2012-09-17T09:28:18-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-01-01 721524988 ANNE CARLSEN CENTER FOUNDATION ANNE 8005685175 701 3RD STREET NW BOX 8000 JAMESTOWN ND 58402 ERIC MONSON 8005685175 2012-09-10 XIAOYAN LUO P01305207 6123764500 2011 2016-02-24 21:20:13Z ERIC MONSON 701 3RD STREET NW BOX 8000 JAMESTOWN ND 58402 3465375 0 X WWW.ANNECENTER.ORG X 2003 ND TO SUPPORT THE MISSION AND PURPOSE OF THE ANNE CARLSEN CENTER. 11 11 0 50 0 0 1731530 1590718 0 0 1172101 2384758 1133 9246 2904764 3984722 0 0 0 0 219919 218309 20337 19909 684161 243809 445943 484065 684161 2420699 3300561 31277972 31719889 202009 258376 31075963 31461513 TO SUPPORT THE ANNE CARLSEN CENTER IN JAMESTOWN, NORTH DAKOTA BY SOLICITING, RECEIVING, HOLDING, INVESTING, ADMINISTERING, DISTRIBUTING AND DISBURSING DONATED FUNDS AND ANY AND ALL TYPES OF DONATED OR PERSONAL PROPERTY IN SUPPORT OF THAT MISSION. 0 0 0 0 0 TO SUPPORT THE MISSION AND PURPOSE OF THE ANNE CARLSEN CENTER. 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN WA ND WI X JUDY KULLA CFO 7019525101 701 3RD STREET NW BOX 8000 JAMESTOWN ND 58402 X THOMAS ROHLEDER 2.00 X X 0 0 0 PAT TRAYNOR 1.00 X X 0 0 0 BRUCE ISERMAN 1.50 X X 0 0 0 HARVEY HUBER 1.50 X X 0 0 0 TIM FLAKOLL 1.00 X 0 0 0 JOEL FREMSTAD 1.00 X 0 0 0 PAT MCCULLOUGH 1.50 X 0 0 0 ROBERT MONTGOMERY 1.00 X 0 0 0 SUE OFFUTT 1.00 X 0 0 0 JANET SEAWORTH 1.00 X 0 0 0 REESA WEBB 1.00 X 0 0 0 ERIC MONSON 10.00 X 0 169551 17334 JUDY KULLA 10.00 X 0 110651 13207 0 280202 30541 0 0 1 0 0 33926 1556792 262000 1590718 1634692 1634692 197245 -552821 750066 750066 750066 42720 33926 33474 9246 9246 3984722 0 0 2394004 183323 183323 2806 2806 18581 18581 13599 13599 19909 19909 173375 173375 19447 19447 39144 39144 18487 18487 25043 25043 82727 82727 ALLOCATION OF CENTER EX 78676 78676 STAFF DEVELOPMENT 4488 4488 EQUIPMENT 4192 4192 GROCERIES 364 364 684161 0 0 684161 6543546 4020471 10700 147090 20667845 24159602 4055881 3392726 31277972 31719889 21610 96827 180399 161549 202009 258376 X 26820694 26860592 1513840 1066097 2741429 3534824 31075963 31461513 31277972 31719889 X 3300561 -2915011 X 0 1 1 X 0 X 1316127 1441144 1134782 1731530 1590718 7214301 1316127 1441144 1134782 1731530 1590718 7214301 114314 7099987 2815937 727013 645500 1172101 1634692 6995243 14209544 103306 0.49970 0.54670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1206731 5000 -37660 1174071 957049 10000 239682 1206731 0.80650 0.19350 0 0 0 TRUST INTERESTS 3392726 C 3392726 ANNUITIES PAYABLE 161549 161549 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO SUPPORT THE MISSION OF ANNE CARLSEN CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 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, 2011, HAS NOT RECORDED A TAX LIABILITY FOR A TAX UNCERTAINTY. ANNE CARLSENS 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 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. X X X 1 BBS & ASSOCIATES 130 SPRINGSIDE DRIVE 200 AKRON OH 44333 FUNDRAISING 0 0 19909 -19909 19909 -19909 MN ND WA WI GOLF TOURNAMENT 32260 25733 6527 2000 3248 1350 7887 NEW YEAR'S EVE GALA 22797 8193 14604 1347 400 10834 2227 4181 1 21589 21589 76646 33926 42720 3347 3648 12184 2227 12068 33474 9246 0 0 0 0 0 0 0 0 0 ERIC MONSON 0 149751 0 19800 0 0 0 2419 0 14915 0 186885 0 0 SUPPLEMENTAL INFORMATION PART III THE FOUNDATION RELIED ON A RELATED ORGANIZATION TO DETERMINE THE COMPENSATION FOR THE CEO WHICH INCLUDED THE FOLLOWING PRACTICES: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. X 1 262000 APPRAISED VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION'S SOLE MEMBER IS ANNE CARLSEN CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, ANNE CARLSEN CENTER APPOINTS THE BOARD OF TRUSTEES OF THE FOUNDATION. THE SOLE MEMBER DETERMINES THE NUMBER OF, APPOINTS, AND MAY REMOVE, WITH OR WITHOUT CAUSE, ALL OF THE OFFICERS OF THE FOUNDATION, EXCEPT THE BOARD CHAIR AND VICE CHAIR, WHO SHALL BE ELECTED BY THE BOARD OF TRUSTEES OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER MUST APPROVE ALL BYLAWS AND AMENDMENTS TO BYLAWS AND AMENDMENTS TO ARTICLES OF INCORPORATION OF THE FOUNDATION; APPROVES THE FOUNDATION'S ANNUAL BUDGET; AND APPROVES ALL DISTRIBUTIONS AND DISBURSEMENTS FROM THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11 THE CHAIR, IMMEDIATE PAST CHAIR, CEO AND CFO CONDUCTED A DETAILED REVIEW OF THE FORM 990. THE FORM 990 IS THEN ELECTRONICALLY FORWARDED TO THE FULL BOARD FOR REVIEW AND APPROVAL BEFORE IT IS FILED WITH IRS. 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 FOUNDATION (AND ITS AFFILIATES AND SUBSIDIARIES) MAY FIND THEMSELVES IN CIRCUMSTANCES GIVING RISE TO A POTENTIAL OR ACTUAL CONFLICT OF INTEREST. TO PROTECT THE FOUNDATION'S INTEREST IN SUCH SITUATIONS, AND TO PROVIDE FOR ADEQUATE REPORTING MECHANISMS, THE FOUNDATION 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). FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. EXPLANATION OF HOURS WORKED FORM 990, PART VII, SECTION A ERIC MONSON, CEO; AND JUDY KULIA, CFO, WORK AN AVERAGE OF 50 HOURS WEEKLY AND ALLOCATE THEIR TIME BETWEEN ANNE CARLSEN CENTER (ACC) AND ANNE CARLSEN CENTER FOUNDATION (ACCF) AS FOLLOWS: ERIC MONSON ACC: 40 HOURS ACCF: 10 HOURS JUDY KULIA ACC: 40 HOURS ACCF: 10 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,835,006. CHANGE IN VALUE OF TRUSTS -80,005. TOTAL TO FORM 990, PART XI, LINE 5: -2,915,011. ANNE CARLSEN CENTER 701 3RD STREET NE BOX 8000 JAMESTOWN ND 58402 870694180 EDUCATIONAL, RESIDENTIAL, MEDICAL AND THERAPY SERVICES FOR CHILDREN ND 501(C)(3) LINE 2 N/A 0 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 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0