2020-08-17T13:49:25-05:00 2019-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2018-10-01 208367966 Shannon Medical Management % JULIAN BESERIL SHAN 3256581511 PO Box 22000 San Angelo TX 76902 JULIAN BESERIL cfo 3256581511 2020-08-17 true Kevin R Ensminger P01310558 9727028262 167.68.126.162 76915820202305000007 2020-08-17 P B49B3FF6BBBA87B030C59CEAC7889EA9C46574FC EB976710118F518B8933A72D91D1D85239D99EDA 2018 2020-09-22 18:59:49Z SHANE PLYMELL PO BOX 22000 SAN ANGELO TX 76902 64483978 false X WWW.SHANNONHEALTH.COM X 2007 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. 3 1 1051 10 0 0 0 62769600 64483676 0 0 303 302 62769903 64483978 0 0 0 0 44899088 45175006 0 0 0 15555452 16690992 60454540 61865998 2315363 2617980 3857170 2707629 4320658 4486000 -463488 -1778371 TO PROVIDE SUPPORT SERVICES FOR SHANNON CLINIC IN SUPPORT OF ITS MISSION TO BE THE PREMIERE HEALTH CARE PROVIDER OF PHYSICIAN SERVICES IN THE COMMUNITIES SERVED. false false 51898455 64483978 PROVIDE SUPPORT SERVICES, INCLUDING NURSING, ANCILLARY HEALTHCARE SERVICES, ADMINISTRATIVE AND TECHNOLOGICAL SUPPORT FOR SHANNON CLINIC, AN AFFILIATED NON-PROFIT MULTI-SPECIALTY PHYSICIAN CLINIC THAT PROVIDES HEALTHCARE THROUGHOUT SAN ANGELO AND NEARBY COMMUNITIES REGARDLESS OF ABILITY TO PAY. SHANNON MEDICAL MANAGEMENT IS ORGANIZED AND OPERATED TO SUPPORT ACCESS AND CARE FOR RESIDENTS OF ITS SERVICE AREA, INCLUDING MEDICALLY INDIGENT PATIENTs. 51898455 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 false false false false false false false true true true false false true X 0 0 1051 true false false false false false false false false false false false false X 3 1 false false false false true true false true true false false false true true true true true true true false X JULIAN BESERIL 3256581511 120 E BEAUREGARD SAN ANGELO TX 76903 X Len Mertz Chairman/Trustee 1.0 39.0 X X 0 3958 4365 Kelly Shane Plymell CEO/President 5.0 35.0 X X 0 644415 97897 Ricardo Villareal COO/Secretary/Treasurer 40.0 0.0 X X 245056 0 35742 JULIAN BESERIL CFO, START: 05/19 24.0 16.0 X 0 0 0 West Herbert Lead EKG/Tread Tech 40.0 0.0 X 136713 0 24414 Anna Pittman Chief Nursing Officer 40.0 0.0 X 136880 0 28592 Mark Duncan Sports Medicine Director 40.0 0.0 X 160922 0 15324 Keli Ramsey Former COO 0.0 0.0 X 191066 0 42478 John Dolan Former Assistant CFO 40.0 0.0 X 160683 0 25118 Staci Wetz Former CFO 1.0 39.0 X 0 324641 77929 1031320 973014 351859 6 true true false ALLSCRIPTS 8529 SIX FORKS ROAD FORUM IV RALEIGH TX 27615 STATEMENT PROCESSING 167655 CHAMPION CLEANING SOLUTIONS 6 DONARE SQUARE SAN ANTONIO TX 78229 CLEANING SERVICES 267495 EXECUTIVE COURIER LLC 4525 SUGAR MAPLE LN SAN ANGELO TX 76904 COURIER SERVICES 120622 MEDI-COMM SERVICES OF LUBBOCK 5717 66TH ST SUITE 116 LUBBOCK TX 79424 COLLECTION SERVICES 256006 STERICYCLE COMMUNICATIONS 26604 NETWORK PLACE CHICAGO IL 60673 ANSWERING SERVICES 120111 5 0 Medical Records Income 900099 142957 142957 Lease Income 532000 200 200 Management Fees 900099 64340519 64340519 64483676 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Miscellaneous Income 900099 302 302 302 64483978 64483978 0 0 0 0 97897 97897 0 35744325 31565674 4178651 1012029 797174 214855 5804902 5176338 628564 2515853 2152912 362941 0 0 11737 11737 0 0 0 3053897 2833997 219900 266533 265533 1000 715984 203685 512299 1485182 81884 1403298 0 7818466 7800658 17808 113356 99574 13782 0 0 0 0 828200 368872 459328 21644 21644 Equipment 1551671 56652 1495019 Collection Fees 446661 446661 Education 27164 26009 1155 Recruiting & New Hire 36182 36182 314315 22832 291483 61865998 51898455 9967543 0 0 0 0 0 0 0 578320 21286 0 0 0 0 0 0 0 0 210465 214221 10116606 7795411 2994175 2321195 0 0 0 0 0 0 0 0 74210 150927 3857170 2707629 3356225 3740222 0 0 0 0 0 0 0 0 0 0 0 0 0 0 964433 745778 4320658 4486000 X -463488 -1778371 0 0 0 0 -463488 -1778371 3857170 2707629 X 2617980 -3932863 X false true X true false X X X 2 SHANNON CLINIC 752600873 10 false 61865998 0 SHANNON MEDICAL CENTER 752559845 3 true 0 0 2 61865998 false false false false false false false false false false false false false false false false SCHEDULE A, PART IV, SECTION A, LINE 1 THE ORGANIZATION'S GOVERNING DOCUMENTS LIST SHANNON MEDICAL CENTER. THE ORGANIZATION SUPPORTS SHANNON CLINIC WHO PROVIDES SERVICES THAT ALLOW SHANNON MEDICAL CENTER TO ACCOMPLISH ITS MISSION OF PROVIDING CARE TO ITS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SCHEDULE A, PART IV, SECTION C, LINE 1 THE ORGANIZATION HAS RECEIVED A TYPE II SUPPORTING ORGANIZATION DETERMINATION LETTER FROM THE IRS. THE IRS MADE THIS DETERMINATION BASED ON THE FOLLOWING FACTS. THE PRIMARY PURPOSE OF THE ORGANIZATION IS THE PROVISION OF ADMINISTRATIVE SERVICES TO SHANNON CLINIC (SC), THE PHYSICIAN SERVICES COMPONENT OF THE INTEGRATED HEALTH CARE DELIVERY SYSTEM THAT INCLUDES SHANNON MEDICAL CENTER (SMC), SC, THE ORGANIZATION AND SHANNON HEALTH SYSTEM (SHS), EACH OF WHICH IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX PURSUANT TO SECTION 501(A)[1] BY VIRTUE OF BEING AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). EACH OF THESE ENTITIES ARE RELATED CORPORATIONS. EFFECTIVE JULY 3, 2008, THE ORGANIZATION'S BYLAWS WERE AMENDED TO, AMONG OTHER THINGS, SUBSTITUTE SHS FOR SMC AS THE ORGANIZATION'S MEMBER. THUS, THE ORGANIZATION'S DIRECTORS ARE APPOINTED AND REMOVABLE BY SHS, NOT SMC. AS SUCH, THE ORGANIZATION REQUESTED AND RECEIVED RECLASSIFICATION AS A TYPE II SUPPORTING ORGANIZATION SINCE A MAJORITY OF ITS OFFICERS AND DIRECTORS ARE EITHER DIRECTORS OF SMC OR MEMBERS OF THE SMC'S SENIOR MANAGEMENT TEAM, PLACING MANAGEMENT AND CONTROL OF THE ORGANIZATION IN THE HANDS OF THE SAME INDIVIDUALS WHO MANAGE SMC. 10116606 7795411 2321195 2321195 Pension Fund 150927 150927 0 Pension Plan Liability 199972 Health Claims Payable 545806 745778 64483978 64483978 64483978 61865998 61865998 61865998 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. false true false false false false false false false Kelly Shane Plymell CEO/President 0 571671 0 100 0 72644 0 76691 0 21206 0 742312 0 72177 Ricardo Villareal COO/Secretary/Treasurer 244883 0 0 0 173 0 23462 12280 0 0 268518 12280 0 0 West Herbert Lead EKG/Tread Tech 136522 0 0 0 191 0 4369 0 20045 0 161127 0 0 0 Keli Ramsey Former COO 150053 0 0 0 41013 0 26499 0 15979 0 233544 0 30078 0 Anna Pittman Chief Nursing Officer 135430 0 0 0 1450 0 11263 0 17329 0 165472 0 0 0 John Dolan Former Assistant CFO 158709 0 0 0 1974 0 5116 0 20002 0 185801 0 0 0 Mark Duncan Sports Medicine Director 158641 0 0 0 2281 0 4928 0 10396 0 176246 0 0 0 Staci Wetz Former CFO 0 276097 0 100 0 48444 0 58154 0 19775 0 402570 0 48159 SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN: FIXED CONTRIBUTION - THE PARTICIPANT'S ALLOWANCE PERCENTAGE FOR THE PLAN YEAR MULTIPLIED BY THE PARTICIPANT'S BASE SALARY FOR THE PRECEDING PLAN YEAR. DISCRETIONARY CONTRIBUTION - THE AMOUNT DETERMINED BY THE COMMITTEE, IN ITS SOLE DISCRETION, ON BEHALF OF A PARTICIPANT FOR THE PLAN YEAR BASED UPON CRITERIA ESTABLISHED BY THE COMMITTEE, IN ITS SOLE DISCRETION. THE APPLICABLE PLAN YEAR OF THE DISCRETIONARY CONTRIBUTION SHALL BE PLAN YEAR DURING WHICH IT IS CREDITED TO THE PARTICIPANT'S MUTUAL FUND ACCOUNT PURSUANT TO SECTION 2.1.3.2 OF EXHIBIT A TO THE PLAN. HOWEVER, THE COMMITTEE, IN ITS SOLE DISCRETION, MAY DETERMINE THE AMOUNT OF THE DISCRETIONARY CONTRIBUTION BASED UPON CRITERIA RELATING TO THE PRECEDING PLAN YEAR, AS MEASURED DURING THE FISCAL YEAR OF THE COMPANY ENDING IN SUCH PRECEDING PLAN YEAR. 457(F) DETAIL PARTICIPANT W-2 DEFERRED COMP PAYOR ------------ ------- ---------------- -------- KELLY SHANE PLYMELL $72,177 $65,691 SMC RICARDO VILLAREAL NONE $28,653 SMM ANNA PITTMAN NONE $6,067 SMM KELI RAMSEY $30,078 $23,173 SMM STACI WETZ $48,159 $47,154 SMC FORM 990, PART VI, SECTION A, LINE 6 SHANNON HEALTH SYSTEM IS THE SOLE MEMBER OF SHANNON MEDICAL MANAGEMENT. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, SHANNON HEALTH SYSTEM, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBER EXERCISES ITS POWERS AND 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. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE THE 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 OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF SHANNON MEDICAL MANAGEMENT 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. FORM 990, PART VI, SECTION B, LINE 15A & 15B OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF SHANNON MEDICAL MANAGEMENT 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. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C SHANNON MEDICAL MANAGEMENT DOES NOT HAVE AN AUDIT COMMITTEE, BUT THERE IS A SHANNON HEALTH SYSTEM AUDIT COMPLIANCE COMMITTEE THAT OVERSEES THE CONSOLIDATED AUDIT THAT INCLUDES SHANNON MEDICAL MANAGEMENT. FORM 990, PART V, LINE 1A CHECKS ARE WRITTEN ON BEHALF OF SHANNON MEDICAL MANAGEMENT BY SHANNON CLINIC. ACCORDINGLY ALL FORM 1099'S ARE FILED UNDER THE TAX ID OF SHANNON CLINIC. Form 990, Part XI, Line 9 Other Changes in Net Assets: Transfer To shannon clinic $(58,253,919) Transfer from Shannon business services 1,099 Transfer from Shannon Real estate services 6,725,888 Transfer from Shannon Medical Center 47,594,069 --------------- Total $(3,932,863) TRUSTEES SHANNON WEST TEXAS HOSPITAL PO BOX 49 SAN ANGELO TX 76902 750800679 TRUST TX 501(C)(3) 12B NA false SHANNON REAL ESTATE SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 270075630 SUPPORT SVCS TX 501(C)(3) 12A SMC true SHANNON RURAL HEALTH CLINICS INC 120 E HARRIS AVE SAN ANGELO TX 76903 752940211 HEALTHCARE TX 501(C)(3) 12C 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 BEAUREGARD 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 CENTER 120 E HARRIS AVE SAN ANGELO TX 76903 752559845 SUPPORT SVCS TX 501(C)(3) 3 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 LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 UTILIZ. REVIE TX NA C-CORPORATION false LEGACY HEALTH SOLUTIONS 2018 PULLIAM ST SAN ANGELO TX 76903 200720762 MEDICAL INSUR TX NA C-CORPORATION false false false false false false false false false false false true true true true true true true true true SHANNON CLINIC L 64340519 BOOK VALUE Shannon Clinic r 58253919 Book value Shannon Real Estate Services s 6725888 Book Value Shannon Medical Center s 47594069 Book Value