2022-11-09T15:00:00-06:00 2021-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-01-01 016012835 ISLANDS COMMUNITY MEDICAL SERVICES ISLA 2078634341 15 MEDICAL CENTER LOOP VINALHAVEN ME 04863 RICHARD YOUNG PRESIDENT 2078634341 2022-11-02 1 RICHARD YOUNG 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-11-02 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z RICHARD YOUNG 15 MEDICAL CENTER LOOP VINALHAVEN ME 04863 5881365 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. 15 15 48 18 0 0 2063450 2888825 1148093 1561892 153246 237251 0 39822 3364789 4727790 0 0 0 0 1968697 2411379 0 0 6454 1065331 1282920 3034028 3694299 330761 1033491 7604849 8505939 946438 464364 6658411 8041575 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 1527607 0 1151703 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. 378566 0 282933 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. 97448 0 127256 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 WORK 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. 2003621 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 20 0 48 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 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 BARBARA HAMILTON TREASURER (THRU AUGUST) 1.00 X X 0 0 0 GAIL EIERWEISS SECRETARY 1.00 X X 0 0 0 LAURA BLANKERTZ PHD MEMBER 1.00 X X 0 0 0 JEANNE BINEAU-AMES 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 DIANE COCHRAN MEMBER (THRU MARCH) 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 MD 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 1.00 X 0 0 0 CHESTER WARREN MEMBER 1.00 X 0 0 0 KATHI YOUNG MEMBER 1.00 X 0 0 0 CAMERON GARRETT EXECUTIVE DIRECTOR 40.00 X 80936 0 20299 DINAH MOYER EXECUTIVE DIRECTOR (THRU MARCH) 40.00 X 139049 0 28944 ROXANNE TOLMAN FINANCE DIRECTOR 40.00 X 24836 0 8608 JENNIFER DESMOND CLINICAL DIRECTOR/NP 40.00 X 160728 0 24363 CHRISTINA QUINLAN DIRECTOR OF OPERATIONS 32.00 X 175623 0 15541 JAMES HOGAN PHYSICIAN ASSISTANT 40.00 X 141479 0 28564 KIMBERLY SAUNDERS PHYSICIAN/MEDICAL DIRECTOR 40.00 X 215907 0 32829 PETER LEVANDOSKI DENTIST 40.00 X 124976 0 6249 1063534 0 165397 6 0 1 0 0 2254360 634465 1320 2888825 PATIENT SERVICE REVENUE 621400 1561892 1561892 1561892 89358 89358 1301468 1153575 147893 147893 147893 39822 39822 39822 4727790 1561892 0 277073 302672 161537 141135 1702370 1059470 642900 34043 25769 8274 241671 153615 88056 130623 79927 50696 153423 153423 15471 15471 215759 13764 201995 2551 2551 146746 19622 127124 44597 37907 6690 135752 94648 41104 13585 13585 12388 12388 129943 85108 44835 31560 11952 19608 MEDICAL, LAB, & XRAY SU 137560 137560 REPAIRS & MAINTENANCE 76120 3355 72765 DISPENSARY SUPPLIES 54306 54306 LICENSES & PERMITS 4898 4898 108261 46598 55209 6454 3694299 2003621 1684224 6454 35423 19111 943231 950386 9516 6382 149298 358535 96386 96386 10056 34902 2489831 964533 1410518 1525298 3625787 4099086 0 0 1324634 1415853 7604849 8505939 161815 195714 491159 0 273609 265969 19855 2681 946438 464364 X 4707474 5906739 1950937 2134836 6658411 8041575 7604849 8505939 X 1033491 258454 91219 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 3625787 491331 18032 4099086 3208293 452343 14849 20000 3625787 0.83980 0.16020 0.00000 0 0 136455 136455 989325 196274 793051 662766 180980 481786 571951 457945 114006 129334 129334 0 1525298 BENEFICIAL INTEREST IN CHARITABLE TRUST 1415853 1415853 ACCRUED PENSION PAYABLE 2681 2681 5077463 258454 91219 349673 4727790 0 4727790 3694299 0 3694299 0 3694299 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 91,219. X 1 1 X X X X 1 0 0 0 0 0 0 0 0 KIMBERLY SAUNDERS PHYSICIAN/MEDICAL DIRECTOR 204597 0 60 0 11250 0 11177 0 21652 0 248736 0 0 0 CHRISTINA QUINLAN DIRECTOR OF OPERATIONS 107818 0 15600 0 52205 0 5600 0 9941 0 191164 0 0 0 JENNIFER DESMOND CLINICAL DIRECTOR/NP 158012 0 110 0 2606 0 8327 0 16036 0 185091 0 0 0 JAMES HOGAN PHYSICIAN ASSISTANT 135369 0 6110 0 0 0 7456 0 21108 0 170043 0 0 0 DINAH MOYER EXECUTIVE DIRECTOR (THRU MARCH) 33908 0 0 0 105141 0 2077 0 26867 0 167993 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 - $5,600 CHRISTINA QUINLAN - $2,000 JENNIFER DESMOND - $2,606 KIMBERLY SAUNDERS - $11,250 PART I, LINE 4A DINAH MOYER RECEIVED SEVERANCE COMPENSATION TOTALING $93,470 IN 2021. 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: GAIN FROM BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST 91,219.