2014-11-06T09:08:27-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-01-01 870694180 ANNE CARLSEN CENTER ANNE 8005685175 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 ERIC MONSON CEO 8005685175 2014-10-31 1 JENNIFER TINGLEY P01485570 6123764500 2013 2015-11-30 17:44:51Z ERIC MONSON 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 26697395 0 X WWW.ANNECENTER.ORG X 1941 ND TO PROVIDE SERVICES FOR DEVELOPMENTALLY DISABLED INDIVIDUALS AND OTHER CHILDREN AND ADULTS WITH SPECIALIZED HEALTH CARE AND EDUCATION NEEDS. 11 11 690 125 0 0 8578 1950 23125190 26626725 5301 2481 18227 66239 23157296 26697395 15000 15000 0 0 21674420 24195020 0 0 0 5627564 6272295 27316984 30482315 -4159688 -3784920 12789210 12978645 13513062 17487417 -723852 -4508772 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 12695995 15000 11270008 RESIDENT/MEDICAL:COMPLEX MEDICAL CARE, PSYCHOLOGICAL, HOME LIFE ENVIRONMENT, DIETARY, PHYSICIAN. REVENUE IS REFLECTED AT GROSS, CONTRACTUAL DISCOUNTS TOTAL $843,021. 9655018 0 9283194 COMMUNITY SERVICES:CATEGORY INCLUDES IN HOME AND DAY SUPPORTS, OTHER OUTREACH SERVICES, AND EARLY INTERVENTION PROGRAM GROSS REVENUES. DAY SUPPORT AND IN-HOME SUPPORT REVENUE $4,845,541 DAY SUPPORTS DEDUCTIONS ARE $437,743; IN-HOME SUPPORT DEDUCTIONS ARE $469,911. OUTREACH SERVICES (THERAPY, WORKSHOPS, EVALUATIONS, CONSULTATIONS AND MISC OTHER REVENUE TOTAL $113,286). CONTRACTUAL PAYMENTS FOR OUTREACH THERAPY SERVICES TOTALED $107,481. TOTAL EARLY INTERVENTION REVENUES WERE $3,940,433 AND EXPENSES WERE $3,905,392. 2812826 0 3969098 EDUCATION:NINE MONTH SCHOOL, TEN WEEK EXTENDED SUMMER PROGRAM. SERVED 65 STUDENTS OR 10,455 CENSUS DAYS. 1684610 0 2104425 THERAPEUTIC SUPPORT:PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, RECREATIONAL. PROVIDED TO BOTH CENTER STUDENTS AND OUTPATIENT IN JAMESTOWN, CARRINGTON AND VALLEY CITY. SENSORY MOTOR, INTEGRATION, AQUATIC THERAPY, DYSPHASIA TREATMENT, AND ADAPTIVE EQUIPMENT. TOTAL UNITS OF SERVICES 45,332. REVENUE IS REFLECTED AS GROSS. DEDUCTIONS FROM REVENUE INCLUDE OUTPATIENT MEDICAID $256,033; OUTPATIENT COMMERCIAL INSURANCE $113,405. 1684610 0 2104425 26848449 1 0 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 92 0 690 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN ND WA WI X ALLAN HARTMANN 7012523850 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 BRUCE ISERMAN BOARD CHAIR 2.00 2.00 X X 0 0 0 HARVEY HUBER BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 PAT MCCULLOUGH TREASURER 1.50 1.50 X X 0 0 0 JANET SEAWORTH SECRETARY 1.50 1.50 X X 0 0 0 PAT TRAYNOR IMMEDIATE PAST CHAIR 1.00 1.00 X X 0 0 0 TIM FLAKOLL BOARD MEMBER 1.00 1.00 X 0 0 0 JOEL FREMSTAD BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT MONTGOMERY BOARD MEMBER 1.00 1.00 X 0 0 0 SUE OFFUTT BOARD MEMBER 1.00 1.00 X 0 0 0 THOMAS ROHLEDER BOARD MEMBER 1.00 1.00 X 0 0 0 REESA WEBB BOARD MEMBER 1.00 1.00 X 0 0 0 ERIC MONSON CEO 40.00 10.00 X 175152 0 28911 ALLAN HARTMANN CFO 40.00 10.00 X 97612 0 7888 MARCIA GUMS COO 50.00 0.00 X 120386 0 28711 393150 0 65510 2 0 1 0 AMN HEALTHCARE 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 HEALTH CARE SERVICES 153536 INNOVIS HEALTH LLC 3000 32ND AVE S FARGO ND 58103 HEALTH CARE SERVICES 151752 CERIDIAN PO BOX 10989 NEWARK NJ 07193 PAYROLL SERVICES 126581 CLIFTONLARSONALLEN LLP 220 S SIXTH ST 300 MINNEAPOLIS MN 554021436 ACCOUNTING SERVICES 100724 4 1950 1950 STUDENT SERVICE REVENUE 623990 14806638 14806638 COMMUNITY SUPPORT REVENUE 623990 7681006 7681006 EARLY INTERVENTION 623990 3886815 3886815 RESOURCE CENTER REVENUE 623990 111721 111721 SCHOOL LUNCH PROGRAM 611710 79062 79062 61483 61483 26626725 590 590 1891 0 1891 1891 1891 MISCELLANEOUS REVENUE 900099 66239 66239 66239 26697395 26626725 0 68720 15000 15000 458660 417500 41160 19450937 17530501 1920436 418384 367779 50605 2476441 2275961 200480 1390598 1275766 114832 17961 17961 86570 86570 1117871 671333 446538 297045 235215 61830 1036430 934106 102324 761957 685066 76891 1085204 1085204 185926 185926 PROGRAM SUPPLIES 647049 643992 3057 EQUIPMENT AND REPAIRS 371754 318844 52910 STAFF DEVELOPMENT 212629 130721 81908 DUES AND SUBSCRIPTIONS 57145 20218 36927 394754 55317 339437 30482315 26848449 3633866 0 -298453 304940 4589422 4336383 16836 1536 120453 116427 21652918 13433559 7956109 8219359 404843 0 12789210 12978645 2313116 2495761 908256 11199946 14083400 13513062 17487417 X -723852 -4508772 -723852 -4508772 12789210 12978645 -3784920 0 X 0 1 X 1 0 X 0 0 0 0 0 1 0 1 0 0 0 1 24337 0 0 24337 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. PRESENTATIONS REGARDING CHILDHOOD AUTISM SPECTRUM DISORDER WERE MADE AT THE REQUEST OF LEGISLATIVE COMMITTEES. 1279919 95200 111494 1486613 1173971 15000 90948 1279919 1206731 5000 -37660 100 1173971 959049 10000 239682 1206731 0.00000 0.71000 0.29000 0 1 1 475139 475139 10882776 6453950 4428826 9457471 6435086 3022385 837532 544523 293009 8219359 THIRD PARTY PAYOR SETTLEMENTS 2245444 RELATED PARTY PAYABLE 11837956 14083400 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 CENTER IS ORGANIZED AS A NORTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE CENTER BELIEVES THE ORGANIZATION IS COMPLIANT WITH ALL IRS REGULATIONS AND AS OF DECEMBER 31, 2013, HAS NOT RECORDED A TAX LIABILITY FOR A TAX UNCERTAINTY. THE CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. ANNE CARLSEN IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE FISCAL YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 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 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 PROVIDES SIGNIFICANT RESOURCES TO ENHANCE THE EDUCATION EXPERIENCE FOR THE STUDENTS AT THE CENTER AND DAY STUDENTS. SCHEDULE E, PART I, LINE 6 THE CENTER RECEIVED ASSISTANCE UNDER THE SCHOOL LUNCH PROGRAM - $79,062; TUITION REIMBURSEMENTS FROM LOCAL SCHOOL DISTRICTS, SPECIAL EDUCATION UNITS, BUREAU OF INDIAN EDUCATION AND THE STATE DEPARTMENT OF PUBLIC INSTRUCTIONS. THE CENTER RECEIVED MEDICAID FUNDING FROM NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES FOR RESIDENTIAL/MEDICAL AND KIDS PROGRAM ON STATE MEDICAID PROGRAM. 1 CAMP GRASSICK PO BOX F DAWSON ND 584580005 456012705 501(C)(3) 15000 N/A N/A SUPPPORT DISABLED CHILDREN; IN ADDITION, ACC HOLDS A ONE WEEK TECHNO CAMP 1 0 PART I, LINE 2: THE CENTER RECEIVES AN ANNUAL UPDATE REPORT AS TO THE USE OF THE DOLLARS THAT THEY GRANT TO ELKS CAMP GRASSICK. X X X X 0 0 0 0 0 0 0 0 0 ERIC MONSON CEO 169729 0 0 0 5423 0 7948 0 20963 0 204063 0 0 0 FORM 990, PART III, LINE 1 ADDITIONAL ORGANIZATION MISSION INFORMATION: ADDITIONALLY, THE PURPOSES FOR WHICH THE CORPORATION IS ORGANIZED ARE: A) TO PROVIDE EXCELLENCE IN SERVICES TO INTELLECTUALLY AND DEVELOPMENTALLY DISABLED INDIVIDUALS AND OTHER CHILDREN AND ADULTS WITH SPECIALIZED HEALTH CARE AND EDUCATIONAL 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 ENGAGE IN ANY LAWFUL NONPROFIT ACTIVITY NOT INCONSISTENT WITH THE CORPORATION'S STATUS AS A CHARITABLE TAX-EXEMPT CORPORATION. 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 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. THE COMMITTEE IS RESPONSIBLE FOR BOARD DEVELOPMENT, NOMINATING BOARD MEMBERS, GOVERNANCE POLICIES, AS WELL AS EMPLOYMENT REVIEW AND COMPENSATION OF THE PRESIDENT/CEO. FORM 990, PART VI, SECTION B, LINE 11 THE CFO PROVIDES THE FORM 990 ELECTRONICALLY TO ALL BOARD MEMBERS FOR THEIR REVIEW. THE FINANCE COMMITTEE, CFO AND CEO 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 ARRANGEMENT 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 THE GOVERNANCE 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 AND WAS MOST RECENTLY UNDERTAKEN IN MAY, 2013 FOR THE CEO, E. MONSON. 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. THIS PROCESS WAS MOST RECENTLY UNDERTAKEN IN MAY, 2013 FOR THE CFO, A. HARTMANN, THE COO, M. GUMS AND ALL OTHER EXECUTIVE POSITIONS. 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. ANNE CARLSEN CENTER FOUNDATION 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 721524988 TO SUPPORT THE MISSION OF ANNE CARLSEN CENTER THROUGH FUNDRAISING ND 501(C)(3) LINE 7 ANNE CARLSEN CENTER 1 NIERLING ANNE CARLSEN CENTER TRUST 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 912004887 PRIVATE FOUNDATION ND 501(C)(3) PF ANNE CARLSEN CENTER 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 ANNE CARLSEN CENTER FOUNDATION P 703568 FMV