2023-05-01T12:17:50-05:00 2022-06-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Leon Weed President 2073482351 2023-04-28 1 Leon Weed 999009999 Joseph R Byrne P01289281 2077752387 2023-04-28 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Deborah Adkins 587 North Deer Isle Road Deer Isle ME 04627 2260352 0 X www.islandnursinghome.org X 1975 ME Island Nursing Home is committed to providing the highest level of innovative and quality healthcare to an aging population while maintaining community relationships and honoring our core values of care, compassion, and service. 8 8 116 25 0 0 1033280 226355 4903814 1759157 56696 18517 0 0 5993790 2004029 0 0 0 0 3103889 1446917 0 0 0 3305249 1368472 6409138 2815389 -415348 -811360 4961696 3398014 674926 151840 4286770 3246174 X Island Nursing Home is committed to providing the highest level of innovative and quality healthcare to an aging population while maintaining community relationships and honoring our core values of care, compassion, and service. 0 1 2053560 1759157 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 2053560 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 1 116 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Deborah Adkins 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Ronda Dodge President 25.00 X X 0 0 0 Leon Weed Vice President 3.00 X X 0 0 0 Skip Greenlaw Treasurer 20.00 X X 0 0 0 Tim Hoechst Secretary 12.00 X X 0 0 0 Gidget Fagerberg Director 3.00 X 0 0 0 Roberta Johnson Director 2.00 X 0 0 0 Cindy Lash Director 2.00 X 0 0 0 Karen Vickerson Director 2.00 X 0 0 0 Judy Williams Past Vice President 3.00 X X 0 0 0 Jeffrey Dalrymple Past Treasurer 3.00 X X 0 0 0 Deborah Ludlow Past Secretary 3.00 X X 0 0 0 Debbie Alley Past Director 3.00 X 0 0 0 Barbara Chesney Past Director 2.00 X 0 0 0 Brenda Colson Past Director 2.00 X 0 0 0 Clare Grindal Past Director 2.00 X 0 0 0 Kim Lengert Past Director 5.00 X 0 0 0 Linda Nelson Past Director 5.00 X 0 0 0 Deborah Adkins Finance Controller 50.00 X 70714 0 0 Matthew Trombley Past Executive Director 50.00 X 215785 0 0 286499 0 0 1 0 1 0 Prime Time Healthcare LLC 15380 Weir Street Omaha NE 68137 Medical Staffing Services 732921 Arete Rehabilitation 1 Stiles Road Suite 203 Salem NH 03079 Therapy Services 321250 Maxim Healthcare Staffing Inc 12558 Collections Center Dr Chicago IL 60693 Medical Staffing Services 206521 3 193160 33195 226355 Patient Service Revenu 623000 1727495 1727495 Miscellaneous 623000 31662 31662 1759157 31568 31568 243272 256323 -13051 -13051 -13051 2004029 1759157 0 18517 X 163699 163699 783630 635024 148606 410371 240590 169781 89217 62670 26547 33581 33581 76846 76846 520897 494651 26246 6390 6390 38283 22239 16044 2567 2567 92161 92161 5605 5605 161 161 216255 216255 55098 51146 3952 Miscellanous 130770 36971 93799 Supplies 82798 82798 Provider Tax Expense 63692 63692 Food 43368 43368 2815389 2053560 761829 0 X 600 600 536599 130493 514055 13060 38134 10902 15606 818 5490117 4091957 1561426 1398160 2178418 1724138 116858 119843 4961696 3398014 630155 90705 44771 393 0 60742 674926 151840 X 2636183 1908436 1650587 1337738 4286770 3246174 4961696 3398014 -811360 -229236 0 X 1 X 0 1 0 X 78409 100763 89640 1033280 226355 1528447 4468468 5380920 5579151 4903814 1759157 22091510 4546877 5481683 5668791 5937094 1985512 23619957 8530 2437 650 6200 6360 24177 1127549 1359114 1474908 969424 138680 5069675 1136079 1361551 1475558 975624 145040 5093852 18526105 41790 39031 39652 34475 31568 186516 41790 39031 39652 34475 31568 186516 4588667 5520714 5708443 5971569 2017080 23806473 0.77820 0.77210 0.00780 0.00770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1489908 -163291 93272 1233345 1199269 365019 74380 1489908 1209232 67190 77153 1199269 1194166 89907 74841 1209232 1142878 16409 108127 73248 1194166 0.00000 0.85980 0.14020 0 0 55290 55290 3759198 2765694 993504 1298554 958697 339857 377075 367566 9509 1398160 Refundable Advances 60742 60742 Part IV, Line 2b: The Organization holds private funds for residents and provides these funds to the resident, as requested, for various personal expenses. Part V, Line 4: Intended use of earnings on endowment funds include funding for scholarships and operating activities of the nursing home. X X 1 0 0 0 0 0 0 1 0 Matthew Trombley Past Executive Director 138169 0 25000 0 52616 0 0 0 0 0 215785 0 0 0 Part I, Line 4a During calendar year 2021, Matthew Trombley received a severance payment in the amount of $37,500. Part I, Line 7 Matthew Trombley received a bonus of $25,000 from the Organization during calender year 2021. The bonus was approved by the Board of Directors and was in recognition of Mr. Trombley's performance over the past year. Form 990, Part III, line 3 Organization closed the Nursing Home and Residential Care operations in October 2021 due to severe staffing shortages. Options are being explored for potential reopening of the Residential Care facility. Form 990, Part VI, Section B, line 11b Form 990 was provided to the governing body by email prior to being filed. It was reviewed by the Executive Committee and the Board of Directors. Form 990, Part VI, Section B, line 12c Each director, principal officer and member of a committee with governing board-delegated powers shall annually sign a statement, which affirms such person: (a) has received a copy of the conflict of interest policy, (b) has read and understands the policy, and (c) has complied with the policy. After disclosure of the financial interest and all material facts, and after any discussion with the interested person, he/she shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest transaction shall be approved or ratified. Form 990, Part VI, Section B, line 15a The administrator is reviewed annually by the board. The process for determining the administrator's compensation includes a compensation survey or study and approval by the board. This occurs on a periodic basis. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part IX, line 11g Other Services: Program service expenses 429,929. Management and general expenses 26,246. Fundraising expenses 0. Total expenses 456,175. Therapy services: Program service expenses 64,722. Management and general expenses 0. Fundraising expenses 0. Total expenses 64,722. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Island Nursing Home, Inc. 587 North Deer Isle Road Deer Isle, ME 04627 EIN: 51-0172239 Section 1.263(a)-3(n) Election: Island Nursing Home, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).