2011-02-01T12:25:32-06:00 2010-06-30 BERRY DUNN McNEIL & PARKER LLC 36 PLEASANT STREET BANGOR ME 04401 990 2009-07-01 510172239 Island Nursing Home ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Marc Plourde 2073482351 2011-01-25 1 Barbara J McGuan CPA 2079421600 2011-01-25 2009 2016-02-24 21:20:13Z Marc Plourde 587 North Deer Isle Road Deer Isle ME 04627 4014074 0 X n/a X 1975 ME To provide nursing care and adult day care 8 8 130 60 0 0 25861 26212 3823024 3812146 21838 20134 0 3870723 3858492 500 500 0 2398984 2509806 0 1514 1420866 1217018 3820350 3727324 50373 131168 2988390 3095254 1751338 1709555 1237052 1385699 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 3284840 500 3812146 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 3284840 1 0 0 1 0 0 0 0 0 1 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 12 0 130 1 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 ME X Marc Plourde 2073482351 587 North Deer Isle Rd Deer Isle ME 04627 Suzanne Bergen 1.00 X 0 0 0 Pamela N Siewers 1.00 X X 0 0 0 Claudette O Kydd 1.00 X 0 0 0 Don Holmes 1.00 X 0 0 0 Robert Laskey 1.00 X X 0 0 0 Kathleen Billings-Pezari 1.00 X 0 0 0 Mindy S Marsheutz 1.00 X 0 0 0 John P Eysenbach 1.00 X 0 0 0 Marc Plourde 40.00 X 92886 0 3046 92886 0 3046 0 0 0 0 0 26212 26212 Medicare/medicaid Rev 623000 2907004 2907004 Pvt. Pay Nursing Care 623000 904513 904513 Miscellaneous Revenue 623000 629 629 3812146 20134 20134 155582 155582 0 0 3858492 3812146 0 20134 500 500 92491 92491 1875415 1724631 150784 309028 252088 56940 232872 192824 40048 906 906 33139 33139 22624 10824 11800 10878 10878 205769 198962 5293 1514 108582 108582 4634 4634 64801 64801 165648 165648 98729 98729 Provider tax expense 201763 201763 Food 127633 127633 Therapy services 91599 91599 Other administrative 18606 18606 Data processing costs 17916 17916 43791 29838 13953 3727324 3284840 440970 1514 448 450 497711 453166 450133 317657 42141 45262 10410 8804 4283864 2752685 1647396 1531179 337979 736805 2172 1931 2988390 3095254 447828 555884 1197793 1108608 105717 45063 1751338 1709555 X 1185735 1334122 7310 7570 44007 44007 1237052 1385699 2988390 3095254 X 0 1 0 X 0 X 23693 38460 192198 25861 26212 306424 3520894 3707714 3962082 3823024 3812146 18825860 3544587 3746174 4154280 3848885 3838358 19132284 1876 3795 3233 1675 5350 15929 0 1876 3795 3233 1675 5350 15929 19116355 32174 32965 29285 21838 20134 136396 32174 32965 29285 21838 20134 136396 3576761 3779139 4183565 3870723 3858492 19268680 0.99210 0.99200 0.00710 0.00740 X 0 0 0 0 0 0 0 0 1 1053 1053 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 27% of dues paid to Maine Health Care Association were attributable to lobbying. 55290 55290 2747775 1699580 1048195 1038963 799990 238973 441836 253115 188721 1531179 Estimated third party payor settlement 45063 45063 3858492 3727324 131168 17479 17479 148647 3875971 17479 17479 3858492 0 3858492 3727324 0 3727324 0 3727324 Form 990, Part VI, Section B, line 11 Form 990 was provided to the governing body in person at the board meeting and was reviewed by the governing body at that time. 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 process for determining the administrator's compensation includes a compensation committee, compensation survey or study and approval by the board or compensation committee. 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.