2011-08-15T08:26:08-05:00 2010-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2009-10-01 752600873 SHANNON CLINIC SHAN 3256581511 PO BOX 22000 SAN ANGELO TX 76902 BRYAN HORNER 2011-05-15 true 7134994600 2009 2016-02-24 21:20:13Z BRYAN HORNER PO BOX 22000 SAN ANGELO TX 76902 94425909 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. 18 0 171 10 0 0 271 6349 91841780 94419560 1400 0 0 0 91843451 94425909 0 0 0 0 64385343 68380870 0 0 0 49384581 51530040 113769924 119910910 -21926473 -25485001 21998827 22520618 16998418 19602073 5000409 2918545 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 114438935 94419560 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. 114438935 true false false false false false false false false true 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 87 0 true 171 true false false false false false false false false false 18 0 true 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 JAMES MELOTT 40.0 X X 264323 0 62877 JOHN HARVEY 40.0 X X 291444 0 64023 VIKI FORLANO HALFMANN 40.0 X X 260013 0 63345 HARVEY RUSSWURM 40.0 X 283945 0 49014 MARY SEGER 20.0 X 164909 0 20270 STEPHEN SAWYER 40.0 X 333337 0 60268 CORNELIUS CHINN 40.0 X 331717 0 64343 MICHAEL WAGNON 40.0 X 322280 0 65607 WILLIAM WHITEHEAD 40.0 X X 387021 0 75498 CHRIS COLE 40.0 X X 1150606 0 85625 JOLIE BAILEY 40.0 X X 347069 0 70858 ANTHONY DE MORY 40.0 X 751096 0 76659 LAURA ADAMS 40.0 X 532306 0 70432 JOE MIMS 40.0 X 566520 0 53912 SCOTT GIPSON 40.0 X 431029 0 71482 CHARLES MARSH 40.0 X 686721 0 46575 LUIS DUARTE 40.0 X 3112637 0 98765 IRVIN ZEITLER 5.0 X 3500 322372 55044 BRYAN HORNER 5.0 X 0 457484 69698 TIMOTHY HARTIN 5.0 X 0 207260 49461 DOUG SCHULTZ 40.0 X 360106 0 38929 TIMOTHY HOPKINS 40.0 X 1570844 0 85656 KENNETH BREEDLOVE 40.0 X 1140132 0 75275 MICHAEL SICKELS 40.0 X 1133156 0 85240 VICTOR SCHULZE III 40.0 X 1140537 0 76645 DAVID HUCHTON 40.0 X 1021015 0 80512 BRADLEY MCIVER 40.0 X 492116 0 78305 LESLIE WILLIAMSON 10.0 X 24167 0 5487 EUGENE STOKES 40.0 X 688261 0 45675 DENVER MARSH JR 40.0 X 572410 0 43954 GREGORY DUNHAM 40.0 X 579328 0 76111 TY HUGHSTON 40.0 X 333837 0 67621 J M CORNELL 40.0 X 768097 0 44671 JOHN GILBREATH 5.0 X 0 165336 38339 GARY BOWEN 5.0 X 0 163549 41149 JAMES BARNETT 40.0 X 388304 0 66443 STEPHEN CAINELLI 40.0 X 462569 0 43983 DAVID HARVEY 40.0 X 763562 0 43713 PETER CHANG 40.0 X 903541 0 62645 22562455 1316001 2374109 124 true true false DELTA LOCUM TENENS PO BOX 678082 DALLAS TX 75267 LOCUMS SERVICES 593136 SHANNON MED MGMT PO BOX 22000 SAN ANGELO TX 76903 MANAGEMENT SERVICES 30631222 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 OUTSIDE LAB SERVICES 799065 ALLIANCE RECRUITING RESOURCES 2708 HALIFAX COURT MCKINNEY TX 75070 PHYS CONTRACT SERV'S 241959 SHANNON MEDICAL CTR PO BOX 1879 SAN ANGELO TX 76902 LAB & LAUNDRY SVC 545772 11 6349 6349 NET PATIENT SERVICE REVENUE 621990 93754890 93754890 LEASE INCOME 532000 7900 7900 MISCELLANEOUS INCOME 900099 656770 656770 94419560 0 0 0 0 0 0 0 0 94425909 94419560 0 0 0 0 11719061 11719061 0 46519671 46089779 429892 6876280 6876280 1322889 1317888 5001 1942969 1942969 32373327 27562651 4810676 13451 13451 56968 56968 0 0 0 4233484 4124033 109451 129776 129776 373683 373683 6230 6230 0 118519 118519 245382 245382 0 0 4503 4503 0 1062377 1062377 421026 374490 46536 BAD DEBT 5691689 5691689 MEDICAL SUPPLIES 5390536 5390536 RECRUITING 346919 346919 EQUIPMENT COSTS 463964 463964 DUES/MEMBERSHIP/LICENSES 269568 269568 328638 328638 119910910 114438935 5471975 0 -353910 -416161 1017013 22118 12945303 12347023 141836 47774 39263 44930 761598 768557 10540203 7357128 2222523 3183075 5225201 6523302 21998827 22520618 9090488 9427114 109111 612235 7798819 9562724 16998418 19602073 X 5000409 2918545 5000409 2918545 21998827 22520618 X false true true X false X 2422 3035 2078 3271 6349 17155 87482526 87496019 85042238 91838780 94414909 446274472 87484948 87499054 85044316 91842051 94421258 446291627 446291627 152438 227742 0 0 0 380180 152438 227742 0 0 0 380180 130494 144034 0 0 0 274528 87767880 87870830 85044316 91842051 94421258 446946335 0.99853 0.99817 0.00085 0.00102 X 10540203 7357128 3183075 3183075 RETIREMENT FUND 6523302 6523302 0 PENSION FUND LIABILITY 6970991 HEALTH CLAIMS PAYABLE 142351 ESTIMATED MALPRACTICE COSTS 2449382 9562724 94425909 119910910 -25485001 -25485001 94421258 94421258 4651 4651 94425909 119906259 119906259 4651 4651 119910910 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 XII & XIII LINE 4C 4,651 EXPENSE INCLUDED IN REVENUE ON AUDIT false true false false false false false false false JAMES MELOTT 232579 0 30484 0 1260 0 46380 0 16497 0 327200 0 JOHN HARVEY 258031 0 31792 0 1621 0 46380 0 17643 0 355467 0 VIKI FORLANO HALFMANN 228319 0 30000 0 1694 0 46380 0 16965 0 323358 0 HARVEY RUSSWURM 236965 0 45000 0 1980 0 30380 0 18634 0 332959 0 MARY SEGER 143530 0 20089 0 1290 0 16534 0 3736 0 185179 0 STEPHEN SAWYER 272430 0 59909 0 998 0 44798 0 15470 0 393605 0 CORNELIUS CHINN 310557 0 19688 0 1472 0 46380 0 17963 0 396060 0 MICHAEL WAGNON 294210 0 27032 0 1038 0 44798 0 20809 0 387887 0 WILLIAM WHITEHEAD 349415 0 36644 0 962 0 54280 0 21218 0 462519 0 CHRIS COLE 883125 0 248331 0 19150 0 63180 0 22445 0 1236231 0 JOLIE BAILEY 309572 0 36429 0 1068 0 49838 0 21020 0 417927 0 ANTHONY DE MORY 506609 0 242793 0 1694 0 54505 0 22154 0 827755 0 LAURA ADAMS 484557 0 46542 0 1207 0 54380 0 16052 0 602738 0 JOE MIMS 500954 0 62135 0 3431 0 30380 0 23532 0 620432 0 SCOTT GIPSON 339691 0 90376 0 962 0 50780 0 20702 0 502511 0 CHARLES MARSH 639172 0 42500 0 5049 0 30380 0 16195 0 733296 0 LUIS DUARTE 2634460 0 459983 0 18194 0 76637 0 22128 0 3211402 0 IRVIN ZEITLER 3500 306319 0 0 0 16053 0 42549 0 12495 3500 377416 BRYAN HORNER 0 457484 0 0 0 0 0 30380 0 39318 0 527182 TIMOTHY HARTIN 0 183740 0 0 0 23520 0 34591 0 14870 0 256721 DOUG SCHULTZ 329193 0 27032 0 3881 0 30380 0 8549 0 399035 0 TIMOTHY HOPKINS 1353961 0 215102 0 1781 0 76637 0 9019 0 1656500 0 KENNETH BREEDLOVE 890479 0 248331 0 1322 0 63180 0 12095 0 1215407 0 MICHAEL SICKELS 867003 0 248331 0 17822 0 63180 0 22060 0 1218396 0 VICTOR SCHULZE III 873056 0 248331 0 19150 0 63180 0 13465 0 1217182 0 DAVID HUCHTON 974192 0 45616 0 1207 0 60380 0 20132 0 1101527 0 BRADLEY MCIVER 456966 0 33678 0 1472 0 56224 0 22082 0 570422 0 LESLIE WILLIAMSON 22877 0 0 0 1290 0 641 0 4847 0 29655 0 EUGENE STOKES 631322 0 53296 0 3643 0 30380 0 15295 0 733936 0 DENVER MARSH JR 523917 0 37630 0 10863 0 30380 0 13574 0 616364 0 GREGORY DUNHAM 546970 0 30000 0 2358 0 54380 0 21731 0 655439 0 TY HUGHSTON 302056 0 30000 0 1781 0 46380 0 21241 0 401458 0 J M CORNELL 677401 0 85333 0 5363 0 30380 0 14291 0 812768 0 JOHN GILBREATH 0 159725 0 0 0 5611 0 27206 0 11133 0 203675 GARY BOWEN 0 161569 0 0 0 1980 0 29350 0 11799 0 204698 JAMES BARNETT 356523 0 30000 0 1781 0 46380 0 20063 0 454747 0 STEPHEN CAINELLI 434258 0 23500 0 4811 0 30380 0 13603 0 506552 0 DAVID HARVEY 717810 0 43542 0 2210 0 30380 0 13333 0 807275 0 PETER CHANG 783429 0 101390 0 18722 0 46380 0 16265 0 966186 0 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART 1, QUESTION 4 NONQUALIFIED PLAN PARTICIPANTS NAME AMOUNT JAMES MELOTT $ 33,207 JOHN HARVEY $ 31,039 VIKI FORLANO HALFMANN $ 32,652 MARY SEGER $ 5,341 STEPHEN SAWYER $ 26,030 CORNELIUS CHINN $ 35,567 MICHAEL WAGNON $ 26,505 WILLIAM WHITEHEAD $ 37,214 CHRIS COLE $ 61,663 JOLIE BAILEY $ 29,493 ANTHONY DE MORY $ 42,200 LAURA ADAMS $ 50,881 JOE MIMS $ 13,166 SCOTT GIPSON $ 31,351 CHARLES MARSH $ 35,441 LUIS DUARTE $152,255 IRVIN ZEITLER $ 12,169 TIMOTHY HARTIN $ 15,538 DOUG SCHULTZ $ 7,639 TIMOTHY HOPKINS $101,200 KENNETH BREEDLOVE $ 61,663 MICHAEL SICKELS $ 61,663 VICTOR SCHULTZE III $ 61,663 DAVID HUCHTON $ 80,967 BRADLEY MCIVER $ 47,884 LESLIE WILLIAMSON $ 22,877 EUGENE STOKES $ 22,925 DENVER MARSH, JR. $ 25,916 GREGORY DUNHAM $ 52,931 TY HUGHSTON $ 30,603 J.M. CORNELL $ 24,069 JOHN GILBREATH $ 12,730 GARY BOWEN $ 12,896 JAMES BARNETT $ 29,552 STEPHEN CAINELLI $ 25,351 DAVID HARVEY $ 50,067 PETER CHANG $ 48,713 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 70200 SHANNON CLINIC EMPLOYEE false SUSAN SCHULTZ DOUG SCHULTZ'S SPOUSE 12098 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 MEDICAL CENTER, 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 MEDICAL CENTER, 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 XI, 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. RELATED COMPENSATION HOURS WORKED FORM 990, PART VII AVG HOURS WORKED FOR RELATED ORG BRYAN HORNER 39 TIMOTHY HARTIN 40 IRVIN ZEITLER 36 JOHN GILBREATH 40 GARY BOWEN 40 RECONCILIATION OF NET ASSETS BEGINNING NET ASSETS $ 5,000,409 + INCOME $ 94,421,258 - EXPENSES $(119,906,259) + TRANSFER FROM AFFILIATE $ 23,403,137 ------------------ ENDING NET ASSETS $ 2,918,545 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. FAMILY/BUSINESS RELATIONSHIP WITH ANOTHER OFFICER, DIRECTOR, TRUSTEE, ETC FORM 990, PART VI, QUESTION 2 CHARLES MARSH AND DENVER MARSH HAVE A FAMILY RELATIONSHIP. TRUSTEES SHANNON WEST TEXAS HOSPITAL PO BOX 49 SAN ANGELO TX 76902 750800679 TRUST TX 501(C)(3) 11B NA SHANNON RURAL HEALTH CLINICS INC 120 E HARRIS AVE SAN ANGELO TX 76903 752940211 HEALTHCARE TX 501(C)(3) 11C NA SHANNON REAL ESTATE SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 270075630 SUPPORT SVCS TX 501(C)(3) 11B NA SHANNON HEALTH SYSTEM 120 E HARRIS AVE SAN ANGELO TX 76903 752602411 SUPPORT SVCS TX 501(C)(3) 11A NA SHANNON MEDICAL CENTER 120 E HARRIS AVE SAN ANGELO TX 76903 752559845 HEALTHCARE TX 501(C)(3) 3 NA SHANNON BUSINESS SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 432038769 SUPPORT SVCS TX 501(C)(3) 11B NA SHANNON MEDICAL MANAGEMENT 120 E HARRIS AVE SAN ANGELO TX 76903 208367966 SUPPORT SVCS TX 501(C)(3) 9 NA SHANNON JOINT VENTURES INC PO BOX 22000 SAN ANGELO TX 76902 752951284 DIALYSIS SVC TX 501(C)(3) 9 NA LEGACY HEALTH PLAN INC 2018 PULLIAM ST SAN ANGELO TX 76903 752838410 HEALTH PLAN TX NA C-CORPORATION 0 0 0.00000 LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 MANAGEMENT TX NA C-CORPORATION 0 0 0.00000 LEGACY HEALTH SOLUTIONS 2018 PULLIAM ST SAN ANGELO TX 76903 200720762 MED INSURANCE TX NA C-CORPORATION 0 0 0.00000 false false false false false false false false false false false true false false true true true true