2014-08-14T14:01:12-05:00 2013-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-10-01 752600873 SHANNON CLINIC % SHANNON CLINIC ATTN SHAN 3256581511 PO BOX 22000 Suite SAN ANGELO TX 76902 GARY GIBIAN 3256581511 2014-08-15 true M Paige Gerich 7134994600 2012 2015-11-30 17:44:51Z BRYAN HORNER PO BOX 22000 SAN ANGELO TX 76902 122579477 false X N/A X 1995 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. 19 0 244 10 0 0 0 0 114358708 122449477 0 14689 0 0 114358708 122464166 0 0 0 0 81073405 84917471 0 0 0 63728440 67414947 144801845 152332418 -30443137 -29868252 30700792 26687467 24998350 19163637 5702442 7523830 X OUR MISSION IS TO BE THE PREMIERE HEALTH CARE PROVIDER OF PHYSICIAN SERVICES IN THE COMMUNITIES WE SERVE UTILIZING THE RESOURCES AVAILABLE TO US. WE STRIVE TO PROVIDE THE BEST ACCESS, SERVICE AND MEDICAL MANAGEMENT AVAILABLE TO OUR PATIENTS WHILE SIMULTANEOUSLY PROTECTING THE VIABILITY OF OUR ORGANIZATION AND ITS EMPLOYEES. false false 145236903 122449477 PROVIDE HEALTH CARE SERVICES AS A MULTI-SPECIALTY PHYSICIAN CLINIC AT LOCATIONS THROUGHOUT SAN ANGELO AND NEARBY COMMUNITIES REGARDLESS OF ABILITY TO PAY, INCLUDING CALL COVERAGE FOR SHANNON MEDICAL CENTER, AN AFFILIATED NON-PROFIT HOSPITAL. SHANNON CLINIC IS ORGANIZED AND OPERATED TO PROVIDE ACCESS AND CARE FOR RESIDENTS OF ITS SERVICE AREA, INCLUDING MEDICALLY INDIGENT PATIENTS. RECRUITMENT FOR PROVIDERS INCLUDES NEW PHYSICIANS AND MID-LEVEL PROVIDERS TO EXPAND URGENT CARE AND PRIMARY CARE ACCESS TO COMMUNITIES SERVED, AND SPECIALISTS TO ALLOW SHANNON MEDICAL CENTER TO PROVIDE CARE TO ITS PATIENTS REGARDLESS OF ABILITY TO PAY. 145236903 true false false false false false false false false false true false false true true false false true false false false false false false false false false false false true false false false false false false true false false false false false false true false false false true 113 0 true 244 true false false false false false false false false false false X 19 0 false true false false true true true true true false false false true true true true true true true false X SHANNON CLINIC ATTN 3256581511 ADMINISTRATION 120 E BEAUREGARD SAN ANGELO TX 76903 X JOHN HARVEY 40.0 X X 305589 66916 VIKI FORLANO HALFMANN 40.0 X X 294193 60923 HARVEY RUSSWURM 40.0 X 319686 46146 CORNELIUS CHINN 40.0 X 353817 60640 MICHAEL WAGNON 40.0 X 339447 53967 WILLIAM WHITEHEAD 40.0 X 447233 76237 CHRIS COLE 40.0 X X 1103628 51551 ANTHONY DEMORY 40.0 X X 727068 75386 LAURA ADAMS 40.0 X 620260 75109 JOE MIMS 40.0 X 548946 51638 CHARLES MARSH 40.0 X 535564 46553 LUIS DUARTE 40.0 X 3251462 97492 IRVIN ZEITLER 5.0 37.0 X 464293 64217 ROSS CARMICHAEL 40.0 X X 256425 47321 D'LAINE WESTMORELAND 20.0 X 83446 18906 JOSEPH ZUBAK 40.0 X 496545 84420 MARK MURPHY 40.0 X 360644 27390 NORMA CERNA 40.0 X 234636 8747 ERIC IGLER 40.0 X 425567 71509 BRYAN HORNER 5.0 39.0 X 662358 43860 TIMOTHY HARTIN 5.0 40.0 X 260654 57725 DOUG SCHULTZ 40.0 X 370306 39277 GARY GIBIAN 5.0 40.0 X 371642 83600 TIMOTHY HOPKINS 40.0 X 1763959 87592 KENNETH BREEDLOVE 40.0 X 1092434 84005 MICHAEL SICKELS 40.0 X 1087109 83966 VICTOR SCHULZE III 40.0 X 1088394 54401 DAVID HUCHTON 40.0 X 1030934 83959 JAMES MELOTT 40.0 X 277385 65037 JOHN GILBREATH 5.0 40.0 X 200892 43571 GARY BOWEN 5.0 40.0 X 212891 57292 17414677 2172730 1869353 173 true true false DELTA LOCUM TENENS 1755 WITTINGTON PLACE STE 800 DALLAS TX 75234 LOCUMS SERVICES 1435939 SHANNON MED MGMT 120 E BEAUREGARD SAN ANGELO TX 76903 MANAGEMENT SERVICES 41125419 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 OUTSIDE LAB SERVICES 876754 WEATHERBY LOCUMS 6451 NORTH FEDERAL HWY STE 800 FORT LAUDERDALE FL 33308 PHYS CONTRACT SERV'S 454541 SHANNON MEDICAL CTR 120 E HARRIS SAN ANGELO TX 76903 LAB & LAUNDRY SVC 818620 10 0 Service Revenue 621990 108654870 108654870 Lease Income 532000 5787 5787 HOSPITAL BASED PHYSICIANS' ASSISTANCE 900099 10486174 10486174 Miscellanous Income 900099 3302646 3302646 122449477 0 0 0 0 0 0 130000 115311 14689 14689 14689 0 0 0 0 122464166 122449477 14689 0 0 0 0 12134587 12134587 925119 925119 61003988 60443510 560478 6604885 6604885 1663267 1654058 9209 2585625 2585625 42047602 35740462 6307140 12066 12066 45408 45408 0 0 0 5104278 4987594 116684 226574 226574 548398 548398 4290 4290 0 60449 60449 358016 358016 0 0 8881 8881 0 1038172 1038172 780570 736040 44530 Bad Debt 8805351 8805351 Medical Supplies 6739768 6739768 Recruiting 413997 413997 EDUCATION 396137 396137 824990 824990 152332418 145236903 7095515 0 0 0 19201 0 0 0 14832617 16182025 0 0 0 0 73804 846934 122381 131310 1428110 994724 12447167 10204472 2612909 2242695 0 0 0 0 0 0 0 0 11611770 6289779 30700792 26687467 10764082 9686158 0 0 0 0 0 0 0 0 0 0 361708 236382 0 0 13872560 9241097 24998350 19163637 X 5702442 7523830 0 0 0 0 5702442 7523830 30700792 26687467 X -29868252 31689640 X X false true X true false X 3271 6349 0 0 0 9620 91838780 94414909 101441273 114358708 122449477 524503147 0 0 0 91842051 94421258 101441273 114358708 122449477 524512767 0 0 0 524512767 0 0 0 0 0 0 0 0 0 91842051 94421258 101441273 114358708 122449477 524512767 1.00000 1.00000 0.00000 0.00000 X 12447167 10204472 2242695 2242695 Retirement Fund 6289779 6289779 0 Pension Fund Liability 6289779 Health Claims Payable 221838 Estimated Malpractice Costs 2729480 9241097 71050735 71050735 51413431 51413431 122464166 100918987 100918987 51413431 51413431 152332418 FIN 48 DISCLOSURE 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. PART XI & XII LINE 4B INCOME/EXPENSE RECLASSES FROM AUDIT $42,608,082 BAD DEBT 8,805,349 ----------- $51,413,431 false true false false false false false false false JAMES MELOTT 212888 27500 36997 47000 18037 342422 66622 JOHN HARVEY 236492 30000 39097 47000 19916 372505 60245 VIKI FORLANO HALFMANN 220800 31026 42367 47000 13923 355116 48339 HARVEY RUSSWURM 257201 41235 21250 31000 15146 365832 CORNELIUS CHINN 271892 29323 52602 47000 13640 414457 73567 MICHAEL WAGNON 277957 27032 34458 35418 18549 393414 49979 WILLIAM WHITEHEAD 371354 28513 47366 56200 20037 523470 60470 CHRIS COLE 888139 148573 66916 31000 20551 1155179 75678 ANTHONY DEMORY 530112 137738 59218 55126 20260 802454 77300 LAURA ADAMS 456248 89911 74101 55000 20109 695369 103083 JOE MIMS 454651 51386 42909 31000 20638 600584 38734 CHARLES MARSH 416241 35000 84323 31000 15553 582117 104267 LUIS DUARTE 2589813 501915 159734 77257 20235 3348954 294504 IRVIN ZEITLER 390389 73904 58361 5856 528510 BRYAN HORNER 538661 106697 17000 31000 12860 706218 TIMOTHY HARTIN 243654 17000 46252 11473 318379 DOUG SCHULTZ 320007 21000 29299 31000 8277 409583 22474 TIMOTHY HOPKINS 1327798 288928 147233 77257 10335 1851551 208699 KENNETH BREEDLOVE 863743 148573 80118 63800 20205 1176439 109632 MICHAEL SICKELS 861446 148573 77090 63800 20166 1171075 115926 VICTOR SCHULZE III 876086 148573 63735 31000 23401 1142795 73369 DAVID HUCHTON 895779 37500 97655 61000 22959 1114893 179945 JOHN GILBREATH 174525 6390 19977 33453 10118 244463 GARY BOWEN 176850 6468 29573 39033 18259 270183 ROSS CARMICHAEL 210070 30000 16355 28604 18717 303746 JOSEPH ZUBAK 430961 38918 26666 64211 20209 580965 GARY GIBIAN 282250 59735 29657 52320 31280 455242 MARK MURPHY 286814 71602 2228 16835 10555 388034 NORMA CERNA 205663 28292 681 8747 243383 ERIC IGLER 322981 60796 41790 51400 20109 497076 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART 1, QUESTION 4 SERP DETAIL NAME AMOUNT BRYAN HORNER NONE NONQUALIFIED PLAN PARTICIPANTS NAME AMOUNT JAMES MELOTT $ 82,378 JOHN HARVEY $ 78,622 VIKI FORLANO HALFMANN $ 60,974 ROSS CARMICHAEL NONE HARVEY RUSSWURM NONE D'LAINE WESTMORELAND $ 28,003 CORNELIUS CHINN $104,288 MICHAEL WAGNON $ 66,330 NORMA CERNA NONE WILLIAM WHITEHEAD $ 82,542 CHRIS COLE $ 97,970 ANTHONY DEMORY $106,612 LAURA ADAMS $145,398 JOE MIMS $ 54,335 CHARLES MARSH $141,062 LUIS DUARTE $363,044 MARK MURPHY NONE IRVIN ZEITLER $ 27,361 ERIC IGLER $ 73,130 BRYAN HORNER NONE TIMOTHY HARTIN $ 17,600 DOUG SCHULTZ $ 33,310 TIMOTHY HOPKINS $293,320 KENNETH BREEDLOVE $146,493 MICHAEL SICKELS $150,115 VICTOR SCHULTZE III $ 91,682 DAVID HUCHTON $233,442 JOSEPH ZUBAK $ 25,944 GARY GIBIAN NONE JOHN GILBREATH NONE GARY BOWEN NONE LISA HILL NONE PARTICIPANTS IN THE 457F RETIREMENT ALLOWANCE PLAN ARE PHYSICIANS WHO ARE UNDER AGE 55 & THEIR EXPECTED COMPENSATION IS HIGHER THAN 125,000 OR EXECUTIVES WHO ARE UNDER AGE 62 & THEIR EXPECTED COMPENSATION IS HIGHER THAN $125,000. EACH QUARTER, THEY RECEIVE 8% OF THEIR BASE SALARY FOR THE PRECEEDING YEAR INTO A MUTUAL FUND ACCOUNT. ALL MUTUAL FUND ACCOUNTS HAVE A DEFERRED VESTING DATE OF JUNE 30TH OF THE SECOND CALENDAR YEAR FOLLOWING THE PLAN YEAR FOR WHICH THE MUTUAL FUND ACCOUNT WAS CREATED. IN GENERAL, THE EARLIEST DISTRIBUTION DATE IS AFTER JUNE 30TH OF THE SECOND CALENDAR YEAR FOLLOWING THE PLAN YEAR FOR WHICH THE MUTUAL FUND ACCOUNT WAS CREATED. IN THE 457F ACCOUNTS RECEIVABLE PLAN, PARTICIPANTS ARE PHYSICIANS WHOSE ANNUAL COMPENSATION IS HIGHER THAN 125,000 AND ARE ELIGIBLE TO RECEIVE THE A/R CREDIT. ONCE A YEAR, 20% OF THE A/R CREDIT IS FUNDED INTO A MUTUAL FUND ACCOUNT. VESTING IN THE BENEFIT IS 20% EACH YEAR WITH FULL VESTING AFTER 5 YEARS. DISTRIBUTION WILL OCCUR AT THE END OF THE 5 YEARS OR AT TERMINATION OF EMPLOYMENT. METHODS USED TO ESTABLISH COMPENSATION SCHEDULE J, PART I, QUESTION 3 SHANNON CLINIC'S (SC) EXECUTIVE DIRECTOR IS CONTRACTED THROUGH SHANNON MEDICAL MANAGEMENT (SMM), A RELATED 501(C)(3) ORGANIZATION. THEREFORE, SC RELIES ON THE METHODS USED BY SMM TO ESTABLISH THE COMPENSATION OF THE EXECUTIVE DIRECTOR. MICHELLE CHINN CORNELIUS CHINN'S SPOUSE 67937 SHANNON CLINIC EMPLOYEE false SCOTT WESTMORELAND D. WESTMORELAND'S SPOUSE 323992 SHANNON CLINIC EMPLOYEE false BRANDI WHITEHEAD W. WHITEHEAD'S SPOUSE 27022 SHANNON CLINIC EMPLOYEE false DENVER MARSH CHARLES MARSH'S BROTHER 489533 SHANNON CLINIC EMPLOYEE false SUSAN SCHULTZ DOUG SCHULTZ'S SPOUSE 16635 SHANNON CLINIC EMPLOYEE false DELEGATION OF CONTROL TO A MANAGEMENT COMPANY OR OTHER PERSON FORM 990, PART VI, QUESTION 3 ADMINISTRATIVE SERVICES FOR SHANNON CLINIC ARE CONTRACTED WITH SHANNON MEDICAL MANAGEMENT. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 SHANNON HEALTH SYSTEM, A 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF SHANNON CLINIC. MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, QUESTION 7A THE SOLE MEMBER, SHANNON HEALTH SYSTEM, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBER EXERCISES ITS POWERS & AUTHORITY THROUGH THE ACTION OF THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE MEMBER OR SUCH OTHER PERSON OR PERSONS DESIGNATED BY THE BOARD OF DIRECTORS OF THE MEMBER TO TAKE ACTION. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 7B THE MEMBER HAS THE SOLE AUTHORITY TO ACT WITH RESPECT TO A VARIETY OF SUBJECTS INCLUDING BUDGETING, INCURRENCE OR GUARANTEE OF ANY DEBT, CREATION OR SALE OF ANY SUBSIDIARIES, REAL PROPERTY TRANSACTIONS, MODIFICATIONS OF THE CORPORATION, ARRANGEMENTS BETWEEN THE CORPORATION AND ANY INSURER, ESTABLISHMENT OF TRAINING AND RESIDENCY PROGRAMS, GIVING AND RECEIVING GRANTS, AUDITOR AND LEGAL COUNSEL SELECTION, APPROVAL, ADOPTION, OR AMENDMENT OF: COMPENSATION POLICY THAT ESTABLISHES REASONABLE SALARIES OF OFFICERS, DIRECTORS, PHYSICIANS AND PHYSICIAN EXTENDERS, INSURANCE COVERAGE AND FEE SCHEDULES RELATING TO PATIENT SERVICES, COMMENCEMENT OF LITIGATION BY THE CORPORATION, SELECTION AND APPROVAL OF THE LOCATION OF THE PROVISION OF ANY SERVICES OFFERED BY THE CORPORATION AND ANY OTHER MATTERS WITH RESPECT TO WHICH EXCLUSIVE AUTHORITY IS GRANTED TO THE MEMBER BY LAW, THE ARTICLES, OR THE BYLAWS. 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 MEMBER'S FINANCE COMMITTEE WILL REVIEW AFTER THE FORM IS FILED. PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, QUESTION 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF SHANNON CLINIC ARE EMPLOYED BY SHANNON MEDICAL CENTER OR ITS AFFILIATES, AND AS SUCH ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST AS THEY ARISE, AND ARE REQUIRED TO FILE ANNUAL STATEMENTS AFFIRMING EITHER THE CONFLICTS OF INTEREST THAT THEY MAY HAVE, OR THAT THEY HAVE NO CONFLICTS OF INTEREST. REVIEW OF COMPENSATION FORM 990, PART VI, QUESTION 15A & 15B OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF SHANNON CLINIC ARE EMPLOYED BY SHANNON MEDICAL CENTER OR ITS AFFILIATES, AND AS SUCH HAVE THEIR COMPENSATION REVIEWED ANNUALLY BY THE INDEPENDENT SHANNON MEDICAL CENTER BOARD OF TRUSTEES, WHICH CONSULTS COMPARABILITY DATA AND KEEPS CONTEMPORANEOUS RECORDS OF ITS DECISIONS. EXPLANATION OF COMMITTEE THAT ASSUMES RESPONSIBILITY FORM 990, PART XII, QUESTION 2C SHANNON CLINIC DOES NOT HAVE AN AUDIT COMMITTEE, BUT THERE IS A SHANNON HEALTH SYSTEM AUDIT COMPLIANCE COMMITTEE THAT OVERSEES THE CONSOLIDATED AUDIT THAT INCLUDES SHANNON CLINIC. GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, QUESTION 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 9 TRANSFER TO/FROM AFFILIATES 31,689,640 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 false SHANNON REAL ESTATE SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 270075630 SUPPORT SVCS TX 501(C)(3) 11B SMC false SHANNON HEALTH SYSTEM 120 E HARRIS AVE SAN ANGELO TX 76903 752602411 HEALTHCARE TX 501(C)(3) 11A NA false SHANNON MEDICAL CENTER 120 E HARRIS AVE SAN ANGELO TX 76903 752559845 HEALTHCARE TX 501(C)(3) 3 NA false SHANNON BUSINESS SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 432038769 SUPPORT SVCS TX 501(C)(3) 11B SMC false SHANNON MEDICAL MANAGEMENT 120 E BEAUREGARD SAN ANGELO TX 76903 208367966 SUPPORT SVCS TX 501(C)(3) 9 SHS false REGIONAL CANCER TREATMENT CENTER 102 N MAGDALEN 120 San Angelo TX 76902 752225955 RADIOTHERAPY TX NA N/A 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 false false false false false false false false false false true true true true true true true