2011-11-10T15:08:53-06:00 2011-06-30 Berry Dunn McNeil & Parker LLC 36 Pleasant Street Bangor ME 04401 990 2010-07-01 510172239 Island Nursing Home ISLA 2073482351 587 North Deer Isle Road Deer Isle ME 04627 Marc Plourde 2073482351 2011-10-27 1 Barbara J McGuan CPA 2079421600 2011-10-27 2010 2016-03-07 17:11:31Z Marc Plourde 587 North Deer Isle Road Deer Isle ME 04627 4115548 0 X n/a X 1975 ME To provide nursing care and adult day care 10 10 136 60 0 0 26212 94326 3812146 3995804 20134 23343 0 50 3858492 4113523 500 2310 0 0 2509806 2576922 0 0 0 1217018 1308224 3727324 3887456 131168 226067 3095254 3561185 1709555 1842234 1385699 1718951 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 3426204 2310 3995804 Nursing Home Care - Seventy-bed long term care facility offering skilled nursing, residential and ancillary services to medically needy residents. 3426204 1 1 0 1 0 0 0 0 0 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 0 1 10 0 136 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 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-Pezaris 1.00 X X 0 0 0 John P Eysenbach 1.00 X 0 0 0 Deborah DeWitt 1.00 X 0 0 0 Kathleen Hayward 1.00 X 0 0 0 Joe Perkins 1.00 X 0 0 0 Marilyn Verhey 1.00 X 0 0 0 Marc Plourde 40.00 X 104072 0 4560 104072 0 4560 1 0 0 0 Synertx 7540 North 19th Av Suite 200 Phoenix AZ 85021 Phys & Occup Therapy 129610 1 6206 88120 94326 Medicare/medicaid Rev 623000 5437824 5437824 Pvt. Pay Nursing Care 623000 924377 924377 Miscellaneous Revenue 623000 1016 1016 Contractual Adjustment 623000 -2367413 -2367413 3995804 23854 23854 511 -511 -511 -511 1564 6206 1514 50 50 4113523 3995804 0 23393 2310 2310 108632 108632 1964272 1801036 163236 309168 263065 46103 194850 178237 16613 4884 4884 34116 34116 15560 10972 4588 10508 10508 218933 212982 5951 107453 107453 6160 6160 59225 59225 165647 165647 75617 75617 Provider tax expense 218797 218797 Therapy services 134532 134532 Food 132089 132089 Bad debts 34918 34918 Other administrative 20064 20064 69721 47574 22147 3887456 3426204 461252 0 450 2663 453166 352226 317657 376644 45262 54312 8804 68662 4354350 2907543 1531179 1446807 736805 1258182 1931 1689 3095254 3561185 555884 787689 1108608 1013848 45063 40697 1709555 1842234 X 1334122 1669080 7570 5864 44007 44007 1385699 1718951 3095254 3561185 X 226067 107185 X X 0 1 1 X 0 X 38460 192198 25861 26212 94326 377057 3707714 3962082 3823024 3812146 3995804 19300770 1564 1564 3746174 4154280 3848885 3838358 4091694 19679391 3795 3233 1675 5350 6860 20913 0 3795 3233 1675 5350 6860 20913 19658478 32965 29285 21838 20134 23854 128076 32965 29285 21838 20134 23854 128076 3779139 4183565 3870723 3858492 4115548 19807467 0.99250 0.99210 0.00650 0.00710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1314 1314 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: 33.70% of dues paid to Maine Health Care Association were attributable to lobbying. 55290 55290 2753446 1785789 967657 1103828 842423 261405 441786 279331 162455 1446807 Estimated third party payor settlement 40697 40697 4113523 3887456 226067 107185 107185 333252 4220708 107185 107185 4113523 0 4113523 3887456 0 3887456 0 3887456 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 107,185. Form 990, Part XII, line 2c, Oversight of Audit: The audit process has not changed from the prior year.