2023-05-25T08:10:33-05:00 2022-12-31 450310328 BRADY MARTZ & ASSOCIATES PC PO BOX 1297 BISMARCK ND 585021297 990 2022-01-01 721524988 ANNE CARLSEN CENTER FOUNDATION ANNE 8005685175 701 3RD STREET NW BOX 8000 JAMESTOWN ND 58402 TIM EISSINGER CEO 8005685175 2023-05-18 1 TIM EISSINGER 999009999 1 MELINDA PIATZ P00739198 7012231717 2023-05-18 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TIM EISSINGER 701 3RD STREET NW BOX 8000 JAMESTOWN ND 58402 12337225 0 X WWW.ANNECENTER.ORG X 2003 ND TO SUPPORT THE MISSION AND PURPOSE OF THE ANNE CARLSEN CENTER. 15 15 0 17 0 0 5373461 4749982 0 0 4035129 2329485 51218 91430 9459808 7170897 105290 75970 0 0 628237 857210 0 0 1160187 298991 302977 1032518 1236157 8427290 5934740 76726782 77145040 42961 31385 76683821 77113655 TO SUPPORT THE MISSION AND PURPOSE OF THE ANNE CARLSEN CENTER, 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 75970 75970 TO SUPPORT THE MISSION AND PURPOSE OF THE ANNE CARLSEN CENTER. 75970 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 ND MN WA WI X THE ORGANIZATION 7019525101 701 3RD ST NW JAMESTOWN ND 58401 NICOLE POOLMAN CHAIR 2.00 2.00 X X 0 0 0 DR TAMARA MATHISON VICE CHAIR 2.00 2.00 X X 0 0 0 DR POLLY PETERSON TREASURER 1.50 1.50 X X 0 0 0 CAROL NITSCHKE SECRETARY 1.50 1.50 X X 0 0 0 CASEY STOUDT TRUSTEE 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 THOMAS ROLFSTAD TRUSTEE 1.00 1.00 X 0 0 0 BRUCE FURNESS TRUSTEE 1.00 1.00 X 0 0 0 ALEX SCHWEITZER TRUSTEE 1.00 1.00 X 0 0 0 PETER JOHNSON TRUSTEE 1.00 1.00 X 0 0 0 TAMMY VALVO TRUSTEE 1.00 1.00 X 0 0 0 TIMOTHY EISSINGER CEO 10.00 40.00 X 0 303762 27369 STEPHANIE NELSON COO 10.00 40.00 X 0 214381 10602 KRISTIN SYVERSON CFO (END 2/2023) 10.00 40.00 X 0 181513 9230 MYRA QUANRUD CHIEF MEDICAL OFFICER 10.00 40.00 X 0 203258 12671 TIFFANY HUNT CHIEF DEVELOPMENT OFFICER 10.00 40.00 X 0 91196 4398 MICHAEL MEYER FORMER CHIEF DEVELOPMENT OFFICER 10.00 40.00 X 0 141786 17022 0 1135896 81292 0 1 1 0 0 4749982 46832 4749982 2549467 2549467 4861767 5081749 -219982 -219982 -219982 176009 84579 91430 91430 7170897 0 0 2420915 75970 75970 736780 736780 17791 17791 47030 47030 55609 55609 88837 88837 36758 36758 17706 17706 55208 55208 18583 18583 28209 28209 424 424 245 245 REPAIRS AND MAINTENANAC 28476 28476 MISCELLANEOUS 19720 19720 STAFF DEVELOPMENT 8098 8098 INTEREST, TAXES AND LIC 703 703 10 10 1236157 75970 0 1160187 11106845 2233115 2338376 1077437 49930 8330 93098 91689 1832 1409 25402786 18969602 5308566 4267476 32518447 50587671 76726782 77145040 27074 19191 15887 12194 42961 31385 X 55475784 65655016 21208037 11458639 76683821 77113655 76726782 77145040 X 5934740 -4426684 -1078222 X X 0 1 X 1 0 X 2126535 6129894 2650429 5373461 4749982 21030301 2126535 6129894 2650429 5373461 4749982 21030301 2795032 18235269 2219929 2125130 1442467 3673824 2549467 12010817 33041118 0.55190 0.59280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5077573 153566 -405247 4825892 3211371 369757 2429842 933397 5077573 3134722 76649 410130 410130 3211371 2582904 178407 805049 431638 3134722 2679930 -97026 2582904 0.80690 0.19310 0 0 93098 91689 1409 1409 BENEFICIAL INTEREST IN TRUSTS AND ESTATES 4267476 F 4267476 RELATED PARTY RECEIVABLES 50560035 CASH SURRENDER VALUE OF LIFE INSURANCE 27636 50587671 ANNUITIES PAYABLE 12194 12194 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO SUPPORT THE MISSION OF ANNE CARLSEN CENTER. PART X, LINE 2: THE ANNE CARLSEN CENTER FOUNDATION 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 FOUNDATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE FEDERAL INCOME TAX RETURNS 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. SUIT AND BOOTS 106329 106329 52740 GOLF TOURNAMENT 35725 35725 14134 2 33955 33955 17705 176009 176009 84579 84579 91430 0 ANNE CARLSEN CENTER 701 3RD AT NE BOX 8000 JAMESTOWN ND 58402 870694180 501(C)(3) 75970 0 OPERATIONAL SUPPORTOPERATIONAL SUPPORT 1 0 0 0 0 0 0 0 0 0 TIMOTHY EISSINGER CEO 0 276000 0 27762 0 0 0 12144 0 15225 0 331131 0 0 STEPHANIE NELSON COO 0 196048 0 18333 0 0 0 8575 0 2027 0 224983 0 0 MYRA QUANRUD CHIEF MEDICAL OFFICER 0 185096 0 18162 0 0 0 0 0 12671 0 215929 0 0 KRISTIN SYVERSON CFO (END 2/2023) 0 165253 0 16260 0 0 0 7254 0 1976 0 190743 0 0 MICHAEL MEYER FORMER CHIEF DEVELOPMENT OFFICER 0 126785 0 15001 0 0 0 5671 0 11351 0 158808 0 0 PART I, LINE 3 THE FOUNDATION RELIED ON A RELATED ORGANIZATION, ANNE CARLSEN CENTER, TO DETERMINE COMPENSATION FOR THE CEO WHICH INCLUDED THE FOLLOWING PRACTICES: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OF THE COMPENSATION COMMITTEE. X FURNITURE & EQUIPMENT 0 29302 FMV X CONTRIBUTED SERVICES 0 8355 FMV X ADVERTISING 0 5000 FMV X VENUE RENTAL 0 3375 FMV X FOOD 0 800 FMV 0 0 0 FORM 990, PART I, LINE 1 FOR A READER TO FULLY UNDERSTAND THE ACTIVITY AND PROGRAMS OF THE ANNE CARLSEN CENTER FOUNDATION, MANAGEMENT RECOMMENDS THAT THE READER ALSO REVIEW THE ANNE CARLSEN CENTER FORM 990. FORM 990, PART VI, SECTION A, LINE 1A 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 FOUNDATION 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 SHALL BE RESPONSIBLE FOR BOARD DEVELOPMENT, NOMINATING BOARD MEMBERS, AND GOVERNANCE POLICIES. 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 11B THE BOARD 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). 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 C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF PERPETUAL TRUSTS -895,075. CHANGE IN VALUE OF TRUST HELD AS TRUSTEE -45,425. CHANGE IN VALUE OF CHARITABLE REMAINDER TRUST -100,590. CHANGE IN VALUE OF LIFE ESTATES 2,074. CHANGE IN VALUE OF GIFT ANNUITY -39,206. FORM 990, PART XII, LINE 2C: THE FOUNDATION RELIED ON A RELATED ORGANIZATION TO HIRE THE EXTERNAL AUDITOR. AS PART OF THIS PROCESS, THE RELATED ORGANIZATION DID NOT CHANGE THEIR PROCESS DURING THE YEAR. ANNE CARLSEN CENTER 701 3RD ST NE BOX 8000 JAMESTOWN ND 58402 870694180 EDUCATIONAL, RESIDENTIAL, MEDICAL AND THERAPY SERVICES FOR CHILDREN ND 501(C)(3) LINE 2 0 NIERLING ANNE CARLSEN CENTER TRUST 701 3RD ST NE BOX 8000 JAMESTOWN ND 58402 912004887 PRIVATE FOUNDATION ND 501(C)(3) PF ANN CARLSEN CENTER 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 ANNE CARLSEN CENTER O 857143 CASH ANNE CARLSEN CENTER P 336614 CASH ANNE CARLSEN CENTER R 4028629 CASH