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INDEPENDENT HEALTH NETWORK INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
INDEPENDENT HEALTH NETWORK INC (EIN 47-2845823)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-05-05
IRS object ID
201741259349301664
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-05-05T13:54:07-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN205088556PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1REDIGER & COMPANYBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13434 O STREETAddressLine1Txt
CityLINCOLNCityNm
State AbbreviationNEStateAbbreviationCd
ZIP685101540ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN472845823EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1INDEPENDENT HEALTH NETWORK INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlINDEBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1290 THE APOTHECARY 140 N 8TH STREETAddressLine1Txt
CityLINCOLNCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68508ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRODNEY TRIPLETTPersonNm
Person TitleCHAIRMAN, CEOPersonTitleTxt
Signature2017-05-02SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSCOTT T REDIGER CPAPreparerPersonNm
PTINP00056830PTIN
Phone4024675211PhoneNum
Preparation2017-05-03PreparationDt

Filing Security Information FilingSecurityInformation

FieldValueIRS element (for citing)
At Submission Creation Device Id42E7DD996511C04DB6890F1562694F1DD097F92EAtSubmissionCreationDeviceId
At Submission Filing Device Id42E7DD996511C04DB6890F1562694F1DD097F92EAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRODNEY TRIPLETTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1290 THE APOTHECARYAddressLine1Txt
Address Line2140 N 8TH STREETAddressLine2Txt
CityLINCOLNCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68508ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$0GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2015FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionINDEPENDENT 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.ActivityOrMissionDesc
Voting Members Governing Body1VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
CY Total Revenue$0CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$446,004PYOtherExpensesAmt
CY Other Expenses$291,831CYOtherExpensesAmt
PY Total Expenses$446,004PYTotalExpensesAmt
CY Total Expenses$291,831CYTotalExpensesAmt
PY Revenues Less Expenses-$446,004PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$291,831CYRevenuesLessExpensesAmt
Total Assets BOY$2,353,997TotalAssetsBOYAmt
Total Assets EOY$2,065,292TotalAssetsEOYAmt
Total Liabilities EOY$3,126TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,353,997NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,062,166NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionINDEPENDENT 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescTHE ORGANIZATION IS CURRENTLY IN IT'S VERY EARLY STAGES OF PREPARING TO ESTABLISH AND OFFER BROADBAND TELECOMMUNICATIONS NETWORK & INTERNET SERVICES.Desc
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members1GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnfalseAnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PRAIRIE HEALTH VENTURES LLCBusinessNameLine1Txt
Business Name Line2PRAIRIE HEALTH VENTURES LLCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Phone4024767333PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1290 THE APOTHECARY 140 N 8TH STAddressLine1Txt
Address Line2290 THE APOTHECARY 140 N 8TH STAddressLine2Txt
CityLINCOLNCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68508ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RODNEY TRIPLETT
CHAIRMAN, CEYes (X)Yes (X)$0$0$0
CHAD JEFFREY
VICE CHAIRMAYes (X)Yes (X)$0$0$0
JON JONSON
DIRECTORYes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$288,408TotalAmt
Management And General$288,408ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,363TotalAmt
Management And General$1,363ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$2,060TotalAmt
Management And General$2,060ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$291,831TotalAmt
Program Services$0ProgramServicesAmt
Management And General$291,831ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,353,997BOYAmt
EOY$2,065,292EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,353,997BOYAmt
EOY$2,065,292EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
EOY$3,126EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,126EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$2,800,000BOYAmt
EOY$2,800,000EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY-$446,003BOYAmt
EOY-$737,834EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,353,997BOYAmt
EOY$2,062,166EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,353,997BOYAmt
EOY$2,065,292EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$291,831ReconcilationRevenueExpnssAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$2,800,000CurrentTaxYearMinus1YearAmt
Total$2,800,000TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$2,800,000CurrentTaxYearMinus1YearAmt
Total$2,800,000TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$2,800,000PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$2,800,000CurrentTaxYearMinus1YearAmt
Total$2,800,000TotalAmt
FieldValueIRS element (for citing)
Public Support CY5091.00000PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONINDEPENDENT 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.
FORM 990, PAGE 6, PART VI, LINE 11BNO REVIEW WAS OR WILL BE CONDUCTED.
FORM 990, PAGE 6, PART VI, LINE 12CON APRIL 10, 2015, THE BOARD OF DIRECTORS OF THE CHARITY PASSED A RESOLUTION ADOPTING THE CHARITY'S CONFLICT OF INTEREST POLICY, WHICH IS ATTACHED AS EXHIBIT C TO FORM 1023. IT IS CONSISTENT WITH THE SAMPLE CONFLICT OF INTEREST POLICY IN APPENDIX A TO THE INSTRUCTIONS TO IRS FORM 1023.
FORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.

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