2023-11-14T14:58:19-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 016012835 ISLANDS COMMUNITY MEDICAL SERVICES ISLA 2078634341 15 MEDICAL CENTER LOOP VINALHAVEN ME 04863 RICHARD YOUNG PRESIDENT 2078634341 2023-10-20 1 RICHARD YOUNG 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2023-10-20 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RICHARD YOUNG 15 MEDICAL CENTER LOOP VINALHAVEN ME 04863 3690502 0 X HTTP://WWW.ICMSVH.ORG/ X 1946 ME COMMUNITY HEALTH CENTER DEVOTED TO PROVIDING CARE TO ALL IN NEED REGARDLESS OF ABILITY TO PAY. 14 14 35 18 0 0 2888825 2182984 1561892 1441541 237251 47129 39822 24694 4727790 3696348 0 0 0 0 2411379 2283608 0 0 10838 1282920 1602324 3694299 3885932 1033491 -189584 8505939 7277659 464364 396030 8041575 6881629 X ISLANDS COMMUNITY MEDICAL SERVICES IS COMMITTED TO SERVING OUR ISLAND COMMUNITIES BY DEDICATING OURSELVES TO THE HEALTH OF OUR PATIENTS. WE SUPPORT WHOLE HEALTH THROUGH EASE OF ACCESS, PREVENTION, OUTREACH, EDUCATION, AND TREATMENT BY PROVIDING THE HIGHEST QUALITY PRIMARY, URGENT, AND EMERGENT CARE TO OUR PATIENTS AND COMMUNITY. 0 0 1623875 0 1155226 THE ORGANIZATION PROVIDED MEDICAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATIONS OPERATED A MEDICAL CLINIC WITH THREE FULL TIME AND THREE PART TIME MEDICAL PROVIDERS. THE CLINIC PROVIDED COVERAGE 24 HOURS A DAY, 7 DAYS A WEEK. 290871 0 175679 THE ORGANIZATION PROVIDED DENTAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES A DENTAL CLINIC WITH TWO DENTAL PROVIDERS WHO WORK 2.5 DAYS PER WEEK. DENTAL EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE DENTIST IS NOT AVAILABLE. 47224 0 110636 THE ORGANIZATION PROVIDED BEHAVIORAL HEALTH SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES THE BEHAVIORAL HEALTH CLINIC WITH ONE FULL TIME THERAPIST WHO WORKS MONDAY THROUGH FRIDAY, AND THERE IS ALSO THE OPTION FOR AFTERHOURS VISITS VIA ZOOM WITH TELEHEALTH. BEHAVIORAL HEALTH EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE THERAPIST IS NOT AVAILABLE. 1961970 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 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 12 0 35 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CAMERON GARRETT 2078634341 15 MEDICAL CENTER LOOP VINALHAVEN ME 04863 RICHARD YOUNG PRESIDENT 2.00 X X 0 0 0 EMILY LANE VICE PRESIDENT 1.00 X X 0 0 0 GAIL EIERWEISS SECRETARY 1.00 X X 0 0 0 JEANNE BINEAU-AMES MEMBER 1.00 X 0 0 0 LAURA BLANKERTZ PHD MEMBER 1.00 X 0 0 0 STEPHEN BLATT MEMBER 1.00 X 0 0 0 MEREDITH BOONE MEMBER 1.00 X 0 0 0 DOUG FINCHAM MEMBER 1.00 X 0 0 0 CONNIE GEMMER MEMBER 1.00 X 0 0 0 CATHERINE HALEY MEMBER 1.00 X 0 0 0 BARBARA KINDER MEMBER 1.00 X 0 0 0 WILLIAM LIEBER MD MEMBER 1.00 X 0 0 0 JOANNA REIDY MEMBER 1.00 X 0 0 0 WILLIAM TREVASKIS MEMBER (THRU APRIL) 1.00 X 0 0 0 CHET WARREN MEMBER (THRU JUNE) 1.00 X 0 0 0 KATHI YOUNG MEMBER 1.00 X 0 0 0 TYSON BOUYACK CONTRACTED CFO 40.00 X 136500 0 0 JENNIFER DESMOND CLINICAL DIRECTOR/NP 40.00 X 146053 0 41720 JAMES HOGAN PHYSICIAN ASSISTANT 40.00 X 124776 0 38264 KIMBERLY SAUNDERS PHYSICIAN/MEDICAL DIRECTOR 40.00 X 190934 0 41740 PETER LEVANDOSKI DENTIST 40.00 X 129515 0 6475 CAMERON GARRETT EXECUTIVE DIRECTOR 40.00 X 189367 0 22341 917145 0 150540 6 0 1 0 0 1809941 373043 2182984 PATIENT SERVICE REVENU 621400 1441541 1441541 1441541 301 301 40982 -5846 46828 46828 46828 24694 24694 24694 3696348 1441541 0 71823 348208 127024 221184 1532051 998829 533222 66242 39656 26586 207922 124475 83447 129185 77351 51834 3427 3427 86159 86159 377728 14165 363563 2151 2151 208841 18679 190162 45192 38413 6779 61102 42817 18285 8807 8807 11940 11940 152581 76413 76168 58722 2224 56498 MEDICAL, LAB, & XRAY SU 146655 146655 BADDEBTS EXPENSE 103664 103664 REPAIRS & MAINTENANCE 96030 5722 90308 DISPENSARY SUPPLIES 66878 66878 172447 70198 91411 10838 3885932 1961970 1913124 10838 19111 161724 950386 688544 6382 4188 358535 178049 96386 96386 34902 34902 2643391 1117114 1525298 1526277 4099086 3409501 1415853 1178088 8505939 7277659 195714 135003 265969 258301 2681 2726 464364 396030 X 5906739 5100741 2134836 1780888 8041575 6881629 8505939 7277659 X -189584 -732597 -237765 X 0 1 X 1 1 1 X PART I, LINE 3 THE HOSPITAL IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL UNDER SECTION 170(B)(1)(A)(III). THEREFORE, SCHEDULE H IS NOT REQUIRED. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4099086 -611204 78381 3409501 3625787 491331 18032 4099086 3208293 452343 14849 20000 3625787 0.84110 0.15890 0.00000 0 0 136455 136455 989325 196867 792458 662766 252972 409794 725511 498120 227391 129334 169155 -39821 1526277 BENEFICIAL INTEREST IN CHARITABLE TRUST 1178088 1178088 ACCRUED PENSION PAYABLE 2726 2726 2622322 -732597 -341429 -1074026 3696348 0 3696348 3782268 0 3782268 103664 103664 3885932 PART V, LINE 4: IN SUPPORT OF THE MISSION OF ISLANDS COMMUNITY MEDICAL SERVICES, THE FUND'S ASSETS ARE INVESTED TO PROVIDE ANNUAL SUPPORT FOR THE ORGANIZATION'S BUDGETARY REQUIREMENT AND TO MAINTAIN THE PRINICPAL FOR FUTURE OPERATIONAL NEEDS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST -237,765. BAD DEBT EXPENSE -103,664. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 103,664. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 KIMBERLY SAUNDERS PHYSICIAN/MEDICAL DIRECTOR 190784 0 150 0 0 0 9902 0 31838 0 232674 0 0 0 CAMERON GARRETT EXECUTIVE DIRECTOR 161065 0 15312 0 12990 0 5709 0 16632 0 211708 0 0 0 JENNIFER DESMOND CLINICAL DIRECTOR/NP 145620 0 433 0 0 0 7681 0 34039 0 187773 0 0 0 JAMES HOGAN PHYSICIAN ASSISTANT 124464 0 312 0 0 0 6765 0 31499 0 163040 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDED A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE TO THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII: CAMERON GARRETT - $12,000 KIMBERLY SAUNDERS - $10,000 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR DISCUSSION, REVIEW, AND APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE CONFLICT OF INTEREST POLICY COVERS BOTH EMPLOYEES AND BOARD MEMBERS. EACH ARE EXPECTED TO SIGN A CONFLICT OF INTEREST FORM. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS FOR CONFLICTS ON THE BOARD, THE EXECUTIVE DIRECTOR AND RISK MANAGER FOR POTENTIAL CONFLICTS. THE EXECUTIVE COMMITTEE THEN BRINGS CONFLICTS OF INTEREST FOR REVIEW TO THE ENTIRE BOARD. IF A CONFLICT IS IDENTIFIED THE BOARD OR STAFF MEMBER IS ASKED TO RECUSE THEMSELVES FROM ANY DECISION MAKING OR PARTICIPATION IN A DECISION/EVENT RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION UTILIZED A COMPENSATION CONSULTANT AND FQHC SALARY SURVEY IN 2021 IN EVALUATING, DETERMINING AND APPROVING SALARIES FOR MANAGEMENT EMPLOYEES AND CERTAIN MD POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 PRINT COPIES OF GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY COULD BE PICKED UP AT OFFICE HEADQUARTERS. FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC HOWEVER PERTINENT ANNUAL FINANCIAL RESULTS ARE REPORTED IN THE ORGANIZATION'S ANNUAL REPORT. FORM 990, PART XI, LINE 9: LOSS FROM BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST -237,765.