2019-11-14T06:25:32-06:00 2019-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Jeffrey Dalrymple Treasurer 2073482351 2019-11-13 1 Joseph R Byrne CPA P01289281 2077752387 2019-11-13 69.49.157.66 2019-11-13 08:51:25 ES P B6CABA93EC29A130F91389D5843EEEAA10181012 15D84E00388989A2FD892B611AF49EE7CA45C0C7 2018 2020-03-31 21:24:44Z Matthew Trombley 587 North Deer Isle Road Deer Isle ME 04627 5766240 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. 12 12 127 100 0 0 78409 100763 4468468 5380920 48518 24480 0 0 4595395 5506163 1000 500 0 0 3094757 2883988 0 0 0 1758676 2765122 4854433 5649610 -259038 -143447 5172295 4981945 726110 590238 4446185 4391707 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 4780454 500 5380920 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 4780454 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 1 127 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 ME X Matthew Trombley 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Bobbi Billings President 5.00 X X 0 0 0 Judith Williams Vice President 2.00 X X 0 0 0 Jeff Dalrymple Treasurer 2.00 X X 0 0 0 Deborah Ludlow Secretary 2.00 X X 0 0 0 Linda Campbell Director 2.00 X 0 0 0 Karen Chapman Director 2.00 X 0 0 0 Ronda Dodge Director 2.00 X 0 0 0 Evelyn Duncan Director 2.00 X 0 0 0 Clare Grindal Director 2.00 X 0 0 0 Samuel Harrington Director 2.00 X 0 0 0 Susan Ostertag Director 2.00 X 0 0 0 Dianne Thompson Director 2.00 X 0 0 0 Anne Sigmund Past President and Administrator 8.00 X X 1961 0 0 Deborah Cummins Past Director 2.00 X 0 0 0 Kathleen Osborn Past Director 2.00 X 0 0 0 Deborah DeWitt Past Director 4.00 X 0 0 0 Robert Lasky Past Director 2.00 X 0 0 0 Matthew Trombley Executive Director 40.00 X 41544 0 0 Samantha Blackman Past Administrator 40.00 X 30773 0 0 74278 0 0 0 0 0 0 BK Burgess Inc 561 N Deer Isle Rd Deer Isle ME 04627 Construction 321439 Arete Rehabilitation 110 Haverhill Road Ste 101 Amesbury MA 01913 Therapy Services 276707 2 100763 1018 100763 Medicare/Medicaid Rev. 623000 5451588 5451588 Pvt. Pay Nursing Care 623000 1736428 1736428 Miscellaneous Revenue 623000 1533 1533 Contractual Adjustment 623000 -1808629 -1808629 5380920 39031 39031 244926 600 232970 27107 11956 -26507 -14551 -14551 5506163 5380920 0 24480 X 500 500 141889 141889 2066143 1867544 198599 494191 396437 97754 181765 153853 27912 64255 64255 1058232 1040818 17414 24394 24394 79086 24505 54581 5858 5858 128940 128940 5854 5854 4313 3728 585 249526 249526 118864 118864 Miscellanous 304908 44599 260309 Provider Tax Expense 302159 302159 Supplies 272673 272673 Food 146060 146060 5649610 4780454 869156 0 X 600 600 545034 364904 104943 36000 607470 657801 47253 58986 25488 16737 5333024 3429700 1876528 1903324 1871442 1810582 93537 133011 5172295 4981945 556066 561456 18857 20918 151187 7864 726110 590238 X 2847990 2953254 537779 378037 1060416 1060416 4446185 4391707 5172295 4981945 -143447 88969 0 X 0 1 X 1 0 X 1588948 702311 145494 78409 100763 2615925 4309001 4451327 4830728 4468468 5380920 23440444 5897949 5153638 4976222 4546877 5481683 26056369 232750 59400 7360 8530 2437 310477 944297 975487 949060 1127549 1359114 5355507 1177047 1034887 956420 1136079 1361551 5665984 20390385 42656 51434 50214 41790 39031 225125 42656 51434 50214 41790 39031 225125 5940605 5205072 5026436 4588667 5520714 26281494 0.77580 0.78220 0.00860 0.00890 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1110 1110 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 1194166 89909 74841 1209234 1142878 16409 108127 73248 1194166 1089373 124017 70512 1142878 1062719 27154 500 1089373 47598 1000000 15706 585 1062719 0.00000 0.87690 0.12310 0 0 55290 55290 3571979 2313609 1258370 1226460 753098 473362 479295 362993 116302 1903324 5617389 88969 26507 115476 5501913 4250 4250 5506163 5671867 26507 26507 5645360 4250 4250 5649610 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 26,507. Part XI, Line 4b - Other Adjustments: Provision for Uncollectible Pledges 4,250. Part XII, Line 2d - Other Adjustments: Loss on Disposal of Equipment 26,507. Part XII, Line 4b - Other Adjustments: Provision for Uncollectible Pledges 4,250. 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 Consulting: Program service expenses 690,659. Management and general expenses 17,414. Fundraising expenses 0. Total expenses 708,073. Therapy services: Program service expenses 350,159. Management and general expenses 0. Fundraising expenses 0. Total expenses 350,159. 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).