2013-11-06T09:06:18-06:00 2013-06-30 010391345 Berry Dunn McNeil & Parker LLC 36 Pleasant Street Bangor ME 04401 990 2012-07-01 510172239 Island Nursing Home Inc ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Marc Plourde 2073482351 2013-10-31 1 Barbara J McGuan CPA P00219457 2079421600 2013-10-31 2012 2016-02-24 21:20:13Z Marc Plourde 587 North Deer Isle Road Deer Isle ME 04627 4047377 0 X n/a X 1975 ME To provide nursing care 12 12 133 50 0 0 133237 123311 3972672 3886660 25845 13505 0 -558 4131754 4022918 2750 750 0 0 2628091 2673824 0 0 0 1330929 1424353 3961770 4098927 169984 -76009 3800178 3922555 1896372 1959728 1903806 1962827 X The mission of Island Nursing Home, Deer Isle, Maine, a non-profit facility, is to incorporate the values of dignity, compassion, professionalism and community in providing life-care services or resources to individuals and families in need; to instill purpose and hope; and to support all stages of living and dying.The Island Nursing Home is committed to a primary obligation to serve residents of the communities of Deer Isle, Stonington, Isle au Haut, Brooksville, Brooklin, Sedgwick and Blue Hill. 0 0 3488847 750 3886660 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 3488847 1 1 0 1 0 0 0 0 0 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 21 0 1 133 1 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 0 0 1 0 0 ME X Marc Plourde 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Deborah DeWitt 1.00 X X 0 0 0 Robert Lasky 1.00 X X 0 0 0 Marilyn Verhey 1.00 X X 0 0 0 Pamela Siewers 1.00 X X 0 0 0 Kathleen Billings-Pezaris 1.00 X 0 0 0 John Eysenbach 1.00 X 0 0 0 Kathleen Hayward 1.00 X 0 0 0 Don Holmes 1.00 X 0 0 0 Kathleen Osborn 1.00 X 0 0 0 Joe Perkins 1.00 X 0 0 0 Deborah Cummins 1.00 X 0 0 0 Lisa Veazie 1.00 X 0 0 0 Joan Freeman 1.00 X 0 0 0 Claudette Kydd 1.00 X 0 0 0 Marc Plourde 40.00 X 110734 0 0 110734 0 0 1 0 0 0 Synertx 7540 North 19th Av Suite 200 Phoenix AZ 85021 Phys & Occup Therapy 123160 1 8403 114908 123311 Medicare/medicaid Rev 623000 5727862 5727862 Pvt. Pay Nursing Care 623000 791488 791488 Miscellaneous Revenue 623000 511 511 Contractual Adjustment 623000 -2633201 -2633201 3886660 33549 33549 3000 23044 -20044 -20044 -20044 857 8403 1415 -558 -558 4022918 3886660 0 12947 750 750 98408 98408 1940705 1790527 150178 389023 300110 88913 245688 207998 37690 26006 26006 48119 48119 151866 137883 13983 10086 10086 40627 33808 6819 111661 111661 14448 14448 39910 39910 169361 169361 80149 80149 Provider tax expense 219579 219579 Supplies 206571 206571 Food 123746 123746 Bad debts 100441 100441 81783 42260 39523 4098927 3488847 610080 0 3439 900 440535 458019 414273 276337 59600 56820 57676 23202 4135938 2748933 1422356 1387005 1400862 1719065 1437 1207 3800178 3922555 915815 1099175 915350 800489 65207 60064 1896372 1959728 X 1841673 1897491 18126 21329 44007 44007 1903806 1962827 3800178 3922555 -76009 135030 0 X X 0 1 X 1 0 X 25861 26212 94326 133237 123311 402947 3823024 3812146 3995804 3972672 3886660 19490306 1564 897 857 3318 3848885 3838358 4091694 4106806 4010828 19896571 1675 5350 6860 8500 11007 33392 0 1675 5350 6860 8500 11007 33392 19863179 21838 20134 23854 28326 33549 127701 21838 20134 23854 28326 33549 127701 3870723 3858492 4115548 4135132 4044377 20024272 0.99200 0.99260 0.00640 0.00610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1110 1110 0 Explanation of Lobbying Activities: Part II-B, Line 1: 29.80% of dues paid to Maine Health Care Association were attributable to lobbying. 1468405 232520 168204 43275 1825854 1295208 146678 42680 16161 1468405 721890 475923 130404 33009 1295208 435937 254946 37015 6008 721890 548983 25861 -58999 79908 435937 0.96420 0.02410 0.01170 0 0 55290 55290 2595300 1809354 785946 1048359 690213 358146 436989 249366 187623 1387005 Estimated third party payor settlement 60064 60064 4157948 135030 135030 4022918 0 4022918 4098927 0 4098927 0 4098927 Description of Intended Use of Endowment Funds: Part V, Line 4: The intended uses of the endowment funds include funding for scholarships and other 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. Oversight of Audit Form 990, Part XII, Line 2c The audit process has not changed from the prior year. Form 990, Part VI, Section B, Line 13 & 14 Due to an oversight prior year Forms 990 erroneously indicated that a written document retention and destruction policy as well as a written whistleblower policy were in place. Although written policies were not in use at 6/30/13, the Organization has adhered to the Department of Labor's requirement for whistleblower protection by posting the rules in a public place, and by following the State of Maine and Center for Medicare and Medicaid Services' regulations for document retention and destruction for nursing and assisted living facilities. The Organization is in the process of drafting written whistleblower protection and document retention/destruction policies. These written policies will be adopted by December 31, 2013.