As Part of the Disclosure Requirements on the Form 990-Return of Organization Exempt From

ORGANIZATION North Dakota Center for NursingTAX YEAR2013

As part of the disclosure requirements on the Form 990-Return of Organization Exempt From Income Tax, an organization must disclose certain relationships among officers, directors, trustee, and key employees of the organization and certain transactions. In order to comply with these requirements, we are asking that you complete the following questionnaire concerning your relationship with the organization and the other identified individuals.

The following individuals have been identified as officers, directors, trustees, key employees or highly compensated employees of the organization as defined on page 2:

Current/Former Officers:

Patricia MoultonMargaret ReedMary Anne MarshJulie Hanson

Constance Kalanek

Current/Former Directors:

Rosanne DiehlDenise AndressChris AmanRoberta Young

Amber KrachtAmanda RemynseJeanna KujavaCarla Hanson

Nancy Johnson

Current/Former Trustees:

______

Current/Former Key Employees:

______

Current/Former Officers:A person elected or appointed to manage the organization’s daily operations, such as President, Vice-President, Secretary or Treasurer. They are determined by reference to the organizing documents, bylaws or resolutions of the governing body. For 990 purposes, the organization’s top management official (Executive Director, General Manager, CEO, etc.) and the top financial official (Finance Manager, CFO, Business Manager, etc.) are always officers. Current officers include all who served one day in that capacity during the current year. Former officers include all individuals who were officers within the last five years and who received more than $100,000 in compensation from the organization and related organizations during the current year.

Current/Former Directors/Trustees:A member of the organization’s governing body, but only if the member has voting rights. A member of an advisory board that does not exercise any governance authority over the organization is notconsidered a director or trustee. Current director/trustee includes all individuals who served one day in that capacity during the current year. Former directors/trustees include all individuals who were directors or trustees within the last five years and who received more than $10,000 in compensation from the organization and related organizations during the current year.

Key Employees:An employee of the organization (other than an officer, director or trustee) who meets all three of the following tests.

Receives reportable compensation from the organization and all related organizations in excess of $150,000 for the calendar year ending with or within the organization’s tax year.

The employee has responsibilities, power or influence over the organization as a whole similar to those of an officer, director or trustee; ormanages a discreet segment or activity of the organization that represents 10% or more of the activities, assets, income or expenses of the organization; or has or shares authority to control or determine 10% or more of the organization’s capital expenditures, operating budget or compensation.

Is one of the 20 employees with the highest reportable compensation for the calendar year ending with or within the organization’s tax year. (Must still satisfy the $150,000 test)

Current key employees include all individuals employed during the current year who satisfy the 3 part test. Former key employees include all individuals who during any of the last five years satisfied the 3 part test and who received more than $100,000 in compensation from the organization and related organizations during the current year.

FAMILY/BUSINESS RELATIONSHIP DISCLOSURES (all individuals)

Family relationship:Includes an individual’s spouse, ancestors, brothers and sisters (whether whole or half blood), children (whether natural or adopted), grandchildren, great-grandchildren, and spouses of brothers, sisters, children, grandchildren and great-grandchildren.

Business relationship: Relationship between two individuals as defined as follows:

One person is employed by the other in a sole proprietorship or by an organization with which the other is associated as a trustee, director, officer, key employee or greater than 35% owner.

One person is transacting business with the other (other than in the ordinary course of either party’s business on the same terms as are generally offered to the public), directly or indirectly, in one or more contracts of sale, lease, license, loan, performance of services, or other transaction involving transfers of cash or property valued in excess of $10,000 in the aggregate during the organization’s tax year. Indirect transactions are transactions with an organization with which the one person is associated as a trustee, director, officer, key employee or greater than 35% owner.

The two persons are each a director, trustee, officer, or greater than 10% owner in the same business or investment entity.

Excludes a) attorney/client, b) medical professional/patient and c) priest/clergy and penitent/communicant.

Do you have a family relationship or a business relationship with any individual listed on page 1 during the current tax year? YES _____ NO _____

If yes, please list the name of the other individual and the family or business relationship:

NAME:FAMILY/BUSINESS RELATIONSHIP:

______

The answer to the above question is correctly stated to the best of my knowledge and belief:

______

Signature, TitleDate

REPORTABLE TRANSACTIONS DISCLOSURES (all individuals)

Reportable transactions include certain transactions between the organization and the following individuals.

Yourself
Your family members (as defined on previous page)
A business owned more than 35% by you and your family members
Any taxable business or organization for which you also serve as an officer, director, trustee, key employee, or directly or indirectly (through family members) are more than a 5% owner.

Reportable transactions include the following types of transactions:

An excess benefit transaction in which an excess benefit is provided to any of the individuals noted above. An excess benefit is that in which an individual receives an economic benefit from the organization in excess of the amount or services provided by the member. This would include payment of compensation in excess of fair market value or the sale of an asset at more than fair market value.

An outstanding loan, salary advance, or receivable from or to the organization at year end.

A grant or other assistance was provided by the organization during the tax year.

Business transactions involving the organization in which a single transaction exceeds $10,000 or total transactions for the tax year exceed $100,000.

The organization paid compensation exceeding $10,000 to a family member.

Are you aware of any such transactions described occurring during the current tax year? YES _____ NO_____

If yes, please list the individuals/business involved and describe the transaction.

INDIVIDUAL/BUSINESS:TRANSACTION:

______

The answer to the above question is correctly stated to the best of my knowledge and belief:

______

Signature, TitleDate

INDEPENDENT VOTING MEMBER OF THE GOVERNING BODY

(voting members only)

A voting member of the governing body of the organization is considered independent if at all times during the tax year, the member meets all three tests:

Did not receive compensation as an officer or an employee of the organization or a related organization.

Did not receive total compensation or other payments exceeding $10,000 as an independent contractor, other than reimbursement of expenses under an accountable plan or reasonable compensation for services provided in the capacity as a member of the governing body.

Neither the member or a family member of the member was involved in one or more of the following types of transactions:

An outstanding loan, salary advance, or receivable from or to the member or family member at year end.
A grant or other assistance was provided to the member or family member during the tax year.
Business transactions involving the member or family member in which the single transaction exceeds $10,000 or total transactions for the tax year exceed $100,000.
The organization paid compensation exceeding $10,000 to a family member of the member.
Also if the organization is a 501(c)(3) or (c)(4) entity—a transaction in which the member or family member received an economic benefit from the organization in excess of the amount or services provided by the member.

Do you qualify as an independent voting member of the board? YES ____NO___

If no, please list the reason and describe the disqualifying transaction.

REASON:TRANSACTION:

______

The answer to the above question is correctly stated to the best of my knowledge and belief:

______

Signature, TitleDate