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CHARITABLE ORGANIZATION REGISTRATION STATEMENT SECRETARY OF STATE SFN 11300(11-2012)

FOR OFFICE USE ONLY ID Number

WO Number

Issued By

Instructions: 1. For reference, see North Dakota Century Code Section 50-22. 2. Please type or print, complete all blanks, enter "None" when appropriate. 3. Any omission or failure to report complete and/or accurate information in this application may result in

an investigation by the Secretary of State and/or the Attorney General and may result in forfeiture of your registration.

Privacy: In accordance with the provisions in N.D.C.C. Chapter 44-04, the disclosure of a Federal ID number is voluntary. Failure to provide it will not result in the rejection of the registration. The number is not disclosed to the public. It is used by the Secretary of State to accurately maintain charitable organization records.

Secretary of State State of North Dakota 600 E Boulevard Ave Dept 108 Bismarck ND 58505-0500 Telephone 701-328-3665 Toll Free 800-352-0867 Ext 328-3665 Fax 701-328-1690 Website: www.nd.gov/sos

Legal Name of Organization

North Dakota Center for Nursing

Federal ID Number

452605788

Name(s) Under Which the Organization Solicits Contributions North Dakota Center for Nursing and North Dakota Action Coalition

Street and Mailing Address of Principal Executive Office

417 Main Avenue Suite #402

City Fargo

State

ND

ZIP Code

58,103

Telephone Number

701-365-0408

Street and Mailing Address of Principal Office in North Dakota

417 Main Avenue Suite #402 ~2 None

City Fargo

State

ND

ZIP Code

58103

Telephone Number

701-365-0408 The registrant is a: "Unincorporated nonprofit association

[~~| State of Origin:

[71 Non-profit Corporation [~J Trust Year Organized: 06/17/2011

Is the organization exempt from federal income taxes? If yes, attach a copy of your IRS determination letter. If the application is pending attach a copy of the first page of the application.

[7] Yes • No • Application Pending Status: 501 (c)(3 )

Check one or more methods of soliciting the organization anticipates using. Direct Mail Personal Contact

_| Vending Business

Radio 3 Television ["jNational ["jLocal

Show or Concert 7 ] Grant Writing

[7J Other (please describe): e m a | | n e w s | e t t e r a n d w e b s i t e

Telemarketing Newspaper Magazines or Periodicals Membership Enrollment

Period of Time During Which Solicitation is to be Conducted

continous

General Purposes for Which Organized Charitable, educational and scientific. Provision of education, planning, development, research and other services to address issues and obstacles affecting the nursing profession.

General Purposes for Which Contributions to be Solicited will be Used Guide the ongoing development of a well-prepared and diverse nursing workforce to meet the needs of the citizens of ND through research, education, recruitment and retention, advocacy and public policy.

Name of Person in Charge of Organization's Books and Records if not Kept at the Organization's Office

Patrick J. Brown, CPA

Telephone Number 701-223-1717

Address City

207 East Broadway Avenue Bismarck

State ZIP Code

ND 58502

Attach a list of names and addresses of all directors, officers, and trustees. Indicate the individuals having the final discretion or authority as to the distribution and use of contributions received. The Board of Directors has the final discretion or authority.

(continue on reverse side)

S=N 11330 (11-2012)

s - (Attach a list of total compensation inducing salaries, fees, bonuses, fringe benefits severance payments and deferred compensation, paic I to employees by the charitable organization and all its affiliated organizations.

Month and day accounting year ends June 30th

State the total contnbutions the organization received during the last ended accounting yea'

$310 758 36

Attach financial statement or IRS Form 9S0 If neither is available complete the following for the most recent twelve-month accounting year

INCOME EXPENSES Contributions from the publ.c ! Amount spent for prooram cr chaiitabte purposes $

Government Grants s Management / qeneral expense S

Fees for p-ogram service $ Fund-raising expense $

Other Revenue $ Amounts paid to affilated organizations $

TOTAL INCOME $ TOTAL EXPENSES S EXCESS or Deficit IS TOTAL Assets i END OF YEAR FUND BALANCE / NET WORTH TOTAL liabilities $ (Assets minus LiabiHies) s

Will the solicitation be conducted by [71 voluntary unpaid solicitors [~jpaid solicitors •both

If in whole or part by paid solicitor, list the name and address of each professional fundraiser supplying the solicitors and a copy of the agreement Attach an additional sheet if necessary If a contract written agreement, or statement of any arrangement is made between ar applicant and professional fundraiser/solicitor after a solicitation registration the applicant agrees to file a copy of such contract or agreement with the Secretary of State. Name of Professional Funaraiser Telephone Number

Address City State ZIP Code

Name of Professional Fundraiser Telephone dumber

Address City State ZIP Code

Has your organization or a member thereof been involved in any civil or criminal litigation in the past year' • yes - attach a summary staterre-t of the litigation the outcome, and the parties invotved. [7J "-to

Has yoi-r organization been denied the nght to solicit contributions at any time by any government or any court7

| |Yes - attach an explanation [7J No

SIGNATURE AND CERTIFICATION

I the undersigned state and certfy that I am a duly constituted officer of this organization, being the f f t S sA^-CV^" ... ,Title) and that this

Registration Statement is executed on behalf of the organization by me pursuant to resolutions of the Ji C>",-<~1 - O ' f t C - T o r S (Board of Directors Trustees or Managing Sroup) adopted on the_ day of 20 ...... approving tn« contents of the Registration Statement and ds hereby certify that the O p c c S (Board of Directors Trustees or

Managing Group) has assumed and wil continue to assume responsibility for determining matters of policy and have supervised, and v«ill continue to

supervise tne finances of the organization. I the undersigned, state mat the information supplied ts true correct and complete to the best of my knovdedge

and I understand that if I make a false statement in this registration. I may be subject to criminal penalties

SFN 11300(11-2012)

CREDIT CARD PAYMENT AUTHORIZATION SECRETARY OF STATE SFN 51478(4-2012)

(All items required to complete transaction)

Amount Authorized

Name Telephone Number

Address City

2 £ v i S A MasterCard Discover Account Number

</|0|1|2| i ^ q G | q I, l,^|3| fe, V \

CSC Number*

5,2T|0

Card Expires Month Year

6 | 7 l - I ) IS

State

N "0 ZIP Code

Signature (Required by Credit Card Companies)

Date

13 ' (CSC is the three-digit security code on the back of your card by the signature)

INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201

DEPARTMENT OF THE TREASURY

Date FEB 27 2013 Employer I d e n t i f i c a t i o n Number: 45-2605788

DliN: 17053080317042

NORTH DAKOTA CENTER FOR NURSING 919 SOUTH 7TH ST S STE 504 BISMARCK, ND 58504

Contact Person: GINGER L JONES ID# 31646

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: June 30

Public C h a r i t y S t a t u s : 1 7 0 ( b ) ( 1 ) ( A ) ( v i )

Form 990 Required: Yes

E f f e c t i v e Date of Exemption: June 17, 2011

Contribution D e d u c t i b i l i t y : Yes

Addendum Applies: No

Dear Applicant:

We are pleased to inform you that upon review of your a p p l i c a t i o n f o r tax exempt, s t a t u s we have determined that you are exempt from Federal income tax under s e c t i o n 501(c)(3) of the I n t e r n a l Revenue Code. Contributions to you are deductible under s e c t i o n 170 of the Code. You are a l s o q u a l i f i e d to r e c e i v e tax deductible bequests, devises, t r a n s f e r s or g i f t s under s e c t i o n 2055, 2106 or 2522 of the Code. Because t h i s l e t t e r could help r e s o l v e any questions regarding your exempt s t a t u s , you should keep i t i n your permanent records.

Organizations exempt under s e c t i o n 501(c)(3) of the Code are f u r t h e r c l a s s i f i e d as e i t h e r p u b l i c c h a r i t i e s or p r i v a t e foundations. We determined that you are a p u b l i c c h a r i t y under the Code s e c t i o n ( s ) l i s t e d i n the heading of t h i s l e t t e r .

Please see enclosed P u b l i c a t i o n 4221-PC, Compliance Guide f o r 501(c)(3) P u b l i c C h a r i t i e s , for some h e l p f u l information about your r e s p o n s i b i l i t i e s as an exempt o r g a n i z a t i o n .

L e t t e r 947 (DO/CG)

-2-

NORTH DAKOTA CENTER FOR NURSING

S i n c e r e l y ,

Holly O. Paz

Dir e c t o r , Exempt Organizations Rulings and Agreements

Enclosure: P u b l i c a t i o n 4221-PC

L e t t e r 947 (DO/CG)

# 9. Attach a list of compensation, including salaries, fees, bonuses, fringe benefits, severance payments and deferred compensation, paid to employees by the charitable organization and its affiliated organizations.

Projected Fiscal Year 2013-2014 Employee Compensation

Name Salary Fringe Benefits Patricia Moulton, Executive Director

$91,936 $22,984

Kyle Martin, Marketing and Communications Coordinator

$41,000 $10,250

TBD, Program Coordinator $31,000 $7,750

4 North Dakota Center for Nursing A uni f ied voice for nursing excellence.

Nonprofit Organization Governing Board of Directors June, 2013

Name Organization Representing City Phone Number Email address Term Margaret Reed, President North Dakota Organization of

Nurse Executives (NDONE) Grand Forks 701-775-2959 [email protected] 2011-2014

Mary Anne Marsh, Vice President

Alternate: Karen Latham

College and University Nursing Education Administrators (CUNEA)

Dickinson

Bismarck

701-483-2480

701-323-6734

[email protected]

KLATHAMr3mocn.edu

2011-2014

Julie Hanson, Secretary ND Chapter of National Assoc Directors of Nursing Admin/LTC (NDNADONA)

Mayville 701-786-3401 [email protected] 2011-2013

Constance Kalanek, Treasurer

Alternate: Char Christianson

North Dakota Board of Nursing (NDBON)

Bismarck

Carrington

701-328-9781

701-652-3117

[email protected]

[email protected]

2011-2014

Rosanne Diehl

Alternate: Renee Peterson

North Dakota Association of Nurse Anesthetists (NDANA)

Fargo

Minot

(713)-806-9224

701-857-5204

[email protected]

[email protected]

2013-2016

Denise Andress

Alternate: Bill Krivarchka

North Dakota Area Health Education Center (NDAHEC)

Hettinger

Mayville

701-637-0178

701-788-4477

[email protected]

[email protected]

2012-2015

Jennifer Moen

Alternate: Rebecca Vigen

North Dakota Nurse Practitioner's Association (NDNPA)

Bismarck 701-202-0071 [email protected]

[email protected]

2013-2016

Roberta Young North Dakota Nursing Association (NDNA)

Fargo 701-234-5428 [email protected] 2011-2014

Susan Pederson

Alternate: Amber Kracht

Nursing Students Association of North Dakota (NSAND)

Bismarck

Fargo

701-223-6740

(701) 367-0778

susan [email protected]

[email protected]

2011-2013

Wayde Sick Workforce Development Division

Bismarck 701-328-5308 [email protected] 2012-2105

Consumer/Public Member TBD

Form 990- EZ Department of trie Treasury Internal Revenue Service

Short Form _ Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of die Internal Revenue Code (except black lung benefit trust or private foundation) ,, _

W~ Sponsoring organizations of doW advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined m section 512(by,13)must file Form 980 All other organizations with gross receipts less man $200,000 and total

IV The organization mal^ve^o^J^c^iroTtf^ requirements

OMBNo 1545-1150

2011 Open to Public

Inspection

B Check rf applicable

L—J Address change

I I Name change

LXJ Initial return

I |Termmat»d

I I Amended return

LXjADDbatioR Doidina

C Name of organization

NORTH DAKOTA CENTER FOR NURSING

D Employer identification number

45-2605788



I I Name change

LXJ Initial return

I |Termmat»d

I I Amended return


Number and street (or P.O. box, if mail is not delivered to street address)

919 SOUTH 7 STREET Room/suite

504 E Telephone number

701-852-1810



I I Name change

LXJ Initial return

I |Termmat»d

I I Amended return


City or town, stale or country, and ZIP + 4

BISMARCK. ND 58504 F Group Exemption

Number • r Amminnng Method- I X I Cash I I Accrual other (specify) iV I Website: kVNDCENTERFORNURSING.ORG

H Check • 1 tt the organization is not required to attach Schedule B (Form990,990-EZ,or990-PF). J Tax-exempt status (check only nne> - i X I 501fci(3ll I 501(c) ( )«*(insert no.) I I 4947(a)(1) or I I 527

H Check • 1 tt the organization is not required to attach Schedule B (Form990,990-EZ,or990-PF).

K Check • • if the organization is not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.

L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, line 25. column (B) below) are $500.000 or more, file Form 990 instead of Form 990-EZ • $ 130 . 887 .

Parti Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Parti

Check if the organization used Schedule 0 to respond to any question in this Part I LxJ

1

I IX

Contributions, gifts, grants, and similar amounts received Program service revenue including government fees and contracts Membership dues and assessments Investment income Gross amount from sale of assets other than inventory Less: cost or other basis and sales expenses Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) Gaming and fundraising events Gross income from gaming (attach Schedule G if greater than $15,000) Gross income from fundraising events (not including $

SEE SCHEDULE 0 I 5a

6a of contributions

6b from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) Less: direct expenses from gaming and fundraising events Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)

6c

Gross sales of inventory, less returns and allowances Less: cost of goods sold Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) Other revenue (describe in Schedule 0) Total revenue Add lines 1.2.3.4.5c. 6d, 7c. and 8

7a

5c

6d

9

130,822.

65.

130,887. c s l

o C_3

-z.

< 8

10 Grants and similar amounts paid (list in Schedule 0) 11 Benefits paid to or for members 12 Salaries, other compensation, and eifiploy.ee benefits-13 Professional fees and other payments^© independent contractors 14 Occupancy, rent, utilities, and maintenance MQy | ^ 2012 15 Prinbng, publications, postage, and sjilpprng 16 Other expenses (describe in Schedule 0) Q G D ^ N , U T 17 Total expenses. Add lines 10 throuqhJG

SEE SCHEDULE 0

1P_

17

90,996. 3,401. 1.462.

23.611. 119.470.

18 Excess or (deficit) for the year (Subtract line 17 from line 9) 19 Net assets or fund balances at beginning of year (from line 27, column (A))

(must agree with end-ot year figure reported on prior year's return) 20 Other changes in net assets or fund balances (explain in Schedule 0) 21 Net assets or fund balances at end ot year. Combine lines 18 through 20

16 11.417.

J l _20_ 21

0. 0.

11,41,7. LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2011)

Q>% ID 132171 02-06-12

Form 990-EZ(2011) NORTH DAKOTA CENTER FOR NURSING 45-2605788 Pase2 Part II Balance Sheets, (see the instructions for Part II.)

22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) SEE SCHEDULE 0 25 Total assets 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 27 Net assets or fund balances (line 27 of column (B) must agree with line 21)

(A) Beginning of year (B) End of year


0. 22 12,546. 22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) SEE SCHEDULE 0 25 Total assets 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 27 Net assets or fund balances (line 27 of column (B) must agree with line 21)

23 22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) SEE SCHEDULE 0 25 Total assets 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 27 Net assets or fund balances (line 27 of column (B) must agree with line 21)

0. 24 1.626. 22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) SEE SCHEDULE 0 25 Total assets 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 27 Net assets or fund balances (line 27 of column (B) must agree with line 21)

0. 25 14.172.


0. 26 2.755.

22 Cash, savings, and investments 23 Land and buildings 24 Other assets (describe in Schedule 0) SEE SCHEDULE 0 25 Total assets 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0 27 Net assets or fund balances (line 27 of column (B) must agree with line 21) 0. 27 11.417. Part III I Statement of Program Service Accomplishments (see the instructions for Part III.)

Check if the organization used Schedule 0 to respond to any question in this Part l l l C x ]

Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional lor others.)

What is theofoanizatjon's orimarv exempt purpose's EE SCHEDULE 0

Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional lor others.) Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses In a clear and concise

manner, deschbe the services provided, the number of persons benefited, and other relevant information tor each program title

Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional lor others.)

28 SEE SCHEDULE 0

28a 111.838. 28a 111.838. 28a 111.838. (Grants $ ) If this amount includes foreiqn qrants, check here • I ] 28a 111.838. 29

29a 29a 29a (Grants $ ) If this amount includes foreiqn qrants, check here kV I 1 29a 30

30a 30a 30a (Grants $ ) If this amount includes foreiqn qrants. check here • [ 30a 31 Other program services (describe in Schedule O)

(Grants $ ) If this amount includes foreiqn qrants. check here kV [ 31a 32 Total urogram service expenses (add lines 28a through 3 1 a ) . • 32 111.838. Part IV | List of Officers, Directors, Trustees, and Key Employees. List each one even n not compensated (see the instructions ft* Part iv>

to respond to any question in this Part IV L I (a) Name and address

(b) Title and average hours per week devoted to

position

(C) Reportable compensation (Forms

W-271096-MISC) (if not paid, enter -0-)

(d) Heaiih benefits, contributions to

employee benefit plans, and deferred

compensation

(e) Estimated amount of other compensation

MARGARET REED PRESIDENT 2.00 0. 0. 0. 919 S 7TH ST. BISMARCK, ND 58504

PRESIDENT 2.00 0. 0. 0.

KAREN LATHAM VICE PRESIDEN 2.00

T 0. 0. 0. 919 S 7TH ST, BISMARCK. ND 58504

VICE PRESIDEN 2.00

T 0. 0. 0.

CONSTANCE KALANEK TREASURER 2.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

TREASURER 2.00 0. 0. 0.

PATRICIA MOULTON EXECUTIVE DIR 40.00

ECTOR 38.958. 2.278. 0. 919 S 7TH ST. BISMARCK. ND 58504

EXECUTIVE DIR 40.00

ECTOR 38.958. 2.278. 0.

JULIE HANSON DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

SUSAN PEDERSON DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

CHERYL RISING DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

JOSH ASKVIG DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

JAMIE SPERLE DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

TRACY EVANSON DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

ROBERT YOUNG DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

ADELE SIGL DIRECTOR 1.00 0. 0. 0. 919 S 7TH ST. BISMARCK. ND 58504

DIRECTOR 1.00 0. 0. 0.

132172 02-08-12 Form 990-EZ (2011)

Form 990-EZ (2011! NORTH DAKOTA CENTER FOR NURSING 45-2605788 Paae3

PartV Other Information (Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Sen. O to respond to any question in this Part V fx]

33

34

Did the organization engage in any significant activity not previously reported to the IRS? II "Yes," provide a detailed description of each activity in Schedule 0 Were any significant changes made to the organizing or governing documents' If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule 0 (see instructions)

35a Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2,6a, and 7a, among others)'

b If "Yes," to line 35a, has the organization filed a Form 990-T for the year' If "No," provide an explanation in Schedule 0 c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax

requirements during the year? If "Yes," complete Schedule C, Part III 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year' If "Yes,"

complete applicable parts of Schedule N 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions. • 1 37a | 0_

b Did the organization hie Form 1120-POL for this year' 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made

in a prior year and still outstanding at the end of the tax year covered by this return' If "Yes," complete Schedule L, Part II and enter the total amount involved Section 501(c)(7) organizations. Enter. Initiation fees and capital contributions included on line 9 Gross receipts, included on line 9, for public use of club facilities Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under secbon4911 • 0. ;section4912 • 0^ ;section4955 p> 0_±_

b 39

a b

40 a

38b

39a 39b

N/A

N/A N/A

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I Secbon 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912,4955, and 4958 • Secbon 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organizabon • All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction' If "Yes," complete Form 8886-T List the states with which a copy of this return is filed. • NONE

0.

33

34

35a 35b

35c

36

37b

38a

40b

40e

Yes

N/

No

41 42 a The organization's books are in care of • PATRICIA MOULTON

Located at • 919 SOUTH 7TH Telephone no. • 701-852-

STREET SOUTH. STE 504, BISMARCK. N 1810

At any bme during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)' If "Yes," enter the name of the foreign country: •

ZIP + 4 • 58504

See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. At any time during the calendar year, did the organization maintain an office outside of the U.S.' If 'Yes," enter the name of the foreign country: •

Yes No 42b X

42c X

43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here and enter the amount of tax-exempt interest received or accrued during the tax year • I 43 N/A

44a Did die organization maintain any donor advised funds during the year' If "Yes," Form 990 must be completed instead of Form 990-EZ

b Did the organization operate one or more hospital facilities during the year' If "Yes," Form 990 must be completed instead of Form 990-EZ

c Did the organizabon receive any payments for indoor tanning services during the year' d If "Yes" to line 44c, has the organization filed a Form 720 to report these payments' If 'No,' provide an explanation

in Schedule O 45a Did the organizabon have a controlled entity within the meaning of section 512(b)(13)' 45 b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section

512(bM 13)' II "Yes." Form 990 and Schedule R may need to be completed instead ol Form 990-EZ (see instructions)

Yes No

44a X

44b X 44c X

44d 45a X

45b

132173 02-06-12

Form 990-EZ (2011)

Form 990-EZ (2011) NORTH DAKOTA CENTER FOR NURSING 45-2605788 Page 4

46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for public office7

If •Yes,' complete Schedule C. Part I . 46

Yes No

Part VII Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only, AII section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 4749b and 52, and com for lines 50 and 51. Check if the organization used Schedule O to respond to any question in this Part VI •

Yes No 47 X 48 X

49a X 49b

47 Did the organization engage in lobbying activities or have a secbon 501(h) election in effect during the tax year? If "Yes," complete Sch. C, Part II 48 Is the organization a school as described in section 170(b)( 1)(A)( n)' If "Yes,* complete Schedule E 49a Did the organization make any transfers to an exempt non-charitable related organization'

b If "Yes,* was the related organizabon a section 527 organization' 50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more

(a) Name and address of each employee paid more than $100,000

NONE

(b) Title and average hours per week devoted to

position

(C) Reportable compensation (Forms

W-2/1089-MISC)

(d) Health benefits, contributions to

employee benefit plans, and deferred

compensation

(e) Estimated amount of other compensation

f Total number of other employees paid over $100,000 • 51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the

a ~ . . . . . . . SS , .

(a) Name and address of each independent contractor paid more than $100,000 (b)Type of service (c) Compensation

d Total number of other independent contractors each receiving over $100,000 52 Did the organization complete Schedule A' Note: All section 501(c)(3) organizai

charitable busts must attach a completed Schedule A Under penalties of perpjry, I declare that i have examined this return, including accompanying schi Declaration of preparer (other than officer) is based on all information of which preparer has any knowl

PATRICIA MOULTON. EXECUTIVE D Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

PATRICK J BROWN

Preparer's signature

Firm's name •BRADY. MARTZ & ASSOC Fum's address • p. O. BOX 1297

BISMARCK. ND 58502-12 May the IRS discuss this return with the preparer shown above' See instructions

SCHEDULEA (Form 990 or 990-EZ)

Department of the Treasury Internal Revenue Service

Public Charity Status and Public Support Complete if the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust • Attach to Form 990 or Form 990-EZ. • See separate instructions.

OMBNo 1545-0047

2011 Open to Public

Inspection

Name of the organization NORTH DAKOTA CENTER FOR NURSING

Employer identification number

45-2605788 Parti I Reason for Public Charity Status (Ail organizations must complete this part.) See instructions.

The organization is not a pnvate foundation because rt is: (For lines 1 through 11, check only one box.) 1 I I A church, convention of churches, or association of churches described in section 170(b>(1)(A)(i).

2 O A school described in section 170(bK1){AXii)- (Attach Schedule E.) 3 I I A hospital or a cooperative hospital service organization described in section I70(b)( 1)(A)(iii). 4 CD A medical research organization operated in conjunction with a hospital descnbed in section I70(b)( 1)(AHiii)- Enter the hospital's name,

city, and state-

5 I I An organization operated for the benefit of a college or university owned or operated by a governmental unit descnbed in section 170(b)(1)(AXiv). (Complete Part II.)

6 I I Afederal. state, or local government or governmental unit descnbed in section 170(bK t)(A){v). 7 LXJ An organization that normally receives a substantial part of its support from a governmental unit or from the general public descnbed in

section 170(bX1)(AKvi). {Complete Part II.) 8 [ZD A corrtmunrty trust descnbed in section 170(b)( 1)(AXvi). (Complete Part II.) 9 EZI An organization that normally receives: (1) more than 331/3% of its support from contnbutions, membership fees, and gross receipts from

activities related to its exempt functions - subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30,1975. See section 509(a)(2). (Complete Part III.)

10 I [ An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 11 I I An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or

more publicly supported organizations descnbed in section 509(a)(1) or section 509(a)(2) See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11ethrough 11h. a C H Type I b CZD Type II c E Z l Type III • Functionally integrated d C D Type III • Other

e I I By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations descnbed in section 509(a)(1) or section 509(a)(2).

f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box

g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons descnbed in (ii) and (Hi) below,

the governing body of the supported organization? (ii) A family member of a person descnbed in (i) above? (iii) A 35% controlled entity of a person descnbed in (i) or (ii) above?

h Provide the following information about the supported organization(s)

Yes No Hcrfi) llgfii)

11flP)

(i) Name of supported organization

(ii)EIN (iii) Type of organization

(described on lines 1-9 above or IRC section (see instructions))

iv) Is the organization n col (i) listed in your governing document?

(v) Did you notify the organization in col. (i) of your support?

(vi) Is the organization in col. (i) organized in the

U.S.?

(vii) Amount of support

(i) Name of supported organization

(ii)EIN (iii) Type of organization

(described on lines 1-9 above or IRC section (see instructions)) Yes No Yes No Yes No

(vii) Amount of support

Total LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Schedule A (Form 990 or 990-EZ) 2011

132021 01-24-12

Schedule A (Form 990 or 990 EZi 2011 NORTH DAKOTA CENTER FOR NURSING 45-2605788 Page2 Part II Support Schedule for Organizations Described in Sections i70(b)(l)(A)(iv) and 170(b)(i)(A)(vi)

(Complete only if you checked the box on line 5,7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support Calendar year (or fiscal year beginning in) •

1 Gifts, grants, contributions, and membership fees received. (Do not include any 'unusual grants.*)

2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf

3 The value of services or facilities furnished by a governmental unit to the organization without charge

4 Total. Add lines 1 through 3 5 The portion of total contributions

by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)

6 Public SUODOrt Subtract line 5 from line 4

(a) 2007 (b)2008 fc)2009 (d)2010 te)2011 (f) Total Calendar year (or fiscal year beginning in) • 1 Gifts, grants, contributions, and

membership fees received. (Do not include any 'unusual grants.*)






130.822. 130.822.

Calendar year (or fiscal year beginning in) • 1 Gifts, grants, contributions, and





















130.822. 130.822.














6 Public SUODOrt Subtract line 5 from line 4 130,822, Section B. Total Support Calendar yen (or fiscal year beginning in) •

7 Amounts from line 4 8 Gross income from interest,

dividends, payments received on securities loans, rents, royalties and income from similar sources

9 Net income from unrelated business activities, whether or not the business is regularly earned on

10 Other income. Do not include gam or loss from the sale of capital assets (Explain in Part IV) Total support Add lines 7 through 10 11

12 13

(al 2007 CM 2008 (cl 2009 (d)2010 (ei2011 (fl Total 130.822. 130.822.

65. 65.

130.887. etc (see instructions) 12

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization, check this box and stop here JtLl

Section C. Computation of Public Support Percentage 14 15

14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) 15 Public support percentage from 2010 Schedule A, Part II, line 14 16a 331/3% support test - 2011. If the organization did not check the box on line 13, and line 14 is 331/3% or more, check this box and

stop here. The organization qualifies as a publicly supported organization b 33 1/3% support test - 2010. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box

and stop here. The organization qualifies as a publicly supported organization 17a 10% -facts-and-circumstances test - 2011. If the organization did not check a box on line 13,16a, or 16b, and line 14 is 10% or more

and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances* test. The organization qualifies as a publicly supported organization

b 10% -facts-and-circumstances test - 2010. If the organization did not check a box on line 13,16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the 'facts-and-circumstances* test, check this box and stop here. Explain in Part IV how the organization meets the 'facts-and-circumstances' test The organization qualifies as a publicly supported organization

18 Private foundation. If the organization did not check a box on line 13,16a, 16b. 17a, or 17b. check this box and see instructions

99.95 % %

•Lx]

Schedule A (Form 990 or 990-EZ) 2011

132022 01-24-12

Schedule A (Form 990 or 990-EZ) 2011 Page 3

Part 111 J Support Schedule for Organizations Described in Section 509(a)(2) (Complete only rf you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to

qualify under the tests listed below, please complete Part II.) Section A. Public Support Calendar year (or fiscal year beginning in) •

1 Gifts, grants, contributions, and merrtoershtp fees received (Do not include any 'unusual grants.*)

2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose

3 Gross receipts from activities that are not an unrelated trade or business under section 513



6 Total. Add lines 1 through 5 7a Amounts included on lines 1, 2, and

3 received from disqualified persons b Amounts included on lines 2 and 3 received

from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year

c Add unes 7a and 7b 8 Public support fScbtrad lint 7c from Inn 6)

(a) 2007 (b) 2008 (c)2009 td)2010 (e)2011 ffl Total

Section B. Total Support Calendar year (or fiscal year beginning in) •

9 Amounts from line 6 10a Gross income from interest,

dividends, payments received on securities loans, rents, royalties and income from similar sources

b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30,1975

c Add lines 10a and 10b 11 Net income from unrelated business

activities not included in line 10b, whether or not the business is regularly earned on

12 Other income Do not include gain or loss from the sale of capital assets (Explain in Part IV) Total SUppOtt (Add bus 9,10c, 11, and 12) 13

14

(a) 2007 lb) 2008 (c) 2009 (dl2010 (e)2011 ffl Total

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here t > l I

Section C. Computation of Public Support Percentage 15 Public support percentage for 2011 (line 8, column (f) divided by line 13, column (f)) 16 Public support percentage from 2010 Schedule A. Part III, line 15 .

15 16

% _%

Section P. Computation of Investment Income Percentage 17 18

% %

17 Investment income percentage for 2011 (line 10c, column (f) divided by line 13, column (f)) 18 Investment income percentage from 2010 Schedule A, Part III, line 17 19a 331/3% support tests - 2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not

more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization b 33 1/3% support tests - 2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and

line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization 20 Private foundation. If the organization did not check a box on line 14.19a, or 19b, check this box and see instructions i > l I i32023 o i 2 4 - i 2 Schedule A (Form 990 or 990-EZ) 2011

SCHEDULE 0 (Form 990 or 990-EZ)

Department of the Treasury

Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to specific questions on

Form 990 or 990-EZ or to provide any additional information.

OMB No 1545-0047

2011 Open to Public

Internal Revenue Service 1 .

Name of the organization NORTH DAKOTA CENTER FOR NURSING

Employer identification number 45-2605788

FORM 990-EZ. PART I . LINE 4. OTHER INVESTMENT INCOME:

DESCRIPTION OF PROPERTY: AMOUNT:

INTEREST INCOME 65.

FORM 990-EZ. PART I . LINE 16. OTHER EXPENSES:

DESCRIPTION OF OTHER EXPENSES: AMOUNT:

SUPPLIES 2.708.

TRAVEL 7.483.

BANK FEES/MISCELLANEOUS 33.

CONFERENCE FEES 1.225.

BOARD EXPENSES 1.376.

FILING FEES 1.360.

ND CONSENSUS COUNCIL 2.500.

PAYROLL TAXES 6.926.

TOTAL TO FORM 990-EZ. LINE 16 23.611.

FORM 990-EZ. PART I I . LINE 24. OTHER ASSETS:

DESCRIPTION BEG. OF YEAR END OF YEAR

OTHER DEPRECIABLE ASSETS 0. 1.626.

FORM 990-EZ. PART I I . LINE 26. OTHER L I A B I L I T I E S :

DESCRIPTION BEG. OF YEAR END OF YEAR

ACCRUED LIABILITIES 0. 2,755.

FORM 990-EZ. PART I I I . PRIMARY EXEMPT PURPOSE - TO GUIDE THE ONGOING

DEVELOPMENT OF A WELL-PREPARED AND DIVERSE NURSING WORKFORCE TO MEET LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2011) 132211 01-23-12

SCHEDULE 0 (Form 990 or 990-EZ)

Department ot the Treasury

Supplemental Information to Form 990 or 990-EZ Complete to provide Information for responses to specific questions on

Form 990 or 990-EZ or to provide any additional information. • Attach to Form 990 or 990-EZ.

OMB No 1545-0047

2011 Open to Public Inspection

Name of the organizatio n NORTfl DAKOTA CENTER FOR NURSING

Employer identification number 45-2605788

THE NEEDS OF THE CITIZENS OF NORTH DAKOTA THROUGH RESEARCH. EDUCATION,

RECRUITMENT AND RETENTION. ADVOCACY AND PUBLIC POLICY.

FORM 990-EZ. PART I I I . LINE 28. PROGRAM SERVICE ACCOMPLISHMENTS:

TO GUIDE THE ONGOING DEVELOPMENT OF A WELL-PREPARED AND

DIVERSE NURSING WORKFORCE TO MEET THE NEEDS OF THE

CITIZENS OF NORTH DAKOTA THROUGH RESEARCH. EDUCATION.

RECRUITMENT AND RETENTION. ADVOCACY AND PUBLIC POLICY.

FORM 990-EZ. PART V. INFORMATION REGARDING PERSONAL BENEFIT CONTRACTS:

THE ORGANIZATION DID NOT, DURING THE YEAR. RECEIVE ANY FUNDS. DIRECTLY.

OR INDIRECTLY. TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.

THE ORGANIZATION. DID NOT. DURING THE YEAR. PAY ANY PREMIUMS. DIRECTLY.

OR INDIRECTLY. ON A PERSONAL BENEFIT CONTRACT.

L H A For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2011) 132211 01-23-12

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