TY 2020 Form 990 Schedule O

Instrumentl eFile RenderObject ID: 202210959349301461 - Rendered 2024-09-08 TIN: 51-0172239

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Island Nursing Home Inc

Employer identification number

51-0172239

Return Reference	Explanation
Form 990, Part VI, Section A, line 4	During the year, the Organization amended its bylaws. Below are the changes deemed to be significant based on IRS definition: The Organization added a new article to its bylaws regarding the dissolution of the Organization. The bylaws were updated to use a Senior Vice-President model rather than a Co-President model.
Form 990, Part VI, Section B, line 11b	Form 990 was provided to the governing body by email prior to being filed. It was reviewed by the Finance Committee and 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, and (c) has complied with the policy. 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	Other Services: Program service expenses 1,259,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,259,504. Therapy services: Program service expenses 402,990. Management and general expenses 0. Fundraising expenses 0. Total expenses 402,990.
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).

Return Reference

Explanation

Form 990, Part VI, Section A, line 4

During the year, the Organization amended its bylaws. Below are the changes deemed to be significant based on IRS definition: The Organization added a new article to its bylaws regarding the dissolution of the Organization. The bylaws were updated to use a Senior Vice-President model rather than a Co-President model.

Form 990, Part VI, Section B, line 11b

Form 990 was provided to the governing body by email prior to being filed. It was reviewed by the Finance Committee and 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, and (c) has complied with the policy. 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

Other Services: Program service expenses 1,259,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,259,504. Therapy services: Program service expenses 402,990. Management and general expenses 0. Fundraising expenses 0. Total expenses 402,990.

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).

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

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