2022-08-19T15:02:19-05:00 2021-12-31 420714325 RSM US LLP 201 FIRST ST SE SUITE 800 CEDAR RAPIDS IA 52401 990 2021-01-01 472845823 INDEPENDENT HEALTH NETWORK INC INDE 4024767333 575 FALLBROOK BLVD STE 204 LINCOLN NE 685219040 RODNEY TRIPLETT CEO 4024767333 2022-08-16 1 RODNEY TRIPLETT 999009999 SHAWNA HULS P01315330 3192985333 2022-08-16 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z RODNEY TRIPLETT 600 I STREET PO BOX 433 PAWNEE CITY NE 684200433 1104337 0 X N/A X 2015 NE INDEPENDENT HEALTH NETWORK, INC.'S ("CHARITY") PURPOSE IS TO ORGANIZE AND OPERATE EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3); IN PARTICULAR, TO PROMOTE HEALTH BY ALLOWING RURAL HEALTH CARE PROVIDERS TO MORE EFFECTIVELY PROVIDE HIGH-QUALITY, LOW-COST HEALTH CARE SERVICES TO THE COMMUNITIES THEY SERVE. THE CHARITY'S PRIMARY ACTIVITY IN SUPPORT OF THIS PURPOSE WILL BE TO MAKE AVAILABLE TO THOSE PROVIDERS ACCESS TO A BROADBAND TELECOMMUNICATIONS NETWORK AND THE INTERNET. 7 6 0 7 0 0 450000 81916 558846 1022394 403 27 0 0 1009249 1104337 0 0 0 0 0 0 0 0 0 1052913 908061 1052913 908061 -43664 196276 183091 295741 95268 11642 87823 284099 SEE SCHEDULE O 0 0 793884 1022394 ESTABLISH AND OFFER BROADBAND TELECOMMUNICATIONS NETWORK AND INTERNET SERVICES TO RURAL HEALTH CARE PROVIDERS SO THEY CAN MORE EFFECTIVELY PROVIDE HIGH-QUALITY, LOW-COST HEALTH CARE SERVICES TO THE COMMUNITIES THEY SERVE. 793884 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 X PRAIRIE HEALTH VENTURES LLC 4027422205 575 FALLBROOK BLVD SUITE 204 LINCOLN NE 68521 RODNEY TRIPLETT PRESIDENT & CEO 5.00 X X 0 370196 42531 CURTIS HAWKINSON BOARD CHAIR 0.20 X X 0 0 0 RITA JONES SECRETARY 0.20 X X 0 0 0 TIM SCHNACK VICE CHAIR 0.20 X X 0 0 0 AMANDA ROEBUCK DIRECTOR 0.20 X 0 0 0 RUTH STEPHENS DIRECTOR (UNTIL MAY 2021) 0.20 X 0 0 0 TREG VYZOUREK DIRECTOR 0.20 X 0 0 0 STACY KNOX DIRECTOR 0.20 X 0 0 0 0 370196 42531 0 0 1 0 0 81916 81916 CARRIER CREDIT INCOME 517000 680927 680927 NETWORK SERVICES 517000 295667 295667 USAC REVENUE 517000 45800 45800 1022394 27 27 1104337 1022394 0 27 X 109362 109362 896 896 3859 3859 793884 793884 QUICKBOOKS PAYMENT FEES 60 60 908061 793884 114177 0 161891 279098 21200 16643 183091 295741 95268 11642 95268 11642 X 0 0 2800000 2800000 -2712177 -2515901 87823 284099 183091 295741 196276 0 X 0 0 0 X 0 0 600000 450000 81916 1131916 600000 450000 81916 1131916 562230 569686 8878 7942 2200 403 27 19450 1151366 3028010 0.49480 0.48840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 RODNEY TRIPLETT PRESIDENT & CEO 0 272912 0 97284 0 0 0 19950 0 22581 0 412727 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS THE FOLLOWING THREE CLASSES OF MEMBERS: CLASS A, CLASS B AND CLASS C. PRAIRIE HEALTH VENTURES IS THE SOLE CLASS A MEMBER; CLASS B MEMBERS ARE ALL ELIGIBLE HEALTHCARE PROVIDERS; CLASS C MEMBERS ARE ALL INELIGIBLE HEALTHCARE PROVIDERS. FORM 990, PART VI, SECTION A, LINE 7A CLASS C MEMBERS DO NOT PARTICIPATE IN THE GOVERNANCE OF THE CORPORATION, INCLUDING VOTING ON ANY MATTERS, OTHER THAN IN AN ADVISORY CAPACITY TO THE EXTENT PERMITTED AND REQUESTED BY THE BOARD. THE CLASS A MEMBER HAS MORE THAN FIFTY PERCENT (50%) OF THE VOTING POWER OF ALL MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B ONLY CLASS A AND CLASS B MEMBERS MAY ELECT DIRECTORS. CLASS A MEMBER APPOINTS OVER 50% OF ALL DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING AND REVIEWED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C ON APRIL 10, 2015, THE BOARD OF DIRECTORS OF THE CHARITY PASSED A RESOLUTION ADOPTING THE CHARITY'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONNECTION COSTS: PROGRAM SERVICE EXPENSES 542,412. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 542,412. MONITORING COSTS: PROGRAM SERVICE EXPENSES 78,193. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,193. USAC EXPENSES: PROGRAM SERVICE EXPENSES 54,873. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,873. CARRIER COSTS: PROGRAM SERVICE EXPENSES 118,406. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 118,406. PRAIRIE HEALTH VENTURES LLC 575 FALLBROOK BLVD SUITE 204 LINCOLN NE 68521 204962103 HEALTHCARE SOLUTIONS NE N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0