2014-08-14T17:40:58-05:00 2013-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-10-01 752559845 SHANNON MEDICAL CENTER % SHANNON MEDICAL CENTER SHAN 3254818644 120 E HARRIS AVENUE Suite SAN ANGELO TX 76903 SHANE PLYMELL 3254818644 2014-08-15 true M Paige Gerich 7134994600 2012 2015-11-30 17:44:51Z BRYAN HORNER 120 E HARRIS AVENUE SAN ANGELO TX 76903 282845153 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 2029 130 332273 -17071 296558 24571437 228539051 249178719 2221159 2427063 5009250 6667934 236066018 282845153 121970 10000 0 0 89308251 118482422 0 0 0 121380958 138128506 210811179 256620928 25254839 26224225 301748880 309018787 45995486 28147646 255753394 280871141 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 203430603 10000 253199048 PROVIDING TOTAL MEDICAL CARE TO THE CITIZENS OF WEST TEXAS. 203430603 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 true false true false false false false false false true false false false false false false true true true false false true 101 0 true 2029 true true true false false false false false false false false false false false X 14 11 false false false false true true true true true false false false true true true true true true true true true X SHANNON MEDICAL CENTER 3256536741 120 E HARRIS AVENUE SAN ANGELO TX 76903 X BRYAN HORNER 32.0 12.0 X X 662358 43860 LEN MERTZ 2.0 18.0 X X 21960 10896 4901 JAMES JOHNSON 2.0 6.0 X X 25978 30000 2881 JOE HENDERSON 2.0 6.0 X 27641 29000 4042 ORAN BERRY III 2.0 6.0 X 25813 30000 9157 VIRGINIA NOELKE 2.0 4.0 X 20600 MIKE BOYD 2.0 6.0 X 1560 MIKE OLIPHANT 2.0 6.0 X 24350 30000 5321 STEVE CECIL 2.0 6.0 X 24750 30000 9119 JOANNE RICE 2.0 4.0 X 20400 PAMELA TALLEY 2.0 4.0 X 24100 EMMETE FLYNN MD 2.0 4.0 X 502638 76283 MICHELLE SNUGGS MD 2.0 4.0 X 560986 85930 ANGELA WILLIAMS 2.0 6.0 X 21000 KELLY SHANE PLYMELL 32.0 8.0 X 367856 72765 DR IRVIN ZEITLER 37.0 5.0 X 464293 64217 WILMA STUART 40.0 0.0 X 278595 36824 PATRICIA TIPTON 40.0 0.0 X 296615 35921 MARVIN HILL 40.0 0.0 X 294189 47345 LANCE KEILERS 40.0 0.0 X 173429 33752 TIMOTHY HARTIN 40.0 5.0 X 260654 57725 PAULINE JAMES 40.0 0.0 X 178252 35157 4278017 159896 625200 62 false true false JOURNEYMAN CONSTRUCTION 2102 MANNIX DRIVE SAN ANTONIO TX 78217 CONSTRUCTION 2547553 MATAGORDA LITHOTRIPSY LLP 6339 E SPEEDWAY STE 201 TUCSON AZ 85710 LITHOTRIPSY 191050 THE TEXAS PURCHASING COALITION 7160 DALLAS PARKWAY 600 PLANO TX 75024 GROUP PURCH SERVICES 571803 BRADLY BUDRANT MD 300 LARGENT AVENUE BALLINGER TX 76821 ER/PHYSICIAN 389439 VINSON ELKINS LLP PO BOX 301019 DALLAS TX 75303 LEGAL SERVICES 257723 9 24571437 0 24571437 Net Patient Revenue 621990 248731174 248514002 217172 Rental Income 532000 447545 447545 249178719 2000318 2000318 0 0 0 0 0 460508 -33763 460508 -33763 426745 426745 0 0 0 Cafeteria 900099 1503847 1503847 Regional Cancer Treatment 900099 258738 258738 All Other Misc Revenue 900099 4905349 4790248 115101 6667934 282845153 255514380 332273 2427063 10000 10000 0 0 0 3322300 3322300 132458 132458 69112822 54731612 14381210 32307548 24800773 7506775 8326057 6431631 1894426 5281237 4010526 1270711 259204 259204 147889 147889 108737 108737 0 0 0 26958298 19319388 7638910 792484 22857 769627 4174761 262351 3912410 2559504 539351 2020153 0 2637487 302740 2334747 394067 204669 189398 0 0 0 0 9877819 5280593 4597226 1160038 2377 1157661 Medical Supplies 48284843 48237769 47074 Bad Debt 35073195 35073195 Equipment Costs 3560514 2961668 598846 Collection Fees 742993 742993 1396673 901068 495605 256620928 203225026 53395902 0 9570703 6369988 85753 0 0 0 19901278 22632481 0 0 0 0 409752 430593 3836122 3950868 1824416 2061931 203697572 145911890 60940221 57785682 53420637 56294174 1000 1000 0 0 2589275 2592529 149169723 156899541 301748880 309018787 18510079 20744662 0 0 2025 3965 0 0 0 0 0 0 0 0 0 0 27483382 7399019 45995486 28147646 X 115476746 130840999 140276648 150030142 0 0 255753394 280871141 301748880 309018787 X 26224225 -1201573 95095 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 5122978 5122978 0 71470672 52350651 19120021 0 123431378 91953852 31477526 0 3672544 1607387 2065157 57785682 Int in Net Assets - Shannon Tr 150030142 Self Insurance Trust 5976548 Non-Compete Agreement 33332 Beneficiary Account 477902 Interest Receiveable 381617 156899541 0 Asset Retirement Obligation 804715 Accrued Pension Cost 1714699 Malpractice Costs 2519520 DUE TO/FROM THIRD PARTY PAYORS 2201696 Long Term Incentive Accrual 158389 7399019 246514969 -1201573 -35083195 -36284768 282799737 45416 45416 282845153 221537733 221537733 35083195 35083195 256620928 INCOME & EXPENSES INCLUDED IN FORM 990 NOT ON BOOKS SCHEDULE D, PART XI, LINE 2D & XII, LINE 4B BAD DEBT (INCLUDED W/ REVENUE ON AUDIT) $ 35,073,195 GRANTS INCLUDED IN REVENUE ON AUDIT 10,000 ------------ $ 35,083,195 UNCERTAIN TAX POSITIONS SCHEDULE D, PART XIV 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. INCOME INCLUDED ON THE RETURN NOT ON BOOKS SCHEDULE D, PART XI, LINE 4B CONTRIBUTIONS RECORDED TO NET ASSETS $45,416 true true true X true X true true true false true true 14598300 14598300 0.06590 25237929 22052396 3185533 0.01440 286671 193280 93391 0.00040 40122900 22245676 17877224 0.08070 477967 253312 224655 0.00100 366497 12800 353697 0.00160 9934513 9934513 0.04480 145192 145192 0.00070 3065 3065 10927234 266112 10661122 0.04810 51050134 22511788 28538346 0.12880 206 24424 24424 0.00010 206 24424 24424 0.00010 true 8280972 74852401 66401421 8450980 X true true 1 1 SHANNON MEDICAL CENTER

120 E HARRIS AVENUE SAN ANGELO TX 76903

X X X X SHANNON MEDICAL CENTER 01 true X X X X X X X X X 13 true false true X X X X X false false true true 200. true 200. true X X true true X true false X X X X true X false false 3 SHANNON SURGERY CENTER

120 E HARRIS AVENUE SAN ANGELO TX 76903

AMBULATROY SURGERY CENTER SHANNON HOME HEALTH

2030 PULLIAM STE 6 SAN ANGELO TX 76905

HOME HEALTH CENTER SHANNON DIALYSIS CENTER

2018 PULLIAM SAN ANGELO TX 76905

DIALYSIS DESCRIPTION OF BAD DEBT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. COSTING METHODOLOGY LINES 2 AND 3 LINE 2: AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS AFTER APPLYING THE COST TO CHARGE RATIO. LINE 3: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SURPLUS OR SHORT FALL SECTION B MEDICARE LINE 7 SHORTFALL: N/A COSTING METHODOLOGY: THE RATIO OF COST TO CHARGES USED IN THE CALCULATION OF COSTS FOR MEDICARE WAS TAKEN FROM THE MEDICARE COST REPORT. WRITTEN DEBT COLLECTION POLICY SECTION C - COLLECTION PRACTICES 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. NEEDS ASSESSMENT PART V, SECTION B The 2013 Community Health Needs Assessment gathered overall health information of the community. Analysis of the community needs assessment data provided a means to evaluate and prioritize areas of greatest need. To facilitate prioritization of identified health needs, a ranking and prioritization process was used. Health needs were ranked based on the following five factors: - How many people are affected by the issue or size of the issue? - What are the consequences of not addressing this problem? - The impact of the problem on vulnerable populations. - How important the problem is to the community? - Prevalence of common themes. As a result from the analysis, priorities were determined by taking into account the overall ranking, the degree to which Shannon can influence long-term change and the identified health needs impact on overall health. The following priorities were identified: - Healthy Living - Prevention and Disease Management - Education Because Access to Care ranks high and relates to each of the priorities, Shannon made it a goal to address Access to Care within each Priority Area. SHANNON MEDICAL CENTER CORRELATED COMMUNITY PRIORITIES HEALTH NEED --------------------------------------------------- HEALTHY LIVING -ACCESS TO CARE -OBESITY -PHYSICAL INACTIVITY -POOR NUTRITION PREVENTION AND DISEASE -ACCESS TO CARE MANAGEMENT -ADULT SMOKING -CANCER -COPD/RESPIRATORY DISEASE -DIABETES -EPISODIC CARE VS. PREVENTATIVE MEASURES -HEART DISEASE -HIGH BLOOD PRESSURE -LACK OF MENTAL HEALTH SERVICES -LACK OF PRIMARY CARE PHYSICIANS EDUCATION -ACCESS TO CARE -DOCTOR'S OFFICE HOURS -LACK OF HEALTH EDUCATION/KNOWLEDGE -LANGUAGE/CULTURAL BARRIERS THE HOSPITALS' COMMUNITY HEALTH NEEDS ASSESSMENT & IMPLEMENTATION PLAN CAN BE FOUND AT: https://www.shannonhealth.com/education-resources/health-needs-assessment. aspx PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE IN EACH OF THE REGISTRATION AREAS THAT OUTLINE ACCESS TO INFORMATION ABOUT ASSISTANCE PROGRAMS. WE ALSO HAVE CONTRACTED ELIGIBILITY WORKERS WHO SCREEN PATIENTS FOR ALL SOCIAL SERVICE PROGRAMS AND ASSIST WITH THE APPLICATION PROCESS IF NEEDED. COMMUNITY INFORMATION The estimated population for all the counties as of 2012, including Tom Green County, is 352,805. The outer counties are Brown, Coke, Coleman, Concho, Crockett, Howard, Irion, Kimble, Mason, McCulloch, Menard, Mills, Mitchell, Nolan, Pecos, Reagan, Runnels, San Saba, Schleicher, Sterling, Sutton, Terrell, Upton and Val Verde. (Source: U.S. Census Bureau, State & County Quickfacts.) Our goal is to provide our patients with the most compassionate and efficient service while ensuring the highest quality care. Tom Green County's population in 2012 is reported at 113,281. The city of San Angelo serves as the county seat and population center of Tom Green County, with an estimated population in 2012 of 95,887. 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.) A. Tom Green County Age Distribution 1. Under 18 years old - 23.2% (26,621) 2. 18-64 years old - 62.6% (70,914) 3. 65 years and older - 14.2% (15,746) B. Tom Green County Ethnic Distribution (More than one category may be self-reported) 1. Caucasian - 56.6% (64,570) 2. Hispanic - 36.7% (41,121) 3. Black - 4.6% (5,324) 4. Other - 2.1% (2,266) C. Tom Green County (Household) 1. Median Household Income - $44,310 (Texas: $51,563) 2. Persons living below poverty level - 16.0% (Texas: 17.4%) D. Tom Green County Health Index 1. Tom Green County uninsured - 25.4% (Texas: 25.7%, United States: 15.4%) (Source: U.S. Census Bureau, Small Area Health Insurance Estimates, 2011; U.S. Census Bureau, Income, Poverty, and Health Coverage in the United States: 2011). 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 75 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 2012 - 2013 charity care figure of more than $62,368,159 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, and cardiovascular health. Through events like Go Red and Health Beat Live, health professionals relay current health information to the public. In addition to public outreach events, Shannon publishes the Health Beat magazine which is delivered to 30,000 households and produces Health Beat television spots that air during the 6 and 10 p.m. news hours on two local stations. They also host a free online health library. These contain a variety of health education information from local healthcare providers. Shannon contributed $93,874 for these programs. Shannon supports The Lighthouse for the Blind by donating used linen to the organization. Based on thrift value, the cost of the linen donated is $12,444. Shannon supports health and fitness activities, as well. Each October Shannon organizes the Pink Ribbon Run for cancer awareness and education with more than 800 participants. Additionally, to address the growing concern over childhood obesity, the Kids' Marathon event provides an opportunity for students, ranging in ages 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 local summer programs and camps that encourage children to remain active through the summer months. Shannon also participates in the American Heart Association Heart Walk in both San Angelo and Sweetwater. These events are provided at a cost of $19,387 to Shannon. Since 2004, the Shannon Sneeze & Wheeze medically-supervised camp has provided children diagnosed with asthma education on topics including "what is asthma," recognizing signs and symptoms, knowing and avoiding triggers, medications (knowing the difference between relievers and controllers), and the importance of compliance and using action plans. The education is provided by health care professionals and costs Shannon $11,040. Shannon provides health and wellness presentations to numerous non-profits, businesses and organizations, including the local school districts and Angelo State University. Representatives from different departments provide support and participate in local health fairs and health-related community events. These presentations and events are provided at a cost of $29,755 to Shannon. Shannon is one of the collaborating organizations of the Tom Green County Partnership for Better Health. The partnership began in January 2012 as a result of an initiative by the Department of State Health Services to reduce potentially preventable hospitalizations. The coalition implements evidence-based strategies for reducing bacterial pneumonia, UTI and COPD. Some of the initiatives include bacterial pneumonia and influenza immunizations, tobacco cessation kits and public awareness campaigns at a cost of $8,400. Shannon is the only provider that operates the Sexual Assault Nurse Examiner program (SANE). 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. Shannon also provided mammography services after hours to accommodate working women's schedules and encourage preventative screenings. Shannon took over the HIV Clinic from the San Angelo Aids Foundation in May 2010. There are three grants that fund the clinic: Ryan White Part B grant, State Services grant, and Housing Opportunities for Persons with Aids (HOPWA) grant in the amount of $253,012. The grants provide outpatient medical services, case management, food bank services, mental health and a host of other services for people living with HIV. Shannon provides grant administration at a cost of $2,180. Additionally, Shannon provides support services such as $2,411 in transportation vouchers. The hospital chaplain also provides free services for the bereaved as well as counseling for patients and their families. Shannon's Trauma Service Department coordinates the annual Gus Eckhardt Trauma Symposium. This is a full day of trauma related education for all health care practitioners in the region. Approximately 200 physicians, nurses, EMTs, students, and Allied Health professionals attended the 2013 symposium. Additionally, injury prevention material covering topics such as bicycle safety, child passenger safety, fall prevention, and home safety tips are continually provided to health care professionals to distribute at their practice and in their community. The cost to host the symposium is $14,352, but funds from Gus Eckhardt Endowment, DSHS funds and fees offset a large portion of the cost. The cost to Shannon to host the symposium is $1,552. 158 ASU nursing students and 25 Howard College nursing students shadow Shannon staff for a cost benefit of $155,299 to the students and the universities. (#hrs x AHR x 50% effort.) 15 Radiology students from Howard College were supervised at a Shannon clinical site. This benefit provides increased access to care for patients seeking radiology services not only in Tom Green County, but the surrounding counties as well. The total cost is $169,335. Shannon provided emergency and trauma services to Coleman, Concho, Fisher, Eden, Eldorado, Menard, Pecos, Runnels, and Reagan Counties in the amount of $2,919,701. Shannon also assisted Crockett, Ector, McCulloch, Schleicher and Tom Green Counties by providing outpatient clinic and indigent health services in the amount of $6,858,752. By providing specialty care for unmet needs, Shannon reduces the burden to local and governmental entities. Lastly, Shannon contributed $156,060 to provide community based mental health services currently not available in the Concho Valley Community. Shannon participates in research efforts through active cancer and trauma registries. Both registries have designated staff to facilitate data collection, which aids in the evaluation of patients who meet specific criteria. Shannon donated funds to social services and community-based efforts, such as the MS Walk, local Project Graduations, and the D.E.S.K program. Additionally, donations of $1,332 were made towards health and education efforts and by assisting the United Way Annual Campaign with administrative support. Shannon contributes planning and financial assistance to community building efforts. This past year, $24,424 was donated to other organizations including Healthy Families, the National Alliance on Mental Illness, San Angelo Independent School District, American Cancer Society-Relay for Life, the All Veterans' Council, and the Chamber of Commerce's Goodfellow Airforce Base Military Appreciation Day. Linen supplies were donated to Lighthouse for the Blind and provided $12,444 in community benefit. Shannon implemented a community health needs assessment that was adopted by the Board in FY2013. $18,591 went towards surveying, interviewing and compiling data to define the needs and prioritizing Shannon's efforts and strategy going forward. As the issues of providing healthcare for the uninsured and the underinsured in Tom Green County as well as our surrounding counties have continued to become more apparent, Shannon leadership has been involved with working internally and externally on improving access for all patients while balancing quality and costs. Shannon has played a major role in the region through the 1115 Medicaid Waiver program. By focusing on maximizing resources and advancing collaboration to improve the health of the people it serves, Shannon strikes a balance among the needs, interests, and resources available through health care providers, payers, public health departments, and community based organizations. Collaboration among Regional Health Partnership 13 has provided a model for local-level agencies to break down their own siloes. This helps overcome barriers that partners face at the local level and encourages new delivery systems by setting an example for collaboration across agencies. Dr. Irv Zeitler, Vice President of Medical Affairs at Shannon, also serves as President of the Texas Medical Board. Appointed by Governor Rick Perry in 2008, Zeitler's role is t 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, the center offers diverse clinical services, including a nationally-recognized cardiac care program, nationally-recognized ICU, the region's only Level III Trauma Facility and AirMed 1 air ambulance serving a 200-mile radius of San Angelo, a dedicated Women's & Children's Hospital which is home to the Children's Miracle Network, and the most extensive Senior Health services in the Concho Valley. 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. STATE FILLING OF COMMUNITY BENEFIT REPORT TEXAS DETERMINATION FOR BILLING FOR EMERGENCY CARE PART V, LINE 20 COLLECTION OF GROSS CHARGES FOR UNINSURED UNLESS PROMPT PAYMENT SECURED, COLLECTION OF DEDUCTIBLES/CONINSURANCE AMOUNTS BASE ON CONTRACTED RATES FOR INSURED PATIENTS. BILLING AND COLLECTIONS SCHEDULE H, PART V, LINE 15, 16, & 17 NEITHER SHANNON MEDICAL CENTER, NOR THIRD PARTIES AUTHORIZED BY SMC, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. BECAUSE NO ACTIONS WERE CHECKED ON LINE 16, LINE 17 INDICATES EFFORTS MADE BEFORE INITIATING ANY OF THE ACTIONS LISTED IN LINE 16. INPUT FROM COMMUNITY REPRESENTATIVES SCHEDULE H, PART V, SECTION B, LINE 3 INTERVIEWS WITH 18 KEY INFORMANTS WERE CONDUCTED THROUGHOUT FEBRUARY AND MARCH 2013. INTERVIEWEES WERE DETERMINED BASED ON THEIR A) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, B) THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY OR C) THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. THREE REPRESENTATIVES FROM SHANNON MEDICAL CENTER CONTACTED ALL INDIVIDUALS NOMINATED FOR INTERVIEWING. THEIR KNOWLEDGE OF THE COMMUNITY, AND THE PERSONAL RELATIONSHIPS THEY EACH HELD WITH THE POTENTIAL INTERVIEWEE'S ADDED VALIDITY TO THE DATA COLLECTION PROCESS. EXPLANATION OF NEEDS NOT ADDRESSED SCHEDULE H, PART V, SECTION B, LINE 7 THERE ARE NEEDS THAT SHANNON WILL NOT ADDRESS IN THE CURRENT IMPLEMENTATION STRATEGY THAT ARE CLEARLY IMPORTANT TO IMPROVING THE HEALTH OF THE COMMUNITY. HOWEVER, THEY ARE CONSIDERED TO HAVE LESS IMMEDIATE IMPACT AND WILL BE ADDRESSED IN A FUTURE PLAN, OR IF THE OPPORTUNITY ARISES, COULD BE INCORPORATED WITHIN A CURRENT STRATEGY. SHANNON WILL CONTINUE TO EXPLORE POTENTIAL PARTNERSHIPS AND INTERNAL STRATEGIES TO FIND A WAY TO PROVIDE THESE ESSENTIAL SERVICES TO OUR PATIENTS. PATIENTS. true HOWARD COLLEGE 3501 N US HWY 67 SAN ANGELO TX 76905 756001827 501(3)(C) 10000 NURSING INSTTRUCTOR 1 PROCEDURES FOR MONITORING USE OF GRANT FUNDS SCHEDULE I, PART I, QUESTION 2 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 BRYAN HORNER 538661 106697 17000 31000 12860 706218 EMMETE FLYNN MD 411099 30496 61043 56200 20083 578921 MICHELLE SNUGGS MD 428713 46000 86273 65800 20130 646916 KELLY SHANE PLYMELL 311100 56756 54121 18644 440621 DR IRVIN ZEITLER 390389 73904 58361 5856 528510 WILMA STUART 231293 47302 31000 5824 315419 PATRICIA TIPTON 296615 31000 4921 332536 MARVIN HILL 294189 31000 16345 341534 LANCE KEILERS 173429 17997 15755 207181 TIMOTHY HARTIN 243654 17000 46252 11473 318379 PAULINE JAMES 178252 18816 16341 213409 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART 1, QUESTION 4 SERP DETAIL NAME AMOUNT BRYAN HORNER NONE 457(F) DETAIL NAME AMOUNT TIMOTHY HARTIN 17,600 SHANE PLYMELL 23,121 DR. IRVIN ZEITLER 27,361 PROVIDED HEALTH, SOCIAL DUES OR INITIATION FEES SCHEDULE J, PART I, QUESTION 1A BRYAN HORNER AND KELLY SHANE PLYMELL RECEIVE MEMBERSHIP TO BENTWOOD COUNTRY CLUB EXCLUSIVELY FOR BUSINESS USE. ANY PERSONAL USE IS REIMBURSED BY THE OFFICER AND THEREFORE NO AMOUNTS ARE REPORTABLE ON THEIR FORM W-2'S. DIANE ZEITLER IRVIN ZEITLER'S SPOUSE 132458 EMPLOYED BY SMC false PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, QUESTION 12C 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. 5. THE SMC COMPLIANCE OFFICER WILL REVIEW DISCLOSURES AND DETERMINE WHICH REQUIRE FURTHER ACTION WITH THE SMC GENERAL COUNSEL AND APPROPRIATE SMC EXECUTIVE STAFF. REVIEW OF COMPENSATION FORM 990, PART VI, QUESTION 15A & 15B INTEGRATED HEALTH STRATEGIES DID AN EXECUTIVE COMPENSATION STUDY IN JUNE 2012 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. GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990 PART VI, QUESTION 6 MARGARET SHANNON ESTATE, A TESTAMENTARY TRUST, IS THE SOLE MEMBER OF THE ORGANIZATION. MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY FORM 990 PART VI, QUESTION 7A 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. PROCESS TO REVIEW THE FORM 990 FORM 990, PART VI, QUESTION 11B 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. THE ORGANIZATIONS FINANCE COMMITTEE WILL REVIEW AFTER THE FORM IS FILED. DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL FORM 990, PART VI, QUESTION 7B APPROVAL OF THE SOLE MEMBER, THE TRUSTEES OF SHANNON WEST TEXAS MEMORIAL HOSPITAL, 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 CONTRACT IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 CHANGE IN ADDITIONAL MINIMUM PENSION LIABILITY 22,098,268 TRANSFERS TO/FROM AFFILIATES (30,178,690) NET ASSETS RELEASED FROM RESTRICTION (TRUST) 8,150,000 CHANGE IN SHANNON TRUST NET ASSETS 32,673,341 NET ASSETS RELEASED FROM RESTRICTION (32,698,395) CARRYING VALUE OF RCTC NET ASSETS 50,571 ------------- $ 95,095 TRUSTEES SHANNON WEST TEXAS HOSPITAL PO BOX 49 SAN ANGELO TX 76902 750800679 TRUST TX 501(C)(3) 11B NA false SHANNON RURAL HEALTH CLINICS INC 120 E HARRIS AVE SAN ANGELO TX 76903 752940211 HEALTHCARE TX 501(C)(3) 11C SMC true SHANNON REAL ESTATE SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 270075630 SUPPORT SVCS TX 501(C)(3) 11B SMC true SHANNON HEALTH SYSTEM 120 E HARRIS AVE SAN ANGELO TX 76903 752602411 SUPPORT SVCS TX 501(C)(3) 11A NA false SHANNON CLINIC 120 E HARRIS AVE SAN ANGELO TX 76903 752600873 HEALTHCARE TX 501(C)(3) 9 SHS true SHANNON BUSINESS SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 432038769 SUPPORT SVCS TX 501(C)(3) 11B SMC true SHANNON MEDICAL MANAGEMENT 120 E HARRIS AVE SAN ANGELO TX 76903 208367966 SUPPORT SVCS TX 501(C)(3) 9 SHS false REGIONAL CANCER TREATMENT CENTER 102 N MAGDALEN STE 120 SAN ANGELO TX 76903 752225955 RADIOTHERAPY TX NA RELATED 926902 4366985 false 0 true 0.56247 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 true false true true true true true true SHANNON CLINIC K 904479 BOOK VALUE SHANNON REAL ESTATE SERVICES J 376342 BOOK VALUE SHANNON BUSINESS SERVICES C 45417 BOOK VALUE SHANNON MEDICAL MANAGEMENT I 37745 BOOK VALUE SHANNON BUSINESS SERVICES I 55862 BOOK VALUE SHANNON BUSINESS SERVICES P 10379639 BOOK VALUE SHANNON BUSINESS SERVICES S 8585037 BOOK VALUE SHANNON CLINIC P 14104887 BOOK VALUE SHANNON CLINIC Q 2460775 BOOK VALUE SHANNON CLINIC R 4974725 BOOK VALUE SHANNON MEDICAL MANAGEMENT Q 7249376 BOOK VALUE SHANNON MEDICAL MANAGEMENT R 23291366 BOOK VALUE SHANNON REAL ESTATE SERVICES Q 592460 BOOK VALUE SHANNON REAL ESTATE SERVICES R 4023478 BOOK VALUE