2022-08-13T14:19:21-05:00 2021-09-30 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2020-10-01 752559845 Shannon Medical Center % JOSEPH WOOLDRIDGE SHAN 3256536741 120 E Harris Avenue San Angelo TX 76903 JOSEPH WOOLDRIDGE CFO 3256536741 2022-08-15 true JOSEPH WOOLDRIDGE 999009999 NOELLE ALBERTO P01704142 9727028262 3 2020 2022-09-23 18:48:47Z KELLY SHANE PLYMELL 120 E HARRIS AVENUE SAN ANGELO TX 76903 575714031 false X SHANNONHEALTH.COM X 1994 TX FOUNDED ON A LEGACY OF CARING, SHANNON IS A LOCALLY OWNED HEALTHCARE SYSTEM DEDICATED TO PROVIDING EXCEPTIONAL HEALTHCARE FOR OUR FAMILY, FRIENDS AND NEIGHBORS. 14 12 2888 152 947047 579005 9068599 11414866 419605273 560820730 780531 990097 2733110 2488338 432187513 575714031 0 0 0 0 120400824 178032624 0 0 0 253336434 317000222 373737258 495032846 58450255 80681185 398658748 508828126 49281446 89268320 349377302 419559806 FOUNDED ON A LEGACY OF CARING, SHANNON IS A LOCALLY OWNED HEALTHCARE SYSTEM DEDICATED TO PROVIDING EXCEPTIONAL HEALTHCARE FOR OUR FAMILY, FRIENDS AND NEIGHBORS. false false 397202048 0 561385560 PROVIDING TOTAL MEDICAL CARE TO THE CITIZENS OF WEST TEXAS. 397202048 true true false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 114 0 true 2888 true true true false false false false false false false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true true true X JOSEPH WOOLDRIDGE 3256536741 120 E HARRIS AVENUE SAN ANGELO TX 76903 X KELLY SHANE PLYMELL CEO 24.0 16.0 X 873771 0 109168 DR JASON FELGER DIRECTOR 2.0 38.0 X 0 787950 119375 DR JAMES C BARNETT CMO 38.0 2.0 X 664431 0 86095 PAMELA BRADSHAW CNO/COO 32.0 8.0 X 479259 0 86317 ALLAN GRAVES GENERAL COUNSEL 40.0 0.0 X 349209 0 60909 JOSEPH WOOLDRIDGE CFO 35.0 5.0 X 336367 0 52514 STEPHEN LUBKE DIRECTOR OF PHARMACY 40.0 0.0 X 202788 0 13381 STACI WETZ FORMER CFO/Controller 40.0 0.0 X 194304 0 20328 MARGARET BENSON CHIEF COMPLIANCE OFFICER 40.0 0.0 X 199690 0 14543 MICHAEL RUSSELL CHIEF INFORMATION OFFICER 40.0 0.0 X 191220 0 22075 STEPHANIE MCCANN ASSISTANT DIRECTOR OF PHARMACY 40.0 0.0 X 183982 0 17732 REBECCA FUENTES ASSOCIATE CNO 40.0 0.0 X 181311 0 12043 ORAN BERRY III VICE CHAIRMAN 2.0 6.0 X X 22350 49246 912 JOE HENDERSON FORMER TRUSTEE 0.0 0.0 X 23600 45917 736 MICHAEL TED WEATHERFORD TRUSTEE 2.0 6.0 X 21850 46902 736 MICHAEL OLIPHANT SECRETARY/TREASURER 2.0 6.0 X X 21350 46589 736 STEVE CECIL TRUSTEE 2.0 6.0 X 22350 29000 14461 LEN MERTZ CHAIRMAN 2.0 38.0 X X 6500 44726 4843 FREDY MOORE TRUSTEE 2.0 6.0 X 13100 17500 50 MICHAEL BOYD FORMER TRUSTEE 0.0 0.0 X 9000 12500 736 ANGELA WILLIAMS DIRECTOR 2.0 4.0 X 22100 0 0 VIRGINIA NOELKE DIRECTOR 2.0 4.0 X 19250 0 0 PAMELA TALLEY DIRECTOR 2.0 4.0 X 17200 0 0 JOANNE RICE FORMER DIRECTOR 0.0 0.0 X 16200 0 0 BRYANT VINCENT DIRECTOR 2.0 4.0 X 16100 0 0 JEFFREY MCCORMICK DIRECTOR 2.0 4.0 X 5400 0 0 WILLIAM C GRIFFIS DIRECTOR 2.0 4.0 X 5400 0 0 4087282 1080330 637690 79 true true false GRESHAM SMITH PO BOX 306023 NASHVILLE TN 37230 ARCHITECTURE/ENGINEE 596382 ONYX SOLUTIONS PO BOX 530 SAN ANGELO TX 76902 CONSTRUCTION 510795 TFE CONTRACTING PO BOX 92522 SOUTHLAKE TX 76092 GENERAL CONTRACTING 297917 JONES DAY PO BOX 7805 BEN FRANKLIN STATION WA 20044 LAW FIRM 240594 DISCOVERY HEALTHCARE CONSULTING PO BOX 93067 LUBBOCK TX 79493 HEALTHCARE CONSULTIN 186464 68 1536647 9166657 711562 11414866 Net Patient Revenue 621990 559213739 559017558 196181 Rental Income 532000 820655 820655 OTHER OPERATING REVENUE 900099 786336 786336 560820730 620814 580005 40809 0 0 0 0 0 313523 55760 313523 55760 369283 369283 0 0 0 0 0 0 0 0 0 Cafeteria 722514 1752647 1752647 LAUNDRY SERVICES 812300 170861 170861 GAIN ON LAWSUIT 900099 475000 475000 89830 89830 2488338 575714031 561189379 947047 2162739 0 0 0 0 3322387 3322387 248704 248704 146913119 120295858 26617261 3680242 3176580 503662 14754677 11540648 3214029 9113495 7306228 1807267 242300 242300 1713896 1713896 181425 181425 0 0 0 34375619 7104009 27271610 1153108 12790 1140318 5614869 668390 4946479 7664132 3403332 4260800 0 5438622 2294209 3144413 573307 212983 360324 0 0 1163384 1163384 0 24472642 15677520 8795122 2670089 2670089 Medical Supplies 136991746 135417159 1574587 Bad Debt 78826238 78826238 Equipment Costs 9661884 7479116 2182768 Collection Fees 1067244 1067244 5189717 3786988 1402729 495032846 397202048 97830798 0 4091363 0 0 0 0 0 34822467 55087958 0 0 0 0 802654 1228405 11269623 11013529 7009922 7232467 457828271 257671074 162156276 200157197 46234361 46491605 587944 809491 0 0 2074024 6235991 129610114 180571483 398658748 508828126 33996487 52975487 0 0 8933100 70170 0 0 0 0 0 0 678989 29736969 0 0 5672870 6485694 49281446 89268320 X 226271000 256922023 123106302 162637783 349377302 419559806 398658748 508828126 X 80681185 1021399 -11520080 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7222978 7222978 184419071 82593403 101825668 103245 5076 98169 250503019 172922672 77580347 15579958 2149923 13430035 200157197 Interest in Net Assets - Shann 162637783 Self Insurance Trust 7211077 DUE FROM 3RD PARTY PAYER 10532075 Interest Receivable 190548 180571483 0 Asset Retirement Obligation 1188932 Accrued Pension Cost 1370452 Malpractice Costs 3776160 Long Term Incentive Accrual 150150 6485694 507956968 1021399 12324338 -78826238 -65480501 573437469 2276562 2276562 575714031 428530946 12324338 12324338 416206608 78826238 78826238 495032846 SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE ON AUDITED FINANCIALS WITH RETURN: BAD DEBT (INCLUDED W/ REVENUE ON AUDIT) $ (78,826,238) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE ON AUDITED FINANCIALS WITH RETURN: CONTRIBUTIONS RECORDED TO NET ASSETS $ 2,276,562 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES ON AUDITED FINANCIALS WITH RETURN: BAD DEBT (INCLUDED W/ REVENUE ON AUDIT) $ 78,826,238 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X false true true true false true true 16042256 16042256 0.03740 36253004 46194799 349603 112113 237490 0.00060 52644863 46306912 16279746 0.03800 741757 741757 0.00170 1424055 1424055 0.00330 20657002 20657002 0.04820 174233 174233 0.00040 7102 7102 0.00000 23004149 23004149 0.05360 75649012 46306912 39283895 0.09160 true 78826238 113674218 116565923 -2891705 X true true 1 1 SHANNON MEDICAL CENTER 120 E HARRIS AVENUE SAN ANGELO TX 76903 SHANNONHEALTH.COM 000168 X X X X SHANNON MEDICAL CENTER 01 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 19 true SEE PART V, SECTION C false true X 200. 0. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM COMMUNITY REPRESENTATIVES: COMMUNITY INPUT WAS PROVIDED THROUGH KEY STAKEHOLDER INTERVIEWS OF STAKEHOLDERS FROM THE FOLLOWING ORGANIZATIONS: SHANNON MEDICAL CENTER, SOCIAL SERVICE AGENCIES, LOCAL SCHOOL SYSTEMS AND UNIVERSITIES, PUBLIC HEALTH AGENCIES, OTHER MEDICAL PROVIDERS, LOCAL ELECTED OFFICIALS AND GOVERNMENTAL AGENCIES AND LOCAL BUSINESS. ELECTRONIC SURVEYS WERE DISTRIBUTED TO 140 INFORMANTS REPRESENTING THE MEDICAL CENTER'S SERVICE AREA. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ADDRESSED AND NOT ADDRESSED: BASED ON SHANNON'S EVALUATION WITHIN THE CURRENT CHNA, THE MEDICAL CENTER IS CURRENTLY MEETING THEIR GOALS OR HAS ALREADY MET THE GOALS FROM THE 2016 CHNA. THE BELOW CHNA ACTION PLAN INCLUDES DETAILS ON HOW SHANNON MEDICAL CENTER IS ADDRESSING SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA CONDUCTED IN 2019. THE NEEDS ARE CATEGORIZED IN THE FOLLOWING PRIORITY AREAS: IMPROVE ACCESS TO CARE, ADULT OBESITY, LACK OF HEALTH KNOWLEDGE/EDUCATION, LACK OF MENTAL HEALTH PROVIDERS, SHORTAGE OF PRIMARY CARE PHYSICIANS AND HEALTHY BEHAVIORS/LIFESTYLE. PRIORITY 1: IMPROVE ACCESS TO CARE (INCLUDING SHORTAGE OF PRIMARY CARE PHYSICIANS) SHANNON MEDICAL CENTER PLANS TO CONNECT PATIENTS WITH APPROPRIATE HEALTH SERVICES TO IMPROVE THE CONTINUUM OF CARE AND WILL IMPROVE COMMUNITY AWARENESS OF AVAILABLE HEALTH SERVICES, EDUCATION AND SUPPORT. IN FISCAL YEAR 2021, THE CARE CORRDINATION PROGRAM EXPANDED SERVICES TO SERVE MORE PATIENTS WITH CHRONIC ILLNESSES AND COVID-19. 817 PATIENTS WERE PROVIDED TRANSPORTATION SERVICES AND $46,325,233 WAS PAID IN CHARITY CARE AND $20,657,002 IN SUBSIDIZED HEALTH SERVICES. PRIORITY 2: HEALTHY BEHAVIORS/LIFESTYLE THE MEDICAL CENTER WILL PROVIDE OPPORTUNITIES TO PROMOTE HEALTHY LIVING IN THE COMMUNITY AND PARTICIPATE AT COMMUNITY OUTREACH EVENTS TO SUPPORT HEALTH LIFESTYLES. IN FISCAL YEAR 2021, SHANNON STAFF SERVED ON 12 COMMUNITY COALITIONS/BOARD AND DEDICATED OVER 290 SERVICE HOURS TO COMMUNITY BUILDING EFFORTS. DONATIONS WERE GIVEN TO SUPPORT TWO COMMUNITY INITIATIVES THAT PROMOTE HEALTH EDUCATION AND PHYSICAL ACTIVITY. SHANNON ALSO PARTNERED WITH 9 ORGANIZATION TO OFFER HEALTH EDUCATION TO MORE THAN 65,000 COMMUNITY MEMBERS. PRIORITY 3: ADULT OBESITY THE MEDICAL CENTER WILL INCREASE PUBLIC AWARENESS OF THE IMPORTANCE OF HEALTH EATING, NUTRITION AND PHYSICAL ACTIVITY. IN FISCAL YEAR 2021, SHANNON PROVIDED INFORMATION MATERIALS TO 9 COMMUNITY EVENTS, LED A BARIATRIC SUPPORT GROUP THAT PROVIDED SUPPORT TO 20 COMMUNITY MEMBERS AND PARTICIPATED AT DIABETES EDUCATIONAL SEMINARS. PRIORITY 4: HEALTH EDUCATION/KNOWLEDGE THE MEDICAL CENTER WILL PROVIDE GREATER HEALTH EDUCATION TO CHILDREN, FAMILIES AND VULNERABLE POPULATIONS. THE CENTER PLANS TO IMPROVE COMMUNITY OUTREACH EFFORTS THAT WILL PROVIDE MORE HEALTH EDUCATION OPPORTUNITIES WITH LOCAL BUSINESSES. THE IMPLEMENTATION STRATEGY WILL ASSURE HEALTHCARE AND SOCIAL SERVICE PROVIDERS IN THE COMMUNITY HAVE THE MOST UP-TO-DATE KNOWLEDGE. IN FISCAL YEAR 2021, SHANNON PROVIDED THE HEALTHBEAT TV SEGMENTS THAT REACHED OVER 30,000 VIEWERS AND A HEALTHBEAT MAGAZINE THAT REACHED 30,000 COMMUNITY MEMBERS. THE HOSPITAL ALSO PARTNERED WITH EMPLOYER GROUPS TO PROVIDE HEALTH EDUCATION TO 65 WORKFORCE MEMBERS, AS WELL AS OTHER COMMUNITY ORGANIZATIONS TO DISTRIBUTE INFORMATION AND RESOURCES TO 2,000 COMMUNITY MEMBERS. SHANNON ALSO PARTNERED WITH 14 COLLEGES AND UNIVERSITIES TO OFFER EDUCATION TO 796 STUDENTS. EXPLANATION OF NEEDS NOT ADDRESSED THERE ARE NEEDS THAT SHANNON WILL NOT ADDRESS IN THE CURRENT IMPLEMENTATION STRATEGY THAT ARE CLEARLY IMPORTANT TO IMPROVING THE HEALTH OF THE COMMUNITY. LACK OF MENTAL HEALTH PROVIDERS IS ONE NEED NOT SPECIFICALLY ADDRESSED IN THE ASSESSMENT. WHILE SHANNON IS NOT INCORPORATING STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS, THE COMMUNITY HAS SEEN IMPROVEMENT AND GROWTH IN THE ACCESSIBILITY OF MENTAL HEALTH PROVIDERS AND AVAILABLE MENTAL HEALTH SERVICES OVER RECENT YEARS. FURTHERMORE, SHANNON WILL CONTINUE TO EXPLORE POTENTIAL PARTNERSHIPS AND INTERNAL STRATEGIES TO FIND A WAY TO PROVIDE THESE ESSENTIAL HEALTH SERVICES TO OUR PATIENTS AND COMMUNITY. SCHEDULE H, PART V, SECTION B, LINES 7A & 10A CHNA & IMPLEMENTATION STRATEGY AVAILABLE ON HOSPITAL FACILITY'S WEBSITE: HTTPS://WWW.SHANNONHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B LINE 16A FAP WEBSITE URL: https://www.shannonhealth.com/media/224035/501r-Financial-Assistance-Polic y-English-2017.pdf SCHEDULE H, PART V, SECTION B LINE 16B FAP APPLICATION FORM URL: https://www.shannonhealth.com/media/192408/Shannon-Financial-Responsibilit y-Report.pdf SCHEDULE H, PART V, SECTION B LINE 16C PLAIN LANGUAGE SUMMARY OF FAP URL: https://www.shannonhealth.com/media/224029/501r-SMC-Financial-Assistance-P olicy-Summary-English-2017.pdf 3 SHANNON SURGERY CENTER 120 E HARRIS AVENUE SAN ANGELO TX 76903 AMBULATORY SURGERY CENTER SHANNON HOME HEALTH 2030 PULLIAM STE 6 SAN ANGELO TX 76905 HOME HEALTH CENTER REGIONAL CANCER TREATMENT CENTER LTD PO BOX 1387 SAN ANGELO TX 76902 CANCER CENTER SCHEDULE H, PART I, LINE 3C METHOD TO DETERMINE ASSISTANCE ELIGIBILITY: SHANNON MEDICAL CENTER ALSO USES INSURANCE STATUS AND UNDERINSURANCE STATUS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. SCHEDULE H, PART III, SECTION A, LINE 2 & 3 Bad Debt METHODOLOGY LINE 2: AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE ORGANIZATION'S INTERNAL FINANCIALS. LINE 3: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: SEE PAGE 12 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE COST REPORT USES COST TO CHARGE RATIOS FOR ANCILLARY DEPARTMENTS, PLUS IN THE ROOM AND BOARD AREAS IT IS A PER DIEM. THE STATE OF TEXAS TREATS SHORTFALL AS A COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. FOR FISCAL YEAR 2021, THERE WAS A SHORTFALL CALCULATED OF $2,891,705. SCHEDULE H, PART III, SECTION C, LINE 9B WRITTEN DEBT COLLECTION POLICY CHARITY CARE AND DISCOUNTING FOR UNINSURED PATIENTS WHO ARE NOT ELIGIBLE FOR GOVERNMENT HEALTH CARE PROGRAMS AND WHOSE FINANCIAL CONDITION IS SUCH THAT THEY ARE NOT ABLE TO PAY FOR HOSPITAL SERVICES MAY BE ELIGIBLE FOR ASSISTANCE UNDER THE SHANNON MEDICAL CENTER CHARITY CARE PROGRAM. PATIENTS WHO ARE UNINSURED, DO NOT QUALIFY FOR COVERAGE UNDER GOVERNMENT HEALTH CARE PROGRAMS, MAY BE ELIGIBLE FOR A 50% DISCOUNT OFF THE TOTAL BILL FOR HOSPITAL SERVICES, IF THE SERVICES ARE PAID FOR WHEN RECEIVED OR WITHIN 30 DAYS OF DISCHARGE. COLLECTION OF ACCOUNTS RECEIVABLE PATIENTS / GUARANTOR WILL BE RESPONSIBLE FOR PAYMENT OF SERVICES RECEIVED AT SHANNON MEDICAL CENTER. PATIENTS / GUARANTORS WILL BE RESPONSIBLE FOR FULL CHARGES, OR PATIENT PORTION NOT COVERED BY INSURANCE. PAYMENT WILL BE REQUESTED PRIOR TO OR ON THE DATE OF SCHEDULED ELECTIVE SERVICES. FULL CHARGES OR PATIENT PORTION NOT COVERED BY INSURANCE FOR URGENT / EMERGENT SERVICES WILL BE COLLECTED UPON DISCHARGE. PATIENTS WHO ARE UNABLE TO PAY THE FULL AMOUNT OF THEIR RESPONSIBILITY AT THE TIME OF SERVICE CAN MAKE PAYMENT ARRANGEMENTS UNDER THE FOLLOWING GUIDELINES: A. BALANCE OF OUTPATIENT SERVICES MUST BE PAID WITHIN SIX (6) MONTHS FROM THE DATE OF SERVICE UNLESS INDIGENT STATUS IS PROVEN B. BALANCE OF INPATIENT SERVICES MUST BE PAID WITHIN TWELVE (12) MONTHS FROM THE DATE OF DISCHARGE UNLESS INDIGENT STATUS IS PROVEN. MONTHLY STATEMENTS WILL BE SENT THROUGHOUT THE COLLECTION CYCLE. COLLECTION LETTERS WILL BE UTILIZED AT THE DISCRETION OF THE PATIENT ACCOUNT REPRESENTATIVE. ACCOUNTS WILL BE REVIEWED FOR OUTSIDE COLLECTION AGENCY PLACEMENT ANYTIME FOLLOWING 90 DAYS FROM THE DATE OF SERVICE. MEDICARE ACCOUNTS WILL NOT BE CONSIDERED FOR PLACEMENT UNTIL 120 DAYS FROM THE FIRST NOTICE OF PATIENT RESPONSIBILITY IN ACCORDANCE WITH MEDICARE REGULATIONS. ANY OVERPAYMENT OF AN ACCOUNT WILL BE REVIEWED FOR REFUND WITHIN 30 DAYS FROM THE DATE THE CREDIT BALANCE IS CREATED BY THE OVERPAYMENT. CREDIT BALANCES ON MEDICARE ACCOUNTS WILL BE PROCESSED THROUGH THE NORMAL CREDIT BALANCE PROCESS AND REPORTED ON A QUARTERLY BASIS IN COMPLIANCE WITH MEDICARE REGULATIONS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: HEALTH NEEDS OF THE COMMUNITY HAVE BEEN IDENTIFIED AND PRIORITIZED SO THAT SHANNON MAY ADOPT AN IMPLEMENTATION STRATEGY TO ADDRESS SPECIFIC NEEDS OF THE COMMUNITY. THE PROCESS INVOLVED: -AN EVALUATION OF THE IMPLEMENTATION STRATEGY FROM THE PREVIOUS NEEDS ASSESSMENT WHICH WAS ADOPTED BY SHANNON BOARD OF DIRECTORS IN 2016. -COLLECTION AND ANALYSIS OF A LARGE RANGE OF DATA, INCLUDING DEMOGRAPHIC, SOCIOECONOMIC, AND HEALTH STATISTICS, AND HEALTHCARE RESOURCES. -OBTAINING COMMUNITY INPUT THROUGH: -INTERVIEWS WITH KEY INFORMANTS WHO REPRESENT A) BROAD INTERESTS OF THE COMMUNITY, B) POPULATIONS OF NEED, OR C) PERSONS WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. -A HEALTH SURVEY WHICH GATHERED A WIDE RANGE OF INFORMATION WHICH WAS DISTRIBUTED TO IDENTIFIED STAKEHOLDERS. THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IS TO UNDERSTAND THE UNIQUE HEALTH OF THE COMMUNITY SERVED BY SHANNON AND TO DOCUMENT COMPLIANCE WITH NEW FEDERAL LAWS. SHANNON MEDICAL CENTER ENGAGED BKD, LLP TO CONDUCT A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT. BASED ON CURRENT LITERATURE AND OTHER GUIDANCE FROM THE TREASURY AND THE IRS, THE FOLLOWING STEPS WERE CONDUCTED AS PART OF SHANNON'S COMMUNITY HEALTH NEEDS ASSESSMENT: AN EVALUATION OF THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE FISCAL YEAR SEPTEMBER 30, 2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND AN IMPLEMENTATION STRATEGY SCORECARD WAS PREPARED TO UNDERSTAND THE EFFECTIVENESS OF SHANNON'S CURRENT STRATEGIES AND PROGRAMS. THE COMMUNITY SERVICE BY SHANNON WAS DEFINED BY UTILIZING INPATIENT AND OUTPATIENT DATA REGARDING PATIENT ORIGIN. THIS PROCESS IS FURTHER DESCRIBED IN COMMUNITY SERVED BY SHANNON. POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED UTILIZING VARIOUS THIRD PARTIES. THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY COUNTYHEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED. COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF SEVEN INFORMANTS AND 66 COMMUNITY HEALTH NEEDS SURVEYS. RESULTS AND FINDINGS ARE DESCRIBED IN THE KEY INFORMANT SECTION OF THE CHNA REPORT. INFORMATION GATHERED IN THE STEPS ABOVE WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTED METHOD THAT WEIGHS: 1) THE SIZE OF THE PROBLEM (HOW MANY PEOPLE ARE AFFECTED BY THE ISSUE) 2) THE SERIOUSNESS OF THE PROBLEM (WHAT ARE THE CONSEQUENCES OF NOT ADDRESSING THE ISSUE) 3) THE PREVALENCE OF COMMON THEMES 4) THE ALIGNMENT WITH SHANNON'S RESOURCES SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE: FINANCIAL ASSISTANCE BROCHURES THAT OUTLINE ACCESS TO INFORMATION ABOUT ASSISTANCE PROGRAMS ARE AVAILABLE IN EACH OF THE REGISTRATION AREAS. WE ALSO HAVE CONTRACTED ELIGIBILITY WORKERS WHO SCREEN PATIENTS FOR ALL SOCIAL SERVICE PROGRAMS AND ASSIST WITH THE APPLICATION PROCESS IF NEEDED. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SHANNON MEDICAL CENTER IS LOCATED IN SAN ANGELO, TEXAS. THE CITY OF SAN ANGELO SERVES AS THE COUNTY SEAT AND POPULATION CENTER OF TOM GREEN COUNTY, WITH AN ESTIMATED POPULATION IN 2020 OF 120,003. TOM GREEN COUNTY'S POPULATION IN 2019 OF 19,200. THE ESTIMATED POPULATION FOR SHANNON'S SERVICE AREA AS OF 2020, INCLUDING TOM GREEN COUNTY, IS 350,913 (U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS). THE COUNTIES INCLUDED IN THE SHANNON SERVICE AREA ARE BROWN, COKE, CONCHO, COLEMAN, CROCKETT, HOWARD, IRION, KIMBLE, MASON, MCCULLOCH, MENARD, MILLS, MITCHELL, NOLAN, PECOS, REAGAN, RUNNELS, SAN SABA, SCHLEICHER, STERLING, SUTTON, TERRELL, TOM GREEN, UPTON, AND VAL VERDE. A BREAKDOWN OF TOM GREEN COUNTY DEMOGRAPHICS IS AS FOLLOWS. (SOURCE: U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS, THE COUNTY INFORMATION PROJECT, TEXAS ASSOCIATION OF COUNTIES.) TOM GREEN COUNTY AGE DISTRIBUTION 1. UNDER 18 YEARS OLD - 23.8% (28,561) 2. 18-64 YEARS OLD - 60.6% (72,722) 3. 65 YEARS AND OLDER - 15.6% (18,720) TOM GREEN COUNTY ETHNIC DISTRIBUTION (MORE THAN ONE CATEGORY MAY BE SELF-REPORTED) 1. CAUCASIAN - 52.4% (62,882) 2. HISPANIC - 40.7% (48,841) 3. BLACK - 4.4% (5,280) 4. OTHER - 2.5% (3,000) TOM GREEN COUNTY (HOUSEHOLD) 1. MEDIAN HOUSEHOLD INCOME - $57,670 (TEXAS: $63,826, US: $64,994) 2. PERSONS LIVING IN POVERTY LEVEL - 12.0% (TEXAS: 13.4%, US: 11.4%) TOM GREEN COUNTY HEALTH INDEX 1. TOM GREEN COUNTY UNINSURED - 17.6% (TEXAS: 20.8%, US: 10.2%) SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: In a county with no hospital taxing authority, a hospital whose mission reflects commitment to treating patients without regard to ability to pay is a highly desirable and pivotal point of community health care. For more than 87 years, Shannon has embraced such a mission and follows through on the wishes of our benefactor, Margaret Shannon, in providing care for the people of West Texas. Our charity care figure of more than $46,325,233 would be a burden to the taxpayers of Tom Green County, and many other counties whose citizens directly benefit from her generosity. Shannon's Care Coordination program is designed to assist in the healthcare of chronically ill patients with multiple disease processes. Patients with multiple chronic illnesses account for the majority of healthcare spending in our society with a mere 5% accounting for nearly 50% of the spending. The purpose of this program is offer patient navigation services to the sickest patients by providing the following services: medication reconciliation, addressing social issues, and helping the patient manage chronic illnesses in their home setting. This program provides an intensive and comprehensive team approach to managing high-risk patients by utilizing health coaches that report to an interdisciplinary team at Shannon. Since March 2020 and throughout fiscal year 2021, the novel coronavirus disease disrupted the services provided by the Care Coordination program due to organization and State enforced restrictions to patient interactions and home visits. In addition, the department goals and focus quickly shifted with the increased community need to provide outpatient and discharge series to patients testing positive for COVID-19. However, the department continues to facilitate coordination of care and transition services to high-risk patients with chronic disease including COVID-19. Shannon provided $587,131 for the operation of this program. Shannon provided access and support services for indigent patients, including $26,899 in transportation vouchers and $3,996 for durable medical equipment, outpatient oxygen, outpatient prescription assistance, and motel expenses for COVID-19 positive patients discharged from the hospital. Shannon often offers Pastoral Care services that are outside the scope of the normal routine spiritual and pastoral care provided in a day-to-day patient care practices. Shannon provides the No One Dies Alone (NODA) program to offer companionship and support to patients who are nearing the end of life. NODA provides a dignified death to individuals who have no family or close friends to sit with them at the end of life. In addition, the Pastoral Care team presided over 24 funeral/memorial services and organized five vigils. These support services were provided at a cost of $10,446 to Shannon. Shannon provides a host of community education events related to topics such as diabetes management and prevention, water safety for children, fitness and nutrition, childbirth and child care, weight management, stroke prevention and cardiovascular health. Through educational events and various community events, health professionals relay current health information to the public. Representatives from different departments provide support and participate in local health fairs and health-related community events where they provide various health screenings and educational material. In addition to public outreach events, Shannon publishes the Healthbeat newsletter magazine which is delivered to 30,000 households and produces Healthbeat television spots that air during the 6 and 10 p.m. news hours on two local stations. Shannon contributed $94,947 for these programs. Regional efforts are provided to Regional Health Partnership 13 for the 1115 Waiver programs including, technical assistance, guidance, educational event planning, survey administration and support. This support is provided at a cost of $801. Shannon donated funds to social services and community-based efforts, such as hosting Vitalant blood drives. This support is provided at a cost of $6301. Shannon contributes planning and financial assistance to community building efforts. This past fiscal year, $130,302 was donated to other community organizations including San Angelo Independent School District, Angelo State University Foundation, San Angelo Stock Show and Rodeo, West Texas Rehabilitation Center, YMCA of San Angelo, Sunset Mall, Laura Bush Institute for Women's Health and many others. Shannon actively participates in various community coalitions and other collaborative efforts with the community to address health and safety issues. This is provided at a cost of $2,553 to Shannon. Shannon supports The Lighthouse for the Blind by donating used linen to the organizations. Based on thrift value, the cost of the linen donated is $1,975. Shannon has recognized a community need to offer supportive services to parents and families suffering from early pregnancy loss, stillbirth, or newborn death. The White Rose Support Group at Shannon hosts a 5-part session called "Grieving the Child I Never Knew" to offer insight, encouragement, healing, hope, and sharing for families experiencing perinatal loss. Furthermore, the White Rose Support Group hosts a Walk to Remember and Candlelight event for those who have suffered. These events are provided at a cost of $7,055 to Shannon. Shannon partners with the American Heart Association to educate, raise awareness and prevent heart disease and stroke. Shannon understands that continued education and awareness is crucial for women and men to fight this deadly disease. This sponsorship is provided at a cost of $7,500 to Shannon. Shannon is the only provider that operates the Sexual Assault Nurse Examiner program (SANE) in the Shannon service are. SANE trained nurses work with the Children's Advocacy Center, the Concho Valley Rape Crisis Center and other community-based organizations to provide training and services related to sexual assault crises. SCHEDULE H, PART VI, LINE 6 Affiliated health care system: Shannon, a non-profit health system established in the 1930's, provides the communities of West Central Texas with a variety of medical services. Dedicated to the region's health and well-being, our facility is licensed for over 400 beds and provides a variety of clinical services to meet each patient's needs. We are the designated Level III Lead Trauma Facility for the region, have a nationally recognized intensive care unit, provide critical care to newborns as young as 28 weeks gestation, perform state-of-the-art diagnostics in our radiology department, and provide complete testing and surgical capabilities for cardiology patients, among many more services. Shannon continues to collaborate and build relationships with a broad range of agencies, organizations and institutions to build community and organizational capacity. By effectively utilizing resources and working together, Shannon plans to implement strategies to improve the community it serves. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS SCHEDULE H, PART 1, LINE 7, COLUMN F COMMUNITY BENEFIT EXPENSE: Bad debt expense of $78,826,238 was included on form 990, part ix, line 25, column (A), but was subtracted from total expense for the calculation of "percent of total expense" in this column. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRS WORKSHEETS 4, 5 & 7 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT PROCESS. X true true X X X X false true false false false false false false false JOE HENDERSON FORMER TRUSTEE 23600 45917 0 0 0 0 0 0 736 0 24336 45917 DR JASON FELGER DIRECTOR 0 631045 0 57172 0 99733 0 81076 0 38299 0 907325 79514 JOANNE RICE FORMER DIRECTOR 16200 0 0 0 0 0 0 0 0 0 16200 0 KELLY SHANE PLYMELL CEO 655276 0 144671 0 73824 0 84170 0 24998 0 982939 0 73824 PAMELA BRADSHAW CNO/COO 348332 0 77548 0 53379 0 61319 0 24998 0 565576 0 53379 DR JAMES C BARNETT CMO 510725 0 95325 0 58381 0 67371 0 18724 0 750526 0 58381 JOSEPH WOOLDRIDGE CFO 276411 0 59956 0 0 0 27516 0 24998 0 388881 0 0 ALLAN GRAVES GENERAL COUNSEL 286755 0 62454 0 0 0 35911 0 24998 0 410118 0 0 STACI WETZ FORMER CFO/Controller 138808 0 10000 0 45496 0 5809 0 14519 0 214632 0 45496 MARGARET BENSON CHIEF COMPLIANCE OFFICER 189690 0 10000 0 0 0 6653 0 7890 0 214233 0 MICHAEL RUSSELL CHIEF INFORMATION OFFICER 181220 0 10000 0 0 0 7523 0 14552 0 213295 0 STEPHANIE MCCANN ASSISTANT DIRECTOR OF PHARMACY 180832 0 3150 0 0 0 7501 0 10231 0 201714 0 STEPHEN LUBKE DIRECTOR OF PHARMACY 195888 0 6900 0 0 0 7799 0 5582 0 216169 0 REBECCA FUENTES ASSOCIATE CNO 171311 0 10000 0 0 0 6895 0 5148 0 193354 0 MICHAEL BOYD FORMER TRUSTEE 9000 12500 0 0 0 0 0 0 736 0 9736 12500 0 SCHEDULE J, PART I, LINE 1A PROVIDED HEALTH, SOCIAL DUES OR INITIATION FEES KELLY SHANE PLYMELL RECEIVES MEMBERSHIP TO BENTWOOD COUNTRY CLUB EXCLUSIVELY FOR BUSINESS USE. ANY PERSONAL USE IS REIMBURSED BY THE OFFICER AND THEREFORE NO AMOUNTS ARE REPORTABLE ON HIS FORM W-2. SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN: FIXED CONTRIBUTION - THE PARTICIPANT'S ALLOWANCE PERCENTAGE FOR THE PLAN YEAR MULTIPLIED BY THE PARTICIPANT'S BASE SALARY FOR THE PRECEDING PLAN YEAR. DISCRETIONARY CONTRIBUTION - THE AMOUNT DETERMINED BY THE COMMITTEE, IN ITS SOLE DISCRETION, ON BEHALF OF A PARTICIPANT FOR THE PLAN YEAR BASED UPON CRITERIA ESTABLISHED BY THE COMMITTEE, IN ITS SOLE DISCRETION. THE APPLICABLE PLAN YEAR OF THE DISCRETIONARY CONTRIBUTION SHALL BE PLAN YEAR DURING WHICH IT IS CREDITED TO THE PARTICIPANT'S MUTUAL FUND ACCOUNT PURSUANT TO SECTION 2.1.3.2 OF EXHIBIT A TO THE PLAN. HOWEVER, THE COMMITTEE, IN ITS SOLE DISCRETION, MAY DETERMINE THE AMOUNT OF THE DISCRETIONARY CONTRIBUTION BASED UPON CRITERIA RELATING TO THE PRECEDING PLAN YEAR, AS MEASURED DURING THE FISCAL YEAR OF THE COMPANY ENDING IN SUCH PRECEDING PLAN YEAR. 457(F) DETAIL PARTICIPANT W-2 DEFERRED COMP PAYOR ------------ --------- --------------- ----------- KELLY SHANE PLYMELL $73,824 $72,770 SMC JAMES BARNETT $58,381 $55,971 SMC PAMELA BRADSHAW $53,379 $49,919 SMC ALAN GRAVES NONE $30,520 SMC JOSEPH WOOLDRIDGE NONE $23,696 SMC STACI WETZ $45,496 NONE SMC JASON FELGER $79,514 $69,676 SC FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: SHANNON HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: THE BOARD OF DIRECTORS SHALL CONSIST OF EACH OF THE SEVEN TRUSTEES OF THE MARGARET SHANNON ESTATE, A TESTAMENTARY TRUST. THE OTHER DIRECTORS SHALL CONSIST OF REPRESENTATIVES OF THE COMMUNITY AND MEMBERS OF THE MEDICAL STAFF OF THE HOSPITAL, TO NUMBER IN AGGREGATE NOT MORE THAN SEVEN WHO ARE APPOINTED BY THE MEMBER AND THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL: APPROVAL OF THE SOLE MEMBER, SHANNON HEALTH SYSTEM, IS REQUIRED FOR BUDGETS, LARGE FINANCIAL EXPENDITURES THAT DEVIATE FROM BUDGET, SALE OF PROPERTY, MERGER, ACQUISITION, OR CONSOLIDATION, BORROWING OF MONEY, SEEKING OR GIVING GRANTS, SETTLEMENT OF CLAIMS OR LITIGATION, AMENDMENT OF BYLAWS, AND CONTRACTS IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS PRIOR TO FILING. A COPY WILL BE MADE AVAILABLE TO THE FINANCE COMMITTEE AND BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: WE REGULARLY AUDIT FOR CONFLICT OF INTEREST STATEMENTS IN THE EMPLOYEES RECORDS. PROCEDURE FOR MONITORING: 1. WITHIN 90 DAYS OF BECOMING AN AFFECTED INDIVIDUAL, THAT INDIVIDUAL MUST REVIEW THIS POLICY AND COMPLETE AN SMC CONFLICT OF INTEREST DISCLOSURE FORM. 2. AT LEAST ANNUALLY THEREAFTER, AFFECTED INDIVIDUALS MUST REVIEW THIS POLICY AND COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. 3. THE CONFLICT OF INTEREST DISCLOSURE FORM SHOULD BE SENT TO THE SMC COMPLIANCE OFFICER. 4. AT ANY TIME WHEN AN ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST ARISES, THE AFFECTED INDIVIDUAL MUST REVISE HIS OR HER CONFLICT OF INTEREST DISCLOSURE FORM AND CONTACT THE SMC COMPLIANCE OFFICER. THE RESPONSIBILITY TO PROMPTLY REPORT SUCH ACTUAL OR POTENTIAL CONFLICTS RESTS WITH THE AFFECTED INDIVIDUAL. 5. THE SMC COMPLIANCE OFFICER WILL REVIEW DISCLOSURES AND DETERMINE WHICH REQUIRE FURTHER ACTION WITH THE SMC GENERAL COUNSEL AND APPROPRIATE SMC EXECUTIVE STAFF. FORM 990, PART VI, SECTION B, LINE 15A & 15B REVIEW OF COMPENSATION: GALLAGHER COMPLETED AN EXECUTIVE COMPENSATION STUDY IN MARCH 2020, AND IT COVERED ALL EXECUTIVE SALARIES. EXECUTIVE COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES' OPERATIONS COMMITTEE, WHICH CONSULTS COMPARABILITY DATA AND KEEPS CONTEMPORANEOUS RECORDS OF ITS DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES Transfers to/from affiliates: (53,634,723) Change in Shannon Trust Net Assets: 41,031,481 Net Assets Released from Restriction: (1,826,836) PURCHASE OF NON-CONTROLLING INTEREST 550,339 Other Changes 2,359,659 ------------------ (11,520,080) TRUSTEES SHANNON WEST TEXAS HOSPITAL PO BOX 49 SAN ANGELO TX 76902 750800679 TRUST TX 501(C)(3) 12B NA false SHANNON RURAL HEALTH CLINICS INC 120 E HARRIS AVE SAN ANGELO TX 76903 752940211 HEALTHCARE TX 501(C)(3) 12C SMC true SHANNON CLINIC 120 E BEAUREGARD AVE SAN ANGELO TX 76903 752600873 HEALTHCARE TX 501(C)(3) 10 SHS true SHANNON REAL ESTATE SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 270075630 SUPPORT SVCS TX 501(C)(3) 12A SMC true SHANNON HEALTH SYSTEM 120 E HARRIS AVE SAN ANGELO TX 76903 752602411 SUPPORT SVCS TX 501(C)(3) 12B TSWTH true SHANNON BUSINESS SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 432038769 SUPPORT SVCS TX 501(C)(3) 12A SMC true SHANNON MEDICAL MANAGEMENT 120 E BEAUREGARD AVE SAN ANGELO TX 76903 208367966 SUPPORT SVCS TX 501(C)(3) 12B SHS true SHANNON MEDICAL CENTER PIONEER FDN 120 E HARRIS AVE SAN ANGELO TX 76903 352229303 SUPPORT TX 501(C)(3) 12A SMC true REGIONAL CANCER TREATMENT CENTER 102 N MAGDALEN STE 120 SAN ANGELO TX 76903 752225955 RADIOTHERAPY TX NA RELATED 885800 0 false 0 true 0.56247 REGIONAL CANCER TREATMENT CTR 102 N MAGDALEN STE 120 SAN ANGELO TX 76903 752225955 RADIOTHERAPY TX NA RELATED 286213 0 false 0 false 0.18709 LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 MANAGEMENT TX NA C - CORPORATION 0 0 false LEGACY HEALTH SOLUTIONS 2018 PULLIAM ST SAN ANGELO TX 76903 200720762 MED INSURANCE TX NA C - CORPORATION 0 0 false false false true false false false false false false true true false false true true true true true true shannon real estate services k 1707002 fmv shannon business services p 24693800 fmv shannon clinic p 27987429 fmv shannon medical management p 2495460 fmv shannon business services q 628325 fmv shannon clinic q 15914998 fmv shannon medical management q 25776113 fmv shannon real estate services q 961209 fmv shannon business services r 11472509 fmv shannon clinic r 170690732 fmv shannon medical management r 35559370 fmv shannon real estate services r 3876285 fmv shannon business services s 11893350 fmv shannon clinic s 138304195 fmv