Civic Intelligence

Independent Health Network Inc

EIN 47-2845823 • 501(c)3 • Lincoln, NE

Profile

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.

575 Fallbrook Blvd Ste 204Lincoln, NE 68521-9040

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

72nd percentile

0.03x

Higher debt load relative to assets than 72% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2024

Liabilities / Revenue

75th percentile

0.03x

Higher debt load relative to revenue than 75% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2024

Net Margin

28th percentile

-13%

Higher net margin than 28% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2024

Top Officer Pay

100th percentile

$509,416

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 121.9% of source-year revenue.

501(c)3 • <$500k nonprofits • Source year 2024

Asset Growth

34th percentile

-17%

Faster asset growth than 34% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2023 to 2024

Revenue Growth

45th percentile

-6.9%

Faster revenue growth than 45% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2023 to 2024

Assets

Down

$343,503

Down $70,062 (-17%) from 2023

Liabilities

Down

$10,656

Down $16,683 (-61%) from 2023

Net Assets

Down

$332,847

Down $53,379 (-14%) from 2023

Revenue

Down

$418,040

Down $31,079 (-6.9%) from 2023

Expenses

Up

$471,419

Up $32,232 (+7.3%) from 2023

Net Income

Down

-$53,379

Down $63,311 (-637%) from 2023

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$3.0M$2.0M$1.0M$0Assets 2015: $2,353,997Liabilities 2015: $0Net Assets 2015: $2,353,9972015Assets 2016: $2,065,292Liabilities 2016: $3,126Net Assets 2016: $2,062,1662016Assets 2017: $930,257Liabilities 2017: $34,868Net Assets 2017: $895,3892017Assets 2018: $278,233Liabilities 2018: $25,459Net Assets 2018: $252,7742018Assets 2019: $192,211Liabilities 2019: $60,724Net Assets 2019: $131,4872019Assets 2020: $183,091Liabilities 2020: $95,268Net Assets 2020: $87,8232020Assets 2021: $295,741Liabilities 2021: $11,642Net Assets 2021: $284,0992021Assets 2022: $385,831Liabilities 2022: $9,537Net Assets 2022: $376,2942022Assets 2023: $413,565Liabilities 2023: $27,339Net Assets 2023: $386,2262023Assets 2024: $343,503Liabilities 2024: $10,656Net Assets 2024: $332,8472024

Highlighted filing

2024

Assets$343,503
Liabilities$10,656
Net Assets$332,847

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$2.0M$1.0M$0-$1.0M-$2.0MRevenue 2015: $0Expenses 2015: $446,004Net Income 2015: -$446,0042015Revenue 2016: $0Expenses 2016: $291,831Net Income 2016: -$291,8312016Revenue 2017: $494,229Expenses 2017: $1,661,006Net Income 2017: -$1,166,7772017Revenue 2018: $454,322Expenses 2018: $1,096,937Net Income 2018: -$642,6152018Revenue 2019: $1,117,237Expenses 2019: $1,238,524Net Income 2019: -$121,2872019Revenue 2020: $1,009,249Expenses 2020: $1,052,913Net Income 2020: -$43,6642020Revenue 2021: $1,104,337Expenses 2021: $908,061Net Income 2021: $196,2762021Revenue 2022: $603,701Expenses 2022: $511,506Net Income 2022: $92,1952022Revenue 2023: $449,119Expenses 2023: $439,187Net Income 2023: $9,9322023Revenue 2024: $418,040Expenses 2024: $471,419Net Income 2024: -$53,3792024

Highlighted filing

2024

Revenue$418,040
Expenses$471,419
Net Income-$53,379

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2024 to Dec 31, 2024
Signed
May 7, 2025
Return Version
2024v5.1
Gross Receipts
$418,040
Mission and Program Overview

Mission

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.

Balance Sheet Detail
LineBeginningEndChange
Assets
Pd in Cap Srpls Land Bldg Eqp Fund$2,800,000$2,800,000→ $0
Savings and Temporary Cash Investments$398,583$335,951▼ $62,632
Cash and Non-Interest-Bearing Accounts$5,319$5,727▲ $408
Accounts Receivable$9,663$1,825▼ $7,838
Cap Stk Tr Prin Current Funds$0$0→ $0
Rtn Earn Endowment Incm Other Fnds$-2,413,774$-2,467,153▼ $53,379
Total Assets$413,565$343,503▼ $70,062
Liabilities
Accounts Payable and Accrued Expenses$27,339$10,656▼ $16,683
Total Liabilities$27,339$10,656▼ $16,683
Net Assets / Fund Balance
Total Net Assets Fund Balance$386,226$332,847▼ $53,379
Total Liabilities and Net Assets / Fund Balance$413,565$343,503▼ $70,062
Compensation and Service Providers

Board Members and Trustees

NameTitle
Curtis HawkinsonBoard Chair
Rodney TriplettPresident & CEO
Tim SchnackVice Chair
Amanda RoebuckDirector
Stacy KnoxDirector
Treg VyzourekDirector

Highest Paid Contractors

ContractorServicesLocationCompensation
Ip PathwaysCarrier Costs3600 109TH STREET, Urbandale, IA 50322$196,715
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$398,672
Investment Income
$19,368
Other Revenue
$0
Change in Net Assets
$-53,379
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$471,419
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$368,933--$368,933
Fees for Services Management-$99,518-$99,518
Fees for Services Accounting-$2,783-$2,783
Other Expenses-$185-$185
Total Functional Expenses$368,933$102,486$0$471,419
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Backup withholding compliance
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

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. An annual statement is required of the board members to affirm understanding of the policy and compliance. If a conflict of interest arises or is of question, steps within the conflict of interest policy are followed to ensure mitigation.

Form 990, Part VI, Section C, Line 19

No documents available to the public.

Filing and Contact Details

Filer

Filer Name
Independent Health Network Inc
EIN
47-2845823
Phone
4024767333
Address
575 FALLBROOK BLVD STE 204, LINCOLN, NE 68521-9040

Signing Officer

Name
Rodney Triplett
Title
CEO
Phone
4024767333
Signed
2025-05-07
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Rodney Triplett
Formed
2015
Legal Domicile
Ne
Voting Board Members
6
Independent Board Members
5
Employees
0
Volunteers
5

Preparer

Firm
Rsm US Llp
Address
201 FIRST ST SE SUITE 800, CEDAR RAPIDS, IA 52401
Preparer
Shawna Huls
Phone
3192985333
Supplemental Narrative

Additional Explanations

Form 990, Part IX, Line 11G

Monitoring costs: program service expenses 500. Management and general expenses 0. Fundraising expenses 0. Total expenses 500. Usac expenses: program service expenses 171,718. Management and general expenses 0. Fundraising expenses 0. Total expenses 171,718. Carrier costs: program service expenses 196,715. Management and general expenses 0. Fundraising expenses 0. Total expenses 196,715.

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IRS990ScheduleJ/CompBasedOnRevenueOfFlngOrgInd00
IRS990ScheduleJ/CompBsdNetEarnsFlngOrgInd00
IRS990ScheduleJ/CompBsdNetEarnsRltdOrgsInd00
IRS990ScheduleJ/CompBsdOnRevRelatedOrgsInd00
IRS990ScheduleJ/EquityBasedCompArrngmInd00
IRS990ScheduleJ/InitialContractExceptionInd00
IRS990/ScheduleJRequiredInd01
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt0129315
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt0328458
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990FilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompReportPrior990RltdOrgsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompensationFlngOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/DeferredCompRltdOrgsAmt023100
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/NontaxableBenefitsRltdOrgsAmt028543
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0RODNEY TRIPLETT
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0PRESIDENT & CEO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt0509416
IRS990ScheduleJ/SeverancePaymentInd00
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0THE RELATED ORGANIZATION USES A COMPENSATION STUDY TO SET THE PRESIDENT/CEO'S COMPENSATION. FINAL COMPENSATION IS DETERMINED BY THE RELATED ORGANIZATION'S BOARD.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 3:
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1CLASS 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2ONLY CLASS A AND CLASS B MEMBERS MAY ELECT DIRECTORS. CLASS A MEMBER APPOINTS OVER 50% OF ALL DIRECTORS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING AND REVIEWED BY THE CEO.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4ON APRIL 10, 2015, THE BOARD OF DIRECTORS OF THE CHARITY PASSED A RESOLUTION ADOPTING THE CHARITY'S CONFLICT OF INTEREST POLICY. AN ANNUAL STATEMENT IS REQUIRED OF THE BOARD MEMBERS TO AFFIRM UNDERSTANDING OF THE POLICY AND COMPLIANCE. IF A CONFLICT OF INTEREST ARISES OR IS OF QUESTION, STEPS WITHIN THE CONFLICT OF INTEREST POLICY ARE FOLLOWED TO ENSURE MITIGATION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5NO DOCUMENTS AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6MONITORING COSTS: PROGRAM SERVICE EXPENSES 500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500. USAC EXPENSES: PROGRAM SERVICE EXPENSES 171,718. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,718. CARRIER COSTS: PROGRAM SERVICE EXPENSES 196,715. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 196,715.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION A, LINE 7B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART IX, LINE 11G
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/DisproportionateAllocationsInd00
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/EIN0204962103
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/GeneralOrManagingPartnerInd00
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/LegalDomicileStateCd0NE
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/PrimaryActivitiesTxt0HEALTHCARE SOLUTIONS
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/RelatedOrganizationName/BusinessNameLine1Txt0PRAIRIE HEALTH VENTURES LLC
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/USAddress/AddressLine1Txt0575 FALLBROOK BLVD SUITE 204
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/USAddress/CityNm0LINCOLN
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/USAddress/StateAbbreviationCd0NE
IRS990ScheduleR/IdRelatedOrgTxblPartnershipGrp/USAddress/ZIPCd068521
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd00
IRS990ScheduleR/PerformOfServicesByOtherOrgInd01
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd00
IRS990ScheduleR/TransferFromOtherOrgInd00
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/StatesWhereCopyOfReturnIsFldCd0NE
IRS990/SubjectToExcsTaxNetInvstIncInd00
IRS990/SubjectToProxyTaxInd00
IRS990/SubjToTaxRmnrtnExPrchtPymtInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt0413565
IRS990/TotalAssetsEOYAmt0343503
IRS990/TotalAssetsGrp/BOYAmt0413565
IRS990/TotalAssetsGrp/EOYAmt0343503
IRS990/TotalCompGreaterThan150KInd01
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt0102486
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt0368933
IRS990/TotalFunctionalExpensesGrp/TotalAmt0471419
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt027339
IRS990/TotalLiabilitiesEOYAmt010656
IRS990/TotalLiabilitiesGrp/BOYAmt027339
IRS990/TotalLiabilitiesGrp/EOYAmt010656
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt0386226
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0332847
IRS990/TotalOtherCompensationAmt051643
IRS990/TotalProgramServiceExpensesAmt0368933
IRS990/TotalProgramServiceRevenueAmt0398672
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt019368
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt0398672
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt0418040
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt05
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IRS990/TrnsfrExmptNonChrtblRltdOrgInd00
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IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt0575 FALLBROOK BLVD STE 204
IRS990/USAddress/CityNm0LINCOLN
IRS990/USAddress/StateAbbreviationCd0NE
IRS990/USAddress/ZIPCd0685219040
IRS990/VotingMembersGoverningBodyCnt06
IRS990/VotingMembersIndependentCnt05
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02025-03-06 01:10:19Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0RODNEY TRIPLETT
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0CEO
ReturnHeader/BusinessOfficerGrp/PhoneNum04024767333
ReturnHeader/BusinessOfficerGrp/SignatureDt02025-05-07
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0INDEPENDENT HEALTH NETWORK INC
ReturnHeader/Filer/BusinessNameControlTxt0INDE
ReturnHeader/Filer/EIN0472845823
ReturnHeader/Filer/PhoneNum04024767333
ReturnHeader/Filer/USAddress/AddressLine1Txt0575 FALLBROOK BLVD STE 204
ReturnHeader/Filer/USAddress/CityNm0LINCOLN
ReturnHeader/Filer/USAddress/StateAbbreviationCd0NE
ReturnHeader/Filer/USAddress/ZIPCd0685219040
ReturnHeader/IRSResponsiblePrtyInfoCurrInd00
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0420714325
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0RSM US LLP
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0201 FIRST ST SE SUITE 800
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0CEDAR RAPIDS
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0IA
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd052401
ReturnHeader/PreparerPersonGrp/PhoneNum03192985333
ReturnHeader/PreparerPersonGrp/PreparationDt02025-05-07
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0SHAWNA HULS
ReturnHeader/ReturnTs02025-05-08T13:41:20-05:00

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