2017-01-19T11:27:02-06:00 2016-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2015-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Robert Lasky Treasurer 2073482351 2017-01-18 1 Joseph R Byrne CPA P01289281 2077752387 2017-01-18 2015 2021-01-29 14:40:06Z Hailey Wetherbee 587 North Deer Isle Road Deer Isle ME 04627 5656772 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. 14 14 143 75 0 0 1588948 702311 4309001 4451327 43856 52095 0 0 5941805 5205733 585 500 0 0 2832643 3118011 0 0 0 1517811 2055554 4351039 5174065 1590766 31668 5205164 5123371 1164293 1059462 4040871 4063909 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 4075376 500 4451327 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 4075376 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 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 11 0 1 143 1 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 0 0 ME X Hailey Wetherbee 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Deborah DeWitt President 2.00 X X 0 0 0 Anne Sigmund Vice President 2.00 X X 0 0 0 Robert Lasky Treasurer 2.00 X X 0 0 0 Deborah Venno Ludlow Secretary 2.00 X X 0 0 0 Marilyn Verhey Past Vice President 2.00 X X 0 0 0 Kathleen Hayward Past Secretary 2.00 X X 0 0 0 Kathleen Billings-Pezaris Director 2.00 X 0 0 0 Donald Holmes Director 2.00 X 0 0 0 Kathleen Osborn Director 2.00 X 0 0 0 Joseph Perkins Director 2.00 X 0 0 0 Deborah Cummins Director 2.00 X 0 0 0 Lisa Veazie Director 2.00 X 0 0 0 Dana Douglass Director 2.00 X 0 0 0 Sara Stone Director 2.00 X 0 0 0 Samuel Harrington Director 2.00 X 0 0 0 Evelyn Duncan Director 2.00 X 0 0 0 Marc Plourde Past Administrator 40.00 X 102422 0 2951 Marjorie Love Past Administrator 40.00 X 19476 0 136 Lori Morey Acting Administrator 40.00 X 55290 0 1290 177188 0 4377 1 0 0 0 Synertx 7540 North 19th Avenue Phoenix AZ 85021 Therapy Services 103034 1 702311 79042 702311 Medicare/Medicaid Rev. 623000 5141527 5141527 Pvt. Pay Nursing Care 623000 1294001 1294001 Miscellaneous Revenue 623000 146 146 Contractual Adjustment 623000 -1984347 -1984347 4451327 51434 51434 450000 1700 442133 8906 7867 -7206 661 661 5205733 4451327 0 52095 X 500 500 84950 84950 2202932 2025938 176994 639272 528282 110990 190857 160413 30444 1686 1686 75585 75585 602109 196957 405152 76044 41019 35025 63986 37130 26856 1095 1095 123147 123147 21129 21129 24061 23599 462 205191 205191 74658 74658 Provider Tax Expense 253990 253990 Supplies 214492 214492 Miscellanous 198088 48638 149450 Food 120293 120293 5174065 4075376 1098689 0 X 600 600 255918 739426 456400 540675 369604 364665 51678 52041 39541 33238 4235584 3134581 1335648 1101003 2695051 2291723 724 5205164 5123371 275424 436106 25476 26529 554531 442201 308862 154626 1164293 1059462 X 2457784 1804840 539080 1215062 1044007 1044007 4040871 4063909 5205164 5123371 31668 -8630 0 X 0 1 X 1 0 X 133237 123311 91945 1588948 702311 2639752 3972672 3886660 4116422 4309001 4451327 20736082 897 857 1754 4106806 4010828 4208367 5897949 5153638 23377588 8500 11007 16525 232750 59400 328182 870592 851743 902094 944297 975487 4544213 879092 862750 918619 1177047 1034887 4872395 18505193 28326 33549 36376 42656 51434 192341 28326 33549 36376 42656 51434 192341 4135132 4044377 4244743 5940605 5205072 23569929 0.78510 0.78270 0.00820 0.00730 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1410 1410 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 1062719 27154 500 1089373 47598 1000000 15706 585 1062719 47369 479 250 47598 48199 -80 750 47369 48647 802 1250 48199 0.00000 0.95840 0.04160 0 0 55290 55290 2645950 2039487 606463 1157269 772598 384671 377075 322496 54579 1101003 Estimated Third Party Payor Settlements 26709 Due to State of Maine 127917 154626 5197103 -8630 -8630 5205733 0 5205733 5174065 0 5174065 0 5174065 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. X 4 79042 Stock Market Value 0 0 1 Part I, Line 32b: Contributions of securities are sold through the Organization's investment broker. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section B, line 11 Form 990 was provided to the governing body by email prior to being filed. It was reviewed by the Chair of 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 23,010. Management and general expenses 405,152. Fundraising expenses 0. Total expenses 428,162. Therapy services: Program service expenses 173,947. Management and general expenses 0. Fundraising expenses 0. Total expenses 173,947. 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).