2019-06-06T08:42:25-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-01-01 870694180 ANNE CARLSEN CENTER ANNE 8005685175 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 TIM EISSINGER CEO 8005685175 2019-05-22 1 KAREN GRIES P00078514 6123764500 67.137.57.251 2019-05-22 20:34:21 CD P 0D02E0A3C8BE6705165B811C19B3E98A210D925A E9B0F9A18C8000C04B4B0CC56389FCB9464530FE 2018 2019-02-21 02:37:17Z TIM EISSINGER 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 37667723 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. 10 10 859 70 0 0 60120 12935 35811567 34833707 296 960 1391380 2820121 37263363 37667723 0 0 0 0 34117735 34397484 0 0 0 7174889 7469235 41292624 41866719 -4029261 -4198996 15723091 15274622 33045649 37013025 -17322558 -21738403 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 17690622 0 15543027 RESIDENT/MEDICAL:COMPLEX MEDICAL CARE, PSYCHOLOGICAL, HOME LIFE ENVIRONMENT, DIETARY, PHYSICIAN. REVENUE IS REFLECTED AT GROSS. SPEECH, OCCUPATIONAL, AND PHYSICAL THERAPY REVENUES WERE $1,054,663 AND EXPENSES WERE $992,271. 11459968 0 10108632 COMMUNITY SERVICES:CATEGORY INCLUDES IN-HOME AND DAY SUPPORTS, OTHER OUTREACH SERVICES, AND EARLY INTERVENTION PROGRAM GROSS REVENUES. DAY SUPPORT AND IN-HOME SUPPORT REVENUES WERE $4,185,282. TOTAL EARLY INTERVENTION REVENUES WERE $5,201,999. EMPLOYMENT PROGRAMMING REVENUES WERE $166,917. 2802732 0 5450163 EDUCATION:NINE-MONTH SCHOOL, TEN-WEEK EXTENDED SUMMER PROGRAM. 3091617 0 1960499 BEHAVIORAL AND MENTAL HEALTH SERVICES:MENTAL HEALTH SERVICES ARE PROVIDED IN MOORHEAD SERVING THE FARGO/MOORHEAD REGION. BEHAVIORAL HEALTH SERVICES ARE PROVIDED TO CHILDREN WITH AUTISM ACROSS NORTH DAKOTA. REVENUE IS REFLECTED AT GROSS. 1752507 0 1771386 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 AND OROFACIAL MYOLOGY. REVENUE IS REFLECTED AT GROSS. 4844124 0 3731885 36797446 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 72 0 859 1 0 0 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 ND WA WI MN X KRISTIN SYVERSON 7019525101 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 CASEY STOUDT BOARD CHAIR 2.00 2.00 X X 0 0 0 BRUCE FURNESS BOARD VICE CHAIR 1.00 1.00 X X 0 0 0 NICOLE POOLMAN TREASURER 1.50 1.50 X X 0 0 0 ALEX SCHWEITZER SECRETARY 1.50 1.50 X X 0 0 0 MATTHEW HANSON BOARD MEMBER 1.50 1.50 X 0 0 0 HARVEY HUBER BOARD MEMBER 1.00 1.00 X 0 0 0 THOMAS ROLFSTAD BOARD MEMBER 1.00 1.00 X 0 0 0 DR TAMARA MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 KRISTI MISHLER-WILFAHRT BOARD MEMBER 1.00 1.00 X 0 0 0 DR POLLY PETERSON BOARD MEMBER 1.00 1.00 X 0 0 0 ERIC MONSON BOARD MEMBER 1.00 1.00 X 0 0 0 LAUREL NELSON BOARD MEMBER 1.00 1.00 X 0 0 0 TIMOTHY EISSINGER CEO 40.00 10.00 X 211194 0 22806 STEPHANIE NELSON COO 40.00 10.00 X 156106 0 8365 DANIEL JOHNSON CFO (FORMER) 40.00 10.00 X 99077 0 14130 KRISTIN SYVERSON CFO 40.00 10.00 X 2404 0 0 PATRICIA OLSON CHIEF HR OFFICER 40.00 10.00 X 85318 0 5250 KRESHA WIEST DIRECTOR OF MGMT SYSTEMS 40.00 10.00 X 133967 0 6006 ERIK WILKIE CHIEF DEVELOPMENT OFFICER 10.00 40.00 X 109581 0 16549 797647 0 73106 4 0 1 0 CERIDIAN PO BOX 10989 NEWARK NJ 07193 PAYROLL MANAGEMENT SERVICES 164229 US FOODS INC 4601 32ND AVE S GRAND FORKS ND 58201 FOODSERVICE DISTRIBUTOR 133583 INNOVIS HEALTH 2422 20TH STREET SW JAMESTOWN ND 58401 MEDICAL CONSULTING 131237 3 9935 3000 12935 STUDENT SERVICE REVENUE 623990 17447396 17447396 COMMUNITY SUPPORT REVENUE 623990 10013793 10013793 KIDS REVENUE 621610 5196394 5196394 BEHAVIOR TREATMENT 623990 1676589 1676589 MENTAL HEALTH REVENUE 623990 293749 293749 205786 205786 34833707 960 960 COST REPORT SETTLEMENT 900099 2704079 2704079 MISCELLANEOUS REVENUE 900099 116042 116042 2820121 37667723 34833707 0 2821081 604650 102617 502033 26866984 24732555 2134429 660863 588103 72760 4029093 3807097 221996 2235894 1882918 352976 13990 13990 51206 51206 14450 14450 1667458 878369 789089 64872 1170 63702 280310 200963 79347 1618840 1352055 266785 875994 741061 134933 1085944 1014291 71653 177514 84349 93165 PROGRAM SUPPLIES 753832 752940 892 MISCELLANEOUS EXPENSE 296009 173652 122357 EQUIPMENT AND REPAIRS 209763 172706 37057 BAD DEBT EXPENSE 199878 199878 159175 112722 46453 41866719 36797446 5069273 0 1224129 1164286 4248405 4915884 178636 205978 1891 1457 243787 227741 24830896 17320620 8377705 7510276 1249000 1249000 199538 0 15723091 15274622 3902337 4031649 1779635 3050805 27363677 29930571 33045649 37013025 X -17322558 -21738403 -17322558 -21738403 15723091 15274622 -4198996 -216849 0 X 0 1 X 1 0 X 0 0 0 0 0 0 1 14450 0 0 14450 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. 2679930 -97026 2582904 2473853 206077 2679930 2158913 95000 219940 2473853 1850104 351866 -43057 2158913 1486613 316302 47189 1850104 0.14800 0.60400 0.24800 0 1 1 1142137 1142137 18516490 13850188 4666302 4609972 3470432 1139540 562297 562297 7510276 THIRD PARTY PAYOR SETTLEMENTS 2551101 RELATED PARTY PAYABLE 26855814 MISCELLANEOUS LIABILITIES 54157 EARN-OUT PAYABLE 469499 29930571 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 AND FOUNDATION ARE ORGANIZED AS NORTH DAKOTA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). ANNE CARLSEN 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. ANNE CARLSEN BELIEVES THEY ARE COMPLIANT WITH ALL IRS REGULATIONS AND AS OF DECEMBER 31, 2018, HAS NOT RECORDED A TAX LIABILITY FOR A TAX UNCERTAINTY. ANNE CARLSEN'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. 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 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 - $105,637; 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. X X X X 0 0 0 0 0 0 0 0 0 TIMOTHY EISSINGER CEO 211194 0 0 0 0 0 9000 0 13806 0 234000 0 0 0 STEPHANIE NELSON COO 144265 0 11841 0 0 0 6326 0 2039 0 164471 0 0 0 FORM 990, PART III, LINE 1 ADDITIONAL ORGANIZATION MISSION INFORMATION: ADDITIONALLY, THE PURPOSES FOR WHICH THE ORGANIZATION IS ORGANIZED ARE: A) TO PROVIDE 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 PROVIDE RESIDENTIAL, EDUCATION, AND COMMUNITY BASED PROGRAM CURRICULUM TO CHILDREN ON THE AUTISM SPECTRUM. 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. 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 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. 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. 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 2 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 LEARN & MOVE CHILDCARE 2800 MAIN AVENUE 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 R 3637000 FMV