2021-04-29T09:55:07-05:00 2020-06-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041011100 990 2019-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Jeffrey Dalrymple Treasurer 2073482351 2021-03-26 1 Joseph R Byrne P01289281 2077752387 2021-03-26 2019 2022-09-23 18:48:47Z Matthew Trombley 587 North Deer Isle Road Deer Isle ME 04627 5708618 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. 13 13 134 100 0 0 100763 89640 5380920 5579151 24480 38470 0 0 5506163 5707261 500 750 0 0 2883988 3075298 0 0 0 2765122 2893255 5649610 5969303 -143447 -262042 4981945 5472086 590238 1275327 4391707 4196759 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 5171568 750 5579151 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 5171568 1 1 0 1 0 0 0 0 1 1 1 0 0 0 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 8 0 1 134 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Matthew Trombley 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Ronda Dodge President 2.00 X X 0 0 0 Judith Williams Vice President 2.00 X X 0 0 0 Jeffrey Dalrymple Treasurer 2.00 X X 0 0 0 Deborah Ludlow Secretary 2.00 X X 0 0 0 Bobbi Billings Past President 2.00 X X 0 0 0 Linda Campbell Director 2.00 X 0 0 0 Barbara Chesney Director 2.00 X 0 0 0 Evelyn Duncan Past Director 2.00 X 0 0 0 Clare Grindal Director 2.00 X 0 0 0 Samuel Harrington Director 4.00 X 0 0 0 Tim Hoechst Director 2.00 X 0 0 0 Cindy Lash Director 2.00 X 0 0 0 Susan Ostertag Past Director 2.00 X 0 0 0 Dianne Thompson Director 2.00 X 0 0 0 Karen Vickerson Director 2.00 X 0 0 0 Matthew Trombley Executive Director 45.00 X 160500 0 0 160500 0 0 1 0 1 0 Primetime Healthcare 15380 Weir Street Omaha NE 68137 Medical Staffing Services 461978 Arete Rehabilitation 110 Haverhill Road Ste 101 Amesbury MA 01913 Therapy Services 398697 Onestaff Medical 11718 Nicholas Street Omaha NE 68154 Medical Staffing Services 339722 3 89640 89640 Medicare/Medicaid Rev. 623000 6891374 6891374 Pvt. Pay Nursing Care 623000 1193955 1193955 Miscellaneous Revenue 623000 73067 73067 Contractual Adjustment 623000 -2579245 -2579245 5579151 39652 39652 175 0 1357 175 -1357 -1182 -1182 5707261 5579151 0 38470 X 750 750 160500 160500 2218006 1989453 228553 500500 409799 90701 196292 165591 30701 67455 67455 1223760 1223760 14223 14223 61151 28795 32356 8477 8477 127264 127264 15040 15040 98 98 240366 239257 1109 68323 66295 2028 Provider Tax Expense 325078 325078 Supplies 318315 318315 Miscellanous 244127 68272 175855 Food 179578 179578 5969303 5171568 797735 0 X 600 600 364904 1119360 36000 7000 657801 581475 58986 45244 16737 11562 5384695 3668443 1903324 1716252 1810582 1916571 133011 74022 4981945 5472086 561456 417524 20918 23804 7864 0 0 833999 590238 1275327 X 2953254 2810394 1438453 1386365 4391707 4196759 4981945 5472086 -262042 67094 0 X 0 1 X 1 0 X 702311 145494 78409 100763 89640 1116617 4451327 4830728 4468468 5380920 5579151 24710594 5153638 4976222 4546877 5481683 5668791 25827211 59400 7360 8530 2437 650 78377 975487 949060 1127549 1359114 1474908 5886118 1034887 956420 1136079 1361551 1475558 5964495 19862716 51434 50214 41790 39031 39652 222121 51434 50214 41790 39031 39652 222121 5205072 5026436 4588667 5520714 5708443 26049332 0.76250 0.77580 0.00850 0.00860 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1526 1526 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 1209232 67190 77153 1199269 1194166 89907 74841 1209232 1142878 16409 108127 73248 1194166 1089373 124017 70512 1142878 1062719 27154 500 1089373 0.00000 0.88420 0.11580 0 0 55290 55290 3688730 2462939 1225791 1256605 840892 415713 384070 364612 19458 1716252 CARES Act Funding 833999 833999 5775712 67094 1357 68451 5707261 0 5707261 5970660 1357 1357 5969303 0 5969303 Part IV, Line 2b: The Organization holds private funds for residents and provides these funds to the resident, as needed, 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 1,357. Part XII, Line 2d - Other Adjustments: Loss on Disposal of Equipment 1,357. X X 0 0 0 0 0 0 0 1 0 Matthew Trombley Executive Director 139430 0 15840 0 5230 0 0 0 0 0 160500 0 0 0 Part I, Line 7 Matthew Trombley received a bonus of $15,840 from the Organization during calender year 2019. 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 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 President of 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, (c) has agreed to comply with the policy and (d) understands the Island Nursing Home is charitable and in order to maintain its federal exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. 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 811,658. Management and general expenses 0. Fundraising expenses 0. Total expenses 811,658. Therapy services: Program service expenses 412,102. Management and general expenses 0. Fundraising expenses 0. Total expenses 412,102. 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).