2016-04-18T00:00:00-05:00 2015-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Robert Lasky Treasurer 2073482351 2016-04-19 1 Joseph R Byrne CPA P01289281 2077752387 2016-04-18 2014 2016-08-17 19:52:53Z Marjorie Love 587 North Deer Isle Road Deer Isle ME 04627 5941805 0 X www.islandnursinghome.org X 1975 ME To provide nursing care 15 15 147 69 0 0 91945 1588948 4116422 4309001 20666 43856 0 0 4229033 5941805 1250 585 0 0 2680174 2832643 0 0 0 1359963 1517811 4041387 4351039 187646 1590766 4010334 5205164 1630874 1164293 2379460 4040871 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 3741885 585 4309001 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 3741885 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 0 0 0 0 0 0 0 0 0 1 8 0 1 147 1 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 0 0 ME X Marjorie Love 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Deborah DeWitt President 2.00 X X 0 0 0 Marilyn Verhey Vice-President 2.00 X X 0 0 0 Robert Lasky Treasurer 2.00 X X 0 0 0 Kathleen Hayward Secretary 1.00 X X 0 0 0 Kathleen Billings-Pezaris Director 1.00 X 0 0 0 John Eysenbach Director 1.00 X 0 0 0 Don Holmes Director 1.00 X 0 0 0 Kathleen Osborn Director 2.00 X 0 0 0 Joe Perkins Director 1.00 X 0 0 0 Deborah Cummins Director 1.00 X 0 0 0 Lisa Veazie Director 1.00 X 0 0 0 Dana Douglass Director 1.00 X 0 0 0 Anne Sigmund Director 1.00 X 0 0 0 Sara Stone Director 1.00 X 0 0 0 Samuel Harrington Director 1.00 X 0 0 0 Deborah Ludlow Director 1.00 X 0 0 0 Marc Plourde Administrator 40.00 X 122965 0 0 122965 0 0 1 0 0 0 Synertx 7540 North 19th Avenue Phoenix AZ 85021 Physical & Occupational Therapy 106326 1 1588948 1588948 Medicare/Medicaid Rev. 623000 5517873 5517873 Pvt. Pay Nursing Care 623000 1039778 1039778 Miscellaneous Revenue 623000 396 396 Contractual Adjustment 623000 -2249046 -2249046 4309001 42656 42656 1200 0 1200 1200 1200 5941805 4309001 0 43856 585 585 112973 112973 2011458 1851049 160409 427896 313205 114691 280316 260658 19658 400 400 52124 52124 180042 145784 34258 54330 33486 20844 35830 31536 4294 149221 149221 14686 14686 29618 29543 75 196973 196973 84166 84166 Supplies 238925 238925 Provider Tax Expense 233184 233184 Miscellanous 126724 37296 89428 Food 121588 121588 4351039 3741885 609154 0 X 600 600 256249 255918 0 456400 323213 369604 56087 51678 47202 39541 4308934 2973286 1278894 1335648 2047124 2695051 965 724 4010334 5205164 301108 275424 23959 25476 680265 554531 625542 308862 1630874 1164293 X 2330171 2457784 5282 539080 44007 1044007 2379460 4040871 4010334 5205164 1590766 70645 0 X 0 1 X 1 0 X 94326 133237 123311 91945 1588948 2031767 3995804 3972672 3886660 4116422 4309001 20280559 1564 897 857 3318 4091694 4106806 4010828 4208367 5897949 22315644 6860 8500 11007 16525 220500 263392 0 6860 8500 11007 16525 220500 263392 22052252 23854 28326 33549 36376 42656 164761 23854 28326 33549 36376 42656 164761 4115548 4135132 4044377 4244743 5940605 22480405 0.98100 0.99070 0.00730 0.00700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1321 1321 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 47598 1000000 15706 585 1062719 47369 479 250 47598 48199 -80 750 47369 48647 802 1250 48199 49353 604 1310 48647 0.00000 0.98240 0.01760 0 0 55290 55290 2645950 1956870 689080 1116185 717176 399009 491509 299240 192269 1335648 Estimated Third Party Payor Settlements 46909 Due to State of Maine 261953 308862 6012450 70645 70645 5941805 0 5941805 4351039 0 4351039 0 4351039 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: The intended uses of the endowment funds include funding for scholarships and operating activities of the nursing home. 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 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).