2020-08-16T10:14:25-05:00 2019-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2018-10-01 752559845 Shannon Medical Center % JOSEPH WOOLDRIDGE SHAN 3256536741 120 E Harris Avenue San Angelo TX 76903 JOSEPH WOOLDRIDGE CFO 3256536741 2020-08-14 true Kevin R Ensminger P00226776 9727028262 167.68.126.162 76915820202295000001 2020-08-16 P 21E6481FF4EC5D606F81E380A49442717B3AD96E EB976710118F518B8933A72D91D1D85239D99EDA 2018 2020-09-22 18:59:49Z KELLY SHANE PLYMELL 120 E HARRIS AVENUE SAN ANGELO TX 76903 397332420 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 11 2424 141 312834 36677337 21176915 333100624 370189700 2826890 3026231 2528843 2939574 375133694 397332420 284317 89730 0 0 118670480 121351517 0 0 0 183323665 214427160 302278462 335868407 72855232 61464013 402689472 397560093 51750176 42805753 350939296 354754340 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DIRECTOR 2.0 4.0 X 22950 0 0 MICHAEL BOYD TRUSTEE 2.0 6.0 X 23450 27000 613 MICHAEL OLIPHANT TRUSTEE 2.0 6.0 X 22900 33728 613 STEVE CECIL TRUSTEE 2.0 6.0 X 23650 29000 12016 JOANNA RICE DIRECTOR 2.0 4.0 X 23800 0 0 PAMELA TALLEY DIRECTOR 2.0 4.0 X 25150 0 0 MICHAEL TED WEATHERFORD TRUSTEE 2.0 6.0 X 22300 29000 1311 MICHELLE SNUGGS MD DIRECTOR 2.0 38.0 X 0 973154 85156 ANGELA WILLIAMS DIRECTOR 2.0 4.0 X 23200 0 0 KELLY SHANE PLYMELL CEO/PRESIDENT 16.0 24.0 X X 644415 0 97897 ANDREW HUME MD DIRECTOR 2.0 38.0 X 0 821759 89224 JAMES C BARNETT MD CHIEF MEDICAL DIRECTOR 38.0 2.0 X 539296 0 45819 PAMELA BRADSHAW CNO/COO 32.0 8.0 X 370344 0 79770 joseph wooldridge cfo, start: 05/19 35.0 5.0 X 0 0 0 LISA HILL GENERAL COUNSEL 40.0 0.0 X 341608 0 70136 MARGARET BENSON CHIEF COMPLIANCE OFFICER 40.0 0.0 X 177349 0 13837 GREGORY WHEELER DIRECTOR OF REIMBURSEMENT 40.0 0.0 X 178136 0 12521 STEPHEN LUBKE DIRECTOR OF PHARMACY 40.0 0.0 X 185931 0 12390 JAMES NAYLOR CHIEF ECHO SONOGRAPHER 40.0 0.0 X 172667 0 21773 Stephanie McCan Assistant Director of PHarmacy 40.0 0.0 X 166866 0 15771 IRVIN ZEITLER MD FORMER MEDICAL DIRECTOR 2.0 38.0 X 7971 151851 31294 STACI WETZ CONTROLLER/FORMER CFO 16.0 24.0 X 324641 0 77929 3344974 2133624 673799 78 true true false Hoar Construction LLC Two Metroplex Drive Suite 400 BIRMINGHAM AL 35209 Construction 24711136 Lott Brothers Construction Co PO Box 203594 AUSTIN TX 78720 Construction 5991547 Avant Healthcare Professionals PO Box 744557 ATLANTA GA 303744554 Contract Labor 2352369 Health Carousel LLC PO Box 714216 CINCINNATI OH 45271 Contract Labor 2316754 Stoltenberg Consulting Inc 5815 Library Rd BETHEL PARK PA 15102 Tech Consulting 716473 17 19500000 1676915 21176915 Net Patient Revenue 621990 369481523 369428155 53368 Rental Income 532000 708177 708177 370189700 1068931 115318 953613 0 0 0 0 0 1931549 25751 1931549 25751 1957300 1957300 0 0 0 0 0 0 0 0 0 Cafeteria 900099 1905649 1905649 ALL OTHER MISC REVENUE 900099 1033925 889777 144148 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0 350939296 354754340 402689472 397560093 X 61464013 -1403050 -56245919 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5122978 5122978 143938690 69288320 74650370 1381 1381 0 217182776 141836134 75346642 10372626 1918520 8454106 163574096 INTEREST IN NET ASSETS - TRUST 124921404 Self Insurance Trust 3775588 Interest Receivable 151410 128848402 0 Asset Retirement Obligation 1078396 Accrued Pension Cost 1086756 Malpractice Costs 2585280 Due to/from third party payors 770384 Long Term Incentive Accrual 117293 5638109 330516870 -1403050 -44301080 -45704130 376221000 21111420 21111420 397332420 291567327 291567327 44301080 44301080 335868407 SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE ON AUDITED FINANCIALS WITH RETURN: BAD DEBT (INCLUDED W/ REVENUE ON AUDIT) $ (44,221,735) GRANTS INCLUDED IN REVENUE ON AUDIT ( 89,730) OTHER CLASSIFICATION DIFFERENCES 10,385 -------------- $ (44,301,080) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE ON AUDITED FINANCIALS WITH RETURN: CONTRIBUTIONS RECORDED TO NET ASSETS $ 21,111,420 SCHEDULE D, PART XII, Line 4B RECONCILIATION OF EXPENSES ON AUDITED FINANCIALS WITH RETURN: BAD DEBT (INCLUDED W/ REVENUE ON AUDIT) $ (44,221,735) GRANTS INCLUDED IN REVENUE ON AUDIT ( 89,730) OTHER CLASSIFICATION DIFFERENCES 10,385 -------------- $ (44,301,080) 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 true X false true true true false false 11860020 11860020 0.04070 29375988 24750727 4625261 0.01590 1189555 161199 1028356 0.00350 42425563 24911926 17513637 0.06010 636949 636949 0.00220 977324 977324 0.00340 11584205 11584205 0.03970 169303 169303 0.00060 203860 203860 0.00070 13571641 13571641 0.04660 55997204 24911926 31085278 0.10670 true 44221735 99056691 96432314 2624377 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 & UNIVERSITIES, PUBLIC HEALTH AGENCIES, OTHER MEDICAL PROVIDERS, LOCAL ELECTED OFFICIALS & 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 & 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. 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. PRIORITY 3: ADULT OBESITY THE MEDICAL CENTER WILL INCREASE PUBLIC AWARENESS OF THE IMPORTANCE OF HEALTH EATING, NUTRITION AND PHYSICAL ACTIVITY. 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. 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/1051/501r-financial-assistance-policy- final-to-marketing-english.pdf SCHEDULE H, PART V, SECTION B LINE 16B FAP APPLICATION FORM URL: https://www.shannonhealth.com/media/1049/shannon-financial-responsibility- 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 2 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 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 COSTING METHODOLOGY LINE 2: AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE ORGANIZATIONS 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 10 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 2019, THERE WAS NO SHORTFALL CALCULATED. 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 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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 2018 of 118,189. Tom Green Countys population in 2019 of 119,200. The estimated population for Shannons service area as of 2019, including Tom Green County, is 357,190 (U.S. Census Bureau, State & 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 & County Quickfacts, The County Information Project, Texas Association of Counties.) Tom Green County Age Distribution 1. Under 18 years old 23.9% (28,489) 2. 18-64 years old 61.6% (72,235) 3. 65 years and older 15.5% (18,476) Tom Green County Ethnic Distribution (More than one category may be self-reported) 1. Caucasian 52.7% (62,818) 2. Hispanic 40.5% (48,276) 3. Black 4.4% (5,245) 4. Other 2.4% (2,861) Tom Green County (Household) 1. Median Household Income $51,676 (Texas: $59,570) 2. Persons living in poverty level 15.5% (Texas: 14.7%) Tom Green County Health Index 1. Tom Green County uninsured 16.8% 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 80 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 FY2019 charity care figure of more than $51,769,930 would be a burden to the taxpayers of Tom Green County, and many other counties whose citizens directly benefit from her generosity. Shannon provides a host of community education events related to topics such as cancer prevention and screenings, diabetes education, fitness and nutrition, childbirth and child care, and cardiovascular health. Through educational events and various community events, health professionals relay current health information to the public. Shannon provides health and wellness presentations to numerous non-profits, businesses and organizations, including regional school districts and Angelo State University. 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 $172,363 for these programs. Shannon is a proud sponsor and contributor to the local Go Red Luncheon. Go Red is a national initiative aimed at uniting women, men, and their friends and family in the fight against heart disease. The luncheon is designed to help educate and bring awareness to the community about how heart disease affects women and men differently, and how to take steps to address their risk for a heart attack. Shannon understands that continued education and awareness is crucial for women and men to fight this deadly disease. In addition, Shannon offers various free screening services, such as blood pressure checks, at this event. Approximately 500 community members were in attendance to the Go Red Luncheon. This event is provided at a cost of $16,937 to Shannon. Shannon supports health and fitness activities, as well. To address the growing concern over childhood obesity, the Kids Marathon event provides an opportunity for students, ranging from Kindergarten through sixth grade, to participate in a program that encourages healthy habit formation early in life. A full marathon is considered 26.2 miles. Students accumulate miles and run the last 0.2 lap during a celebratory event at the San Angelo Stadium. The event hosts organizations that offer local summer programs and camps that encourage children to remain active through the summer months. This event is provided at a cost of $5,057 to Shannon. 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 $15,908 to Shannon. Shannon is the only provider that operates the Sexual Assault Nurse Examiner program (SANE) in the Shannon service area. SANE trained nurses work with the Childrens 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 1930s, provides the communities of West Central Texas with a variety of medical services. Dedicated to the regions 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 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 purposed 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 Shannons 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 Shannons 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 Shannons resources Schedule H, Part I, Line 7, column F COMMUNITY BENEFIT EXPENSE: Bad debt expense of $44,221,735 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. SCHEDULE H, PART I, LINE 7G N/A true TEXAS CARE ALLIANCE 7160 DALLAS PARKWAY DALLAS TX 75024 462829563 501(c)(3) 89730 OPERATING COST PAID-IN-CAPITAL 1 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE ORGANIZATION EVALUATES AND MONITORS DONEES BASED ON PUBLIC AND PRIVATE DATA. X true true X X X X false true false false false false false false false MICHELLE SNUGGS MD DIRECTOR 0 617671 0 268283 0 87200 0 73408 0 11748 0 1058310 79871 KELLY SHANE PLYMELL CEO/PRESIDENT 571671 0 100 0 72644 0 76691 0 21206 0 742312 0 72177 IRVIN ZEITLER MD FORMER MEDICAL DIRECTOR 7919 0 0 31878 52 119973 0 31232 62 0 8033 183083 119973 JAMES C BARNETT MD CHIEF MEDICAL DIRECTOR 490290 0 100 0 48906 0 29833 0 15986 0 585115 0 47616 PAMELA BRADSHAW CNO/COO 326181 0 100 0 44063 0 58564 0 21206 0 450114 0 43347 STACI WETZ CONTROLLER/FORMER CFO 276097 0 100 0 48444 0 58154 0 19775 0 402570 0 48159 ANDREW HUME MD DIRECTOR 0 585810 0 150422 0 85527 0 77528 0 11696 0 910983 76937 LISA HILL GENERAL COUNSEL 293359 0 0 0 48249 0 56934 0 13202 0 411744 0 47639 MARGARET BENSON CHIEF COMPLIANCE OFFICER 175630 0 0 0 1719 0 7295 0 6542 0 191186 0 GREGORY WHEELER DIRECTOR OF REIMBURSEMENT 176473 0 0 0 1663 0 7108 0 5413 0 190657 0 STEPHEN LUBKE DIRECTOR OF PHARMACY 182609 0 0 0 3322 0 7351 0 5039 0 198321 0 JAMES NAYLOR CHIEF ECHO SONOGRAPHER 172449 0 0 0 218 0 7118 0 14655 0 194440 0 Stephanie McCan Assistant Director of PHarmacy 166616 0 0 0 250 0 7058 0 8713 0 182637 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 ------------ --------- --------------- ----------- ANDREW HUME $76,937 $66,528 SC MICHELLE SNUGGS $79,871 $62,408 SC KELLY SHANE PLYMELL $72,177 $65,691 SMC CHRIS BARNETT $47,616 $21,768 SMC PAMELA BRADSHAW $43,347 $47,564 SMC STACI WETZ $48,159 $47,154 SMC IRVIN ZEITLER $119,973 $30,915 SMC/SC LISA HILL $47,639 $45,934 SMC DIANE ZEITLER DR IIRVIN ZEITLER SPOUSE 159299 EMPLOYED BY SMC false 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 AFTER 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: INTEGRATED HEALTH STRATEGIES DID AN EXECUTIVE COMPENSATION STUDY IN 2015 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 ORGANIZATIONS 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: (48,014,453) Change in Shannon Trust Net Assets: 8,713,546 Net Assets Released from Restriction: (16,945,012) ------------------ (56,245,919) FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:2138638 FORM 990 PART IX LINE 11G DESCRIPTION:PROF PHYSICIAN FEES TOTAL FEES:25788882 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:85165 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING SERVICES TOTAL FEES:6839803 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:75169 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 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 CLINIC 120 E HARRIS AVE SAN ANGELO TX 76903 752600873 HEALTHCARE TX 501(C)(3) 10 SHS 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 HARRIS 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 742552 5347309 false 0 true 0.55452 REGIONAL CANCER TREATMENT CTR 102 N MAGDALEN STE 120 SAN ANGELO TX 76903 752225955 RADIOTHERAPY TX NA RELATED 158199 1786174 false 0 false 0.18791 LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 MANAGEMENT TX NA C - CORPORATION 0 0 0.00000 false LEGACY HEALTH SOLUTIONS 2018 PULLIAM ST SAN ANGELO TX 76903 200720762 MED INSURANCE TX NA C - CORPORATION 0 0 0.00000 false false false true false false false false false false true true false false true true true true true true SHANNON BUSINESS SERVICES C 511796 BOOK VALUE SHANNON BUSINESS SERVICES J 140633 BOOK VALUE SHANNON BUSINESS SERVICES P 402387 BOOK VALUE SHANNON BUSINESS SERVICES S 17189678 BOOK VALUE SHANNON BUSINESS SERVICES Q 19234238 BOOK VALUE SHANNON CLINIC P 31044024 BOOK VALUE SHANNON CLINIC Q 20742015 BOOK VALUE SHANNON CLINIC R 110711099 BOOK VALUE SHANNON CLINIC S 106848044 BOOK VALUE SHANNON MEDICAL MANAGEMENT P 1963373 BOOK VALUE SHANNON MEDICAL MANAGEMENT Q 21572748 BOOK VALUE SHANNON MEDICAL MANAGEMENT R 27984692 BOOK VALUE SHANNON REAL ESTATE SERVICES K 851239 BOOK VALUE SHANNON REAL ESTATE SERVICES Q 461944 BOOK VALUE SHANNON REAL ESTATE SERVICES R 2323553 BOOK VALUE SHANNON REAL ESTATE SERVICES S 167523 BOOK VALUE SHANNON REAL ESTATE SERVICES P 60470 BOOK VALUE