2020-05-14T16:08:24-05:00 2019-12-31 450310328 BRADY MARTZ & ASSOCIATES PC PO BOX 1297 BISMARCK ND 585021297 990 2019-01-01 870694180 ANNE CARLSEN CENTER ANNE 8005685175 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 TIM EISSINGER CEO 8005685175 2020-05-13 1 MELINDA PIATZ P00739198 7012231717 2020-05-13 24.111.88.202 2020-05-13 17:49:48 CD P 94C9C43EDDD7B186B83B432AED1754BA48CE5AC5 C7A0703A2F43AAEEA8838C079AB8B109A2E7FBED 2019 2020-09-22 18:59:49Z TIM EISSINGER 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 41983935 0 X WWW.ANNECENTER.ORG X 1941 ND TO PROVIDE SERVICES FOR INTELLECTUALLY AND DEVELOPMENTALLY DISABLED INDIVIDUALS AND OTHER CHILDREN AND ADULTS WITH SPECIALIZED HEALTH CARE AND EDUCATION NEEDS. 13 13 842 70 0 0 12935 9925 34833707 41479683 960 -84417 2820121 271077 37667723 41676268 0 0 0 0 34397484 34143138 0 0 0 7469235 6977996 41866719 41121134 -4198996 555134 15274622 15081693 37013025 36264962 -21738403 -21183269 X TO PROVIDE SERVICES FOR DEVELOPMENTALLY DISABLED INDIVIDUALS AND OTHER CHILDREN AND ADULTS WITH SPECIALIZED HEALTH CARE AND EDUCATION NEEDS. OPERATING LOSSES GENERATED IN FULFILLMENT OF THE CENTER'S MISSION ARE COMPENSATED FOR BY THE ACTIVE FOUNDATION FUND RAISING EFFORTS. 0 0 17954346 20738107 RESIDENT/MEDICAL:COMPLEX MEDICAL CARE, PSYCHOLOGICAL, HOME LIFE ENVIRONMENT, DIETARY, PHYSICIAN. ALSO INCLUDES PHYCICAL, SPEECH AND OCCUPATIONAL THERAPY SERVICES. 10133444 10987417 COMMUNITY SERVICES:CATEGORY INCLUDES IN-HOME AND DAY SUPPORTS, OTHER OUTREACH SERVICES, AND EARLY INTERVENTION PROGRAM. 2658811 5629454 EDUCATION:NINE-MONTH SCHOOL, TEN-WEEK EXTENDED SUMMER PROGRAM. 3366049 2178755 BEHAVIORAL AND MENTAL HEALTH SERVICES:MENTAL HEALTH SERVICES ARE PROVIDED IN MOORHEAD, MN SERVING THE FARGO, ND/MOORHEAD, MN REGION. BEHAVIORAL HEALTH SERVICES ARE PROVIDED TO CHILDREN WITH AUTISM ACROSS NORTH DAKOTA. 1833207 1945950 THERAPEUTIC SUPPORT:PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND RECREATIONAL THERAPY PROVIDED TO BOTH ANNE CARLSEN CENTER STUDENTS AND OUTPATIENTS IN THE JAMESTOWN AND VALLEY CITY REGIONS. FARGO THERAPEUTIC SUPPORT INCLUDES SPEECH THERAPY, OCCUPATIONAL THERAPY AND OROFACIAL MYOLOGY. REVENUE IS REFLECTED AT GROSS. 5199256 4124705 35945857 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 59 0 1 842 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 ND MN WA WI X KRISTIN SYVERSON 7019525101 701 3RD ST NW JAMESTOWN ND 58401 BRUCE FURNESS CHAIR 2.00 2.00 X X 0 0 0 ALEX SCHWEITZER VICE CHAIR 2.00 2.00 X X 0 0 0 NICOLE POOLMAN TREASURER 1.50 1.50 X X 0 0 0 DR TAMARA MATHISON SECRETARY 1.50 1.50 X X 0 0 0 CASEY STOUDT FORMER CHAIR 1.00 1.00 X 0 0 0 RUTH BERGSTROM TRUSTEE 1.00 1.00 X 0 0 0 PATRICIA DWYER TRUSTEE 1.00 1.00 X 0 0 0 ERIC MONSON TRUSTEE 1.00 1.00 X 0 0 0 LAUREL NELSON TRUSTEE 1.00 1.00 X 0 0 0 LORI NORDBY TRUSTEE 1.00 1.00 X 0 0 0 DR POLLY PETERSON TRUSTEE 1.00 1.00 X 0 0 0 THOMAS ROLFSTAD TRUSTEE 1.00 1.00 X 0 0 0 DEL RAE WILLIAMS TRUSTEE 1.00 1.00 X 0 0 0 TIMOTHY EISSINGER CEO 40.00 10.00 X 254404 0 26590 STEPHANIE NELSON COO 40.00 10.00 X 158932 0 8591 KRISTIN SYVERSON CFO 40.00 10.00 X 126874 0 3688 LAURIE MEYER CHIEF HR OFFICER 40.00 10.00 X 114684 0 9053 ERIC WILKIE CHIEF DEVELOPMENT OFFICER 40.00 10.00 X 133717 0 21553 KRESHA WIEST CHIEF INFORMATION OFFICER 40.00 10.00 X 130235 0 7301 918846 0 76776 6 0 1 0 US FOODS INC 4601 32ND AVE S GRAND FORKS ND 58201 FOOD SERVICE DISTRIBUTOR 166438 CERIDIAN PO BOX 10989 NEWARK NJ 07193 PAYROLL MANAGEMENT SERVICES 162261 INNOVIS HEALTH 2422 20TH ST SW JAMESTOWN ND 58401 MEDICAL CONSULTING 149508 3 9925 9925 RESIDENTIAL TREATMENT 623990 20738107 20738107 COMMUNITY SUPPORT SERVICES 623990 10709415 10709415 EARLY INTERVENTION 611710 5629454 5629454 BEHAVIOR AND MENTAL HEALTH 623990 2449832 2449832 OUTPATIENT 621610 1952875 1952875 41479683 2761 2761 220489 307667 -87178 -87178 -87178 MISCELLANEOUS REVENUE 900099 271077 271077 271077 41676268 41479683 0 186660 918845 918845 26419445 24612858 1806587 711290 601026 110264 4048714 3598567 450147 2044844 1806988 237856 45987 45987 50800 50800 36225 36225 1633839 949977 683862 88880 11102 77778 224715 153912 70803 1098933 915678 183255 768788 657165 111623 844610 776505 68105 178488 75875 102613 PROGRAM SUPPLIES 837669 834556 3113 INTEREST, TAXES AND LIC 471981 470818 1163 MISCELLANEOUS 296057 142751 153306 BAD DEBT EXPENSE 169184 169184 231840 168895 62945 41121134 35945857 5175277 0 1164286 1857458 4915884 4926840 205978 270828 1457 1649 227741 210328 24620285 18054695 7510276 6565590 1249000 1249000 15274622 15081693 4031649 4408314 25226 3050805 1187521 29930571 30643901 37013025 36264962 X -21738403 -21183269 -21738403 -21183269 15274622 15081693 555134 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 36225 0 0 36225 0 PART II-B, LINE 1: LOBBYING ACTIVITIES INCLUDED INCURRING COSTS TO ADVOCATE FOR ADDITIONAL FUNDING FOR REIMBURSEMENTS IN ORDER TO MEET THE NEEDS OF CHILDREN WITH MEDICALLY COMPLEX ISSUES AND HIGH BEHAVIORAL CHALLENGES. ACTIVITIES ALSO INCLUDED THE EDUCATION OF LEGISLATORS AND STATE DEPARTMENT OF HUMAN SERVICES ON THE SPECIAL NEEDS OF CHILDREN WHO ARE MEDICALLY COMPLEX OR HAVE HIGH BEHAVIOR CHALLENGES, AS WELL AS EDUCATION ON THE COSTS BEING INCURRED BUT NOT FUNDED. 2582904 178407 805049 431638 3134722 2679930 -97026 2582904 2473853 206077 2679930 2158913 95000 219940 2473853 1850104 351866 -43057 2158913 0.12160 0.87840 0 1 1 915290 915290 18279125 13685015 4594110 861344 737341 124003 4564526 3632339 932187 6565590 RELATED PARTY PAYABLE 30001093 MISCELLANEOUS LIABILITIES 90850 EARN-OUT PAYABLE 469499 CAPITAL LEASE PAYABLE 82459 30643901 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE ANNE CARLSEN CENTER FOUNDATION FOR THE SUPPORT OF THE MISSION OF THE ANNE CARLSEN CENTER PROGRAMS. PART X, LINE 2: THE ANNE CARLSEN CENTER IS EXEMPT FROM PAYMENT OF FEDERAL AND STATE INCOME TAXES BY VIRTUE OF THEIR NONPROFIT ORGANIZATION STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION HAS BEEN CLASSIFIED AS PUBLICLY SUPPORTED ORGANIZATIONS WHICH IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A) OF THE CODE. THE ORGANIZATION'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE ANNE CARLSEN CENTER HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURN OF THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. THE ORGANIZATION IS CURRENT ON THEIR TAX FILINGS. 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 SCHEDULE E, PART I, LINE 3 THE CENTER'S NONDISCRIMINATORY POLICY IS PUBLICIZED IN THE STUDENT HANDBOOKS, EMPLOYEE HANDBOOKS AND THE "AMBASSADOR" NEWSLETTER PUBLICATION. SCHEDULE E, PART I, LINE 4 SEE PART II SCHEDULE E, PART I, LINE 6 THE CENTER RECEIVED ASSISTANCE UNDER THE SCHOOL LUNCH PROGRAM, TUITION REIMBURSEMENTS FROM LOCAL SCHOOL DISTRICTS, SPECIAL EDUCATION UNITS, BUREAU OF INDIAN EDUCATION AND THE STATE DEPARTMENT OF PUBLIC INSTRUCTION. THE CENTER RECEIVED MEDICAID FUNDING FROM NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES FOR RESIDENTIAL/MEDICAL AND EARLY INTERVENTION PROGRAM THROUGH STATE MEDICAID PROGRAM. LINE 4 - EXPLANATION OF RECORDS NON-MAINTENANCE: STUDENT TUITION COSTS FOR BASIC CURRICULUM ARE PAID BY LOCAL SCHOOL DISTRICTS THROUGH CONTRACTS WITH THE CENTER WHILE NOT OFFERING SCHOLARSHIPS. THE CENTER SEEKS AND SECURES DONATIONS FOR ADVANCED CURRICULUM AND STATE OF THE ART TECHNOLOGY APPLICATION IN THE CLASSROOM AND COMMUNITY SETTINGS. NAMED AN APPLE DISTINGUISHED SCHOOL, THE CENTER'S SCHOOL PROCIDES SIGNIFICANT RESOURCES TO ENHANCE THE EDUCATION EXPERIENCE FOR THE STUDENTS AT THE CENTER AND DAY STUDENTS. X X X X 0 0 0 0 0 0 0 0 0 TIMOTHY EISSINGER CEO 254404 0 0 0 0 0 10172 0 16418 0 280994 0 0 0 STEPHANIE NELSON COO 158932 0 0 0 0 0 6357 0 2234 0 167523 0 0 0 ERIC WILKIE CHIEF DEVELOPMENT OFFICER 133717 0 0 0 0 0 5347 0 16206 0 155270 0 0 0 FORM 990, PART I, LINE 1 FOR A READER TO FULLY UNDERSTAND THE ACTIVITY AND PROGRAMS OF THE ANNE CARLSEN CENTER, MANAGEMENT RECOMMENDS THAT THE READER ALSO REVIEW THE ANNE CARLSEN CENTER FOUNDATION FORM 990. FORM 990, PART III, LINE 1: ADDITIONALLY, THE PURPOSES FOR WHICH THE ORGANIZATION IS ORGANIZED ARE: A) TO PROVIDE SERVICES FOR INTELLECTUALLY AND DEVELOPMENTALLY DISABLED INDIVIDUALS AND OTHER CHILDREN AND ADULTS WITH SPECIALIZED HEALTH CARE AND EDUCATION NEEDS; B) TO SUPPORT INDIVIDUALS, ALONG WITH THEIR FAMILIES, AS THEY PURSUE GROWTH AND FULFILLMENT IN THEIR LIVES THROUGH LEADERSHIP IN EDUCATION, LIFE SKILLS TRAINING AND TECHNOLOGY; C) TO SEEK, OBTAIN AND MAINTAIN ONGOING COMMUNITY PARTNERSHIPS AND PHILANTHROPIC SUPPORT TO ACCOMPLISH SUCH PURPOSES; D) TO PROVIDE RESIDENTIAL, EDUCATION, AND COMMUNITY BASED PROGRAM CURRICULUM TO CHILDREN ON THE AUTISM SPECTRUM. FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNANCE COMMITTEE CONSISTS OF THE CHAIR, VICE CHAIR, PAST CHAIR, CORPORATE TREASURER AND CORPORATE SECRETARY. THE GOVERNANCE COMMITTEE HAS THE POWER TO TRANSACT ALL BUSINESS OF THE CENTER DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION SO TAKEN DOES NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF TRUSTEES, AND THE COMMITTEE REFERS ALL MATTERS OF MAJOR IMPORTANCE TO THE FULL BOARD. MINUTES ARE TAKEN BY THE GOVERNANCE COMMITTEE AND SUBMITTED TO THE FULL BOARD. THE COMMITTEE IS RESPONSIBLE FOR BOARD DEVELOPMENT, NOMINATING BOARD MEMBERS, GOVERNANCE POLICIES, AS WELL AS PERFORMANCE REVIEW WHICH ALL BOARD MEMBERS PARTICIPATE IN THE REVIEW OF COMPENSATION OF THE PRESIDENT/CEO. FORM 990, PART VI, SECTION B, LINE 11B THE CFO PROVIDES THE FORM 990 ELECTRONICALLY TO ALL BOARD MEMBERS FOR THEIR REVIEW. THE BOARD CHAIR, FINANCE COMMITTEE CHAIR, CEO, AND CFO WILL CONDUCT A FINAL REVIEW AND APPROVAL OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD, THE PURPOSE OF THIS POLICY IS TO ENSURE IDENTIFICATION AND RESOLUTION OF THOSE INSTANCES IN WHICH GOVERNING BOARD MEMBERS, OFFICERS, EMPLOYEES AND OTHER AGENTS OR REPRESENTATIVES OF THE CENTER (AND ITS AFFILIATES AND SUBSIDIARIES) MAY FIND THEMSELVES IN CIRCUMSTANCES GIVING RISE TO A POTENTIAL OR ACTUAL CONFLICT OF INTEREST. TO PROTECT THE CENTER'S INTEREST IN SUCH SITUATIONS, AND TO PROVIDE FOR ADEQUATE REPORTING MECHANISMS, ANNE CARLSEN CENTER WILL NOT ENTER INTO ANY TRANSACTION OR ARRANGEMENT WITH ANY ENTITY IN WHICH ANY BOARD MEMBER, OFFICER, EMPLOYEE OR AGENT THAT HAS A FINANCIAL INTEREST UNLESS SUCH TRANSACTION OR ARRANGEMENTS IS FULLY DISCLOSED TO, AND APPROVED BY THE PRESIDENT/CEO (OR THE BOARD, IF THE PRESIDENT/CEO OR A BOARD MEMBER HAS THE FINANCIAL INTEREST). AFTER DISCLOSURE OF THE FINANCIAL INTEREST OR FIDUCIARY RESPONSIBILITY AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINAL DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. ALL PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15A CEO COMPENSATION AND BENEFITS ARE REVIEWED, SET AND APPROVED INITIALLY BY THE GOVERNANCE COMMITTEE AND APPROVED BY THE FULL BOARD OF DIRECTORS. AN INDEPENDENT CONSULTANT IS USED TO DEVELOP AND CONDUCT A MARKET SURVEY FOR CASH COMPENSATION AND BENEFITS. THE SURVEY IS SENT TO STATE AND REGIONAL HEALTH AND HUMAN SERVICE PROVIDERS OF LIKE SIZED ORGANIZATIONS. PUBLISHED SURVEYS ARE ALSO USED BY THE CONSULTANT. A REPORT IS FILED WITH THEGOVERNANCE COMMITTEE AND BOARD AS WELL AS REVIEWED WITH THE INDEPENDENT CONSULTANT. DOCUMENTATION WOULD INCLUDE THE COMPENSATION REPORT AND MINUTES OF GOVERNANCE COMMITTEE AND BOARD DELIBERATIONS. ACC FOLLOWS THIS PROCESS EACH YEAR. THE CEO DETERMINES MANAGEMENT COMPENSATION PACKAGES FOR OTHER OFFICERS IN CONSULTATION AND RECOMMENDATION FROM AN EXTERNAL COMPENSATION CONSULTANT. AN INDEPENDENT CONSULTANT IS USED TO DEVELOP AND CONDUCT A MARKET SURVEY FOR CASH COMPENSATION AND BENEFITS. THE SURVEY IS SENT TO STATE AND REGIONAL HEALTH AND HUMAN SERVICE PROVIDERS OF LIKE SIZED ORGANIZATIONS. PUBLISHED SURVEYS ARE ALSO USED BY THE CONSULTANT. ACC FOLLOWS THIS PROCESS EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE SELECTS THE INDEPENDENT AUDITOR AND MEETS WITH THE AUDITOR AT THE END OF THE AUDIT TO DISCUSS THE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION SOLICITED REQUESTS FOR AUDIT PROPOSALS IN FICAL YEAR 2019 AND THE AUDIT COMMITTEE SELECTED THE AUDITOR. ANNE CARLSEN CENTER FOUNDATION 701 3RD ST NE BOX 8000 JAMESTOWN ND 58402 721524988 TO SUPPORT THE MISSION OF ANNE CARLSEN CENTER THROUGH FUNDRAISING ND 501(C)(3) LINE 2 ANNE CARLSEN CENTER 1 NIERLING ANNE CARLSEN CENTER TRUST 701 3RD ST NE BOX 8000 JAMESTOWN ND 58402 912004887 PRIVATE FOUNDATION ND 501(C)(3) PF ANNE CARLSEN CENTER 1 LEARN & MOVE CHILDCARE 2800 MAIN AVE FARGO ND 58103 810697524 DAYTIME CHILDCARE SERVICES ND 501(C)(3) LINE 10 ANNE CARLSEN CENTER 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 1 ANNE CARLSEN CENTER FOUNDATION O 585158 CASH ANNE CARLSEN CENTER FOUNDATION P 364341 CASH ANNE CARLSEN CENTER FOUNDATION R 913887 CASH ANNE CARLSEN CENTER FOUNDATION S 4600000 CASH