-12-31	$0
Value of interest in master investment trust accounts at end of year	2012-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2012-12-31	$0
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$77,561
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$4
Assets. Value of investments in 103.12 investment entities at end of year	2012-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2012-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Asset value of US Government securities at end of year	2012-12-31	$0
Asset value of US Government securities at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$157,480
Net investment gain/loss from pooled separate accounts	2012-12-31	$0
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Net gain/loss from 103.12 investment entities	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Assets. Value of employer real property at end of year	2012-12-31	$0
Assets. Value of employer real property at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$231,654
Employer contributions (assets) at end of year	2012-12-31	$78,861
Employer contributions (assets) at beginning of year	2012-12-31	$103,505
Income. Dividends from preferred stock	2012-12-31	$0
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$624,461
Asset. Corporate debt instrument preferred debt at end of year	2012-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$0
Contract administrator fees	2012-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$87,087
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FEDERSPIEL, PFEIFER & KUBICKI, CPA
Accountancy firm EIN	2012-12-31	161492835
2011 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-111,537
Total unrealized appreciation/depreciation of assets	2011-12-31	$-111,537
Total income from all sources (including contributions)	2011-12-31	$183,329
Total of all expenses incurred	2011-12-31	$207,456
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$200,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$247,310
Value of total assets at end of year	2011-12-31	$2,707,157
Value of total assets at beginning of year	2011-12-31	$2,731,284
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$6,562
Total interest from all sources	2011-12-31	$47,556
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$300,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$1,222
Total non interest bearing cash at beginning of year	2011-12-31	$842
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-24,127
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,707,157
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,731,284
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$6,562
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$2,603,652
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,572,452
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$47,556
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$246,088
Employer contributions (assets) at end of year	2011-12-31	$103,505
Employer contributions (assets) at beginning of year	2011-12-31	$157,990
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$200,894
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	FEDERSPIEL, PFEIFER &KUBICK, CPA
Accountancy firm EIN	2011-12-31	161492835
2010 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$199,874
Total unrealized appreciation/depreciation of assets	2010-12-31	$199,874
Total income from all sources (including contributions)	2010-12-31	$557,319
Total of all expenses incurred	2010-12-31	$149,811
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$148,561
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$313,976
Value of total assets at end of year	2010-12-31	$2,731,284
Value of total assets at beginning of year	2010-12-31	$2,323,776
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,250
Total interest from all sources	2010-12-31	$43,469
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$300,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$4,727
Total non interest bearing cash at end of year	2010-12-31	$842
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$407,508
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,731,284
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,323,776
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$1,250
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,572,452
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,171,916
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$43,469
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$309,249
Employer contributions (assets) at end of year	2010-12-31	$157,990
Employer contributions (assets) at beginning of year	2010-12-31	$151,860
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$148,561
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	FEDERSPIEL,PFEIFER & KUBICKI, CPA
Accountancy firm EIN	2010-12-31	161492835
2009 : LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN

2023: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: LAKE SHORE BEHAVIORAL HEALTH, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	1414
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $422
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	FLEXIBLE INVESTMENT ANNUITY

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	1425
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $445
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Other information about contract	FLEXIBLE INVESTMENT ANNUITY
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	445
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	1247
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	638
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	1175
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	390
Additional information about fees paid to insurance broker	REFERRAL / SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	1089
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	354
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	992
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	752
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

372757

Policy instance

Insurance contract or identification number	372757
Number of Individuals Covered	669
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,740
Total amount of fees paid to insurance company	USD $11,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,740
Amount paid for insurance broker fees	641
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	CADARET GRANT & CO. INC.

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Company Name:	BESTSELF BEHAVIORAL HEALTH, INC.
Employer identification number (EIN):	161004090
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1972-12-27
Company Identification Number:	249829
Legal Registered Office Address:	255 DELAWARE AVENUE SUITE 300 BUFFALO United States of America (USA) 14202