2022-04-05T15:27:07-05:00 2021-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2020-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Ronda Dodge President 2073482351 2022-03-29 1 Ronda Dodge 999009999 Joseph R Byrne P01289281 2077752387 2022-03-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Heidi Gillen 587 North Deer Isle Road Deer Isle ME 04627 6274540 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. 10 10 128 25 0 0 89640 1033280 5579151 4903814 38470 56696 0 0 5707261 5993790 750 0 0 0 3075298 3103889 0 0 0 2893255 3305249 5969303 6409138 -262042 -415348 5472086 4961696 1275327 674926 4196759 4286770 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 0 5508109 4903814 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 5508109 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 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 8 0 1 128 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Heidi Gillen 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Ronda Dodge President 4.00 0.00 X X 0 0 0 Judith Williams Vice President 2.00 0.00 X X 0 0 0 Jeffrey Dalrymple Treasurer 2.00 0.00 X X 0 0 0 Deborah Ludlow Secretary 2.00 0.00 X X 0 0 0 Barbara Chesney Director 2.00 0.00 X 0 0 0 Brenda Colson Director 2.00 0.00 X 0 0 0 Clare Grindal Director 2.00 0.00 X 0 0 0 Tim Hoechst Director 2.00 0.00 X 0 0 0 Cindy Lash Director 2.00 0.00 X 0 0 0 Karen Vickerson Director 2.00 0.00 X 0 0 0 Bobbi Billings Past President 2.00 0.00 X X 0 0 0 Linda Campbell Past Director 2.00 0.00 X 0 0 0 Sam Harrington Past Director 4.00 0.00 X 0 0 0 Dianne Thompson Past Director 2.00 0.00 X 0 0 0 Matthew Trombley Executive Director 55.00 0.00 X 178077 0 0 178077 0 0 1 0 1 0 Prime Time Healthcare LLC 15380 Weir Street Omaha NE 68137 Medical Staffing Services 428312 Arete Rehabilitation 1 Stiles Road Suite 203 Salem NH 03079 Therapy Services 384426 OneStaff Medical LLC 11718 Nicholas Street Omaha NE 68154 Medical Staffing Services 268219 3 913015 120265 1033280 Patient Service Revenu 623000 4903814 4903814 4903814 34475 34475 300000 2971 277517 3233 22483 -262 22221 22221 5993790 4903814 0 56696 X 178077 178077 2035430 1759023 276407 707711 538630 169081 182671 147830 34841 7946 7946 59639 59639 1662494 1662494 30721 30721 78260 30046 48214 5016 5016 128331 128331 2518 2518 364 364 239603 239603 97765 97765 Supplies 356631 356631 Provider Tax Expense 288734 288734 Miscellanous 187059 65615 121444 Food 160168 160168 6409138 5508109 901029 0 X 600 600 1119360 536599 7000 0 581475 514055 45244 38134 11562 15606 5437128 3875702 1716252 1561426 1916571 2178418 74022 116858 5472086 4961696 417524 630155 23804 44771 833999 0 1275327 674926 X 2810394 2636183 1386365 1650587 4196759 4286770 5472086 4961696 -415348 505359 0 X 0 1 X 1 0 X 145494 78409 100763 89640 1033280 1447586 4830728 4468468 5380920 5579151 4903814 25163081 4976222 4546877 5481683 5668791 5937094 26610667 7360 8530 2437 650 6200 25177 949060 1127549 1359114 1474908 969424 5880055 956420 1136079 1361551 1475558 975624 5905232 20705435 50214 41790 39031 39652 34475 205162 50214 41790 39031 39652 34475 205162 5026436 4588667 5520714 5708443 5971569 26815829 0.77210 0.76250 0.00770 0.00850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1510 1510 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which are attributable to lobbying expenses. 0 1 X 1199269 365019 74380 1489908 1209232 67190 77153 1199269 1194166 89907 74841 1209232 1142878 16409 108127 73248 1194166 1089373 124017 70512 1142878 0.00000 0.71173 0.28827 0 0 55290 55290 3702740 2614021 1088719 1293166 895452 397714 385932 366229 19703 1561426 6499411 505359 262 505621 5993790 0 5993790 6409400 262 262 6409138 0 6409138 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. Part XI, Line 2d - Other Adjustments: Loss on Disposal of Equipment 262. Part XII, Line 2d - Other Adjustments: Loss on Disposal of Equipment 262. X X 0 0 0 0 0 0 0 1 0 Matthew Trombley Executive Director 150580 0 21727 0 5770 0 0 0 0 0 178077 0 0 0 Part I, Line 7 Matthew Trombley received a bonus of $21,727 from the Organization during calender year 2020. 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 VI, Section A, line 4 During the year, the Organization amended its bylaws. Below are the changes deemed to be significant based on IRS definition: The Organization added a new article to its bylaws regarding the dissolution of the Organization. The bylaws were updated to use a Senior Vice-President model rather than a Co-President model. 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 Finance 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 1,259,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,259,504. Therapy services: Program service expenses 402,990. Management and general expenses 0. Fundraising expenses 0. Total expenses 402,990. 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).