2016-08-13T11:03:45-05:00 2015-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2014-10-01 752600873 SHANNON CLINIC % SHANNON CLINIC ATTN ADMIN SHAN 3256581511 PO BOX 22000 SAN ANGELO TX 76902 STACI WETZ CFO 7134994600 2016-08-15 true Jana Kirksey P01261744 7134994600 2014 2016-09-27 15:27:22Z BRYAN HORNER PO BOX 22000 SAN ANGELO TX 76902 136781678 false X SHANNONHEALTH.COM 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. 17 0 256 10 0 0 0 0 130516858 136780927 -1742 751 0 0 130515116 136781678 0 0 0 0 88355743 93895508 0 0 0 72169209 80374232 160524952 174269740 -30009836 -37488062 27861858 28276438 20918021 25031778 6943837 3244660 X OUR MISSION IS TO BE THE PREMIER 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 166076685 0 136780927 PROVIDE HEALTHCARE 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. 166076685 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 true true false false true 117 0 true 256 true false false false false false false false false false false X 17 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 ADMIN 3256581511 120 E BEAUREGARD SAN ANGELO TX 76903 X JOHN HARVEY PHYSICIAN/DIVISION CHAIRMAN 40.0 0.0 X X 376848 0 71614 VIKI FORLANO HALFMANN PHYSICIAN/DIVISION VICE CHAIR 40.0 0.0 X X 323012 0 65787 HARVEY RUSSWURM PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 325346 0 62393 WILLIAM WHITEHEAD PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 464049 0 80703 CHRIS COLE PHYSICIAN / CHAIRMAN 40.0 0.0 X X 835219 0 105856 ANTHONY DEMORY PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 776373 0 82599 JOE MIMS PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 524366 0 82680 IRVIN ZEITLER MEDICAL DIRECTOR 5.0 35.0 X 0 467700 21357 DOUG SCHULTZ PHYSICIAN/MEDICAL DIRECTOR 40.0 0.0 X 328824 0 51987 JOSEPH ZUBAK PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 553824 0 69778 MARK MURPHY PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 323904 0 67822 NORMA CERNA PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 317640 0 60337 ERIC IGLER PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 401136 0 78316 LAURA ADAMS PHYSICIAN / SECRETARY 40.0 0.0 X X 582925 0 85909 SARAH JACKSON-VANCE PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 369666 0 69406 STEVEN BURGESS PHYSICIAN / BOARD DIRECTOR 40.0 0.0 X 333761 0 66676 JASON FELGER PHYSICIAN / BOARD DIRECTOR 40.0 0.0 X 651617 0 96474 RUDY HADDAD PHYSICIAN/BOARD DIRECTOR 40.0 0.0 X 822113 0 32316 BRYAN HORNER PRESIDENT 5.0 35.0 X 0 692737 14336 JOHN GILBREATH CFO 5.0 35.0 X 0 248329 52357 GARY BOWEN COO 5.0 35.0 X 0 240706 59145 GARY GIBIAN SMM EXECUTIVE DIRECTOR 5.0 35.0 X 0 414004 80755 FRANK KUNZE SMM CHIEF OPERATING OFFICER 5.0 35.0 X 0 0 0 TIMOTHY HOPKINS PHYSICIAN 40.0 0.0 X 1766723 0 84542 DAVID HUCHTON PHYSICIAN 40.0 0.0 X 1094613 0 81290 DAVID CUMMINGS PHYSICIAN 40.0 0.0 X 1058579 0 94224 STEPHEN COATES PHYSICIAN 40.0 0.0 X 984139 0 69559 LUIS DUARTE PHYSICIAN 40.0 0.0 X 3429297 0 100594 JAMES MELOTT PHYSICIAN/FORMER OFFICER 40.0 0.0 X 294209 0 67959 ROSS CARMICHAEL PHYSICIAN/FORMER OFFICER 40.0 0.0 X 197933 0 34263 17136116 2063476 1991034 179 true true false DELTA LOCUM TENENS 1755 WITTINGTON PLACE STE 800 DALLAS TX 75234 LOCUMS SERVICES 947387 SHANNON MED MGMT 120 E BEAUREGARD SAN ANGELO TX 76903 MANAGEMENT SERVICES 44849494 SHANNON MEDICAL CTR 120 E HARRIS SAN ANGELO TX 76903 LAB AND LAUNDRY SVC 1134598 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84108 OUTSIDE LAB SERVICES 838676 STONE SETTLE ADVERTISING INC PO BOX 60187 SAN ANGELO TX 76906 ADVERTISING 598129 13 0 SERVICE REVENUE 621990 122988957 122988957 LEASE INCOME 532000 6608 6608 HOSPITAL BASED PHYSICIANS' ASSISTANCE 900099 9473764 9473764 MISCELLANOUS INCOME 900099 4311598 4311598 136780927 0 0 0 0 0 0 751 751 751 751 0 0 0 0 136781678 136780927 751 0 0 0 0 10138742 10138742 0 1401451 1401451 72253601 71576830 676771 5931624 5931624 1293370 1293370 2876720 2876720 48405625 41144781 7260844 0 43062 43062 0 0 0 6700632 6532724 167908 246709 246709 558548 558548 3685 3685 0 50129 50129 473535 473535 0 0 1201 1201 0 949383 949383 320601 276131 44470 BAD DEBT 11928840 11928840 MEDICAL SUPPLIES 8717741 8717741 RECRUITING 623087 623087 EDUCATION 474301 474301 877153 877153 174269740 166076685 8193055 0 0 0 0 0 0 0 16035239 13801150 0 0 0 0 619315 446212 61304 261972 1097360 978791 14660369 12105112 2250185 2555257 0 0 0 0 0 0 0 0 7798455 10233056 27861858 28276438 8783893 10434724 0 0 0 0 0 0 0 0 0 0 107369 0 0 0 12026759 14597054 20918021 25031778 X 6943837 3244660 0 0 0 0 6943837 3244660 27861858 28276438 X -37488062 33788885 X false true X true false X 0 0 0 0 0 0 101441273 114358708 122449477 130516856 136780927 605547241 0 0 0 101441273 114358708 122449477 130516856 136780927 605547241 0 0 0 605547241 0 0 0 0 0 101441273 114358708 122449477 130516856 136780927 605547241 1.00000 1.00000 0.00000 0.00000 X 14615521 12105112 2555257 44848 2555257 RETIREMENT FUND 10233056 10233056 0 PENSION FUND LIABILITY 12560195 HEALTH CLAIMS PAYABLE 193361 ESTIMATED MALPRACTICE COSTS 1843498 14597054 75767294 75767294 61014384 61014384 136781678 113255356 113255356 61014384 61014384 174269740 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 $49,085,546 BAD DEBT 11,928,838 ---------- $61,014,384 false true false false false false false false false JAMES MELOTT PHYSICIAN/FORMER OFFICER 205581 0 71985 0 16643 0 46120 0 21839 0 362168 0 16000 0 JOHN HARVEY PHYSICIAN/DIVISION CHAIRMAN 253479 0 89281 0 34088 0 46800 0 24814 0 448462 0 16000 0 VIKI FORLANO HALFMANN PHYSICIAN/DIVISION VICE CHAIR 228946 0 75228 0 18838 0 46120 0 19667 0 388799 0 16000 0 HARVEY RUSSWURM PHYSICIAN/BOARD DIRECTOR 276613 0 42164 0 6569 0 51080 0 11313 0 387739 0 0 0 WILLIAM WHITEHEAD PHYSICIAN/BOARD DIRECTOR 314277 0 115291 0 34481 0 57419 0 23284 0 544752 0 25200 0 CHRIS COLE PHYSICIAN / CHAIRMAN 621553 0 186676 0 26990 0 73840 0 32016 0 941075 0 0 0 ANTHONY DEMORY PHYSICIAN/BOARD DIRECTOR 616143 0 127443 0 32787 0 56365 0 26234 0 858972 0 24126 0 JOE MIMS PHYSICIAN/BOARD DIRECTOR 464843 0 52043 0 7480 0 57046 0 25634 0 607046 0 0 0 IRVIN ZEITLER MEDICAL DIRECTOR 0 385197 0 82503 0 0 0 17734 0 3623 0 489057 0 0 BRYAN HORNER PRESIDENT 0 550607 0 125130 0 17000 0 10400 0 3936 0 707073 0 0 DOUG SCHULTZ PHYSICIAN/MEDICAL DIRECTOR 282838 0 41206 0 4780 0 44102 0 7885 0 380811 0 0 0 ROSS CARMICHAEL PHYSICIAN/FORMER OFFICER 132698 0 59915 0 5320 0 20932 0 13332 0 232197 0 0 0 JOSEPH ZUBAK PHYSICIAN/BOARD DIRECTOR 382168 0 119895 0 51761 0 43544 0 26234 0 623602 0 33211 0 MARK MURPHY PHYSICIAN/BOARD DIRECTOR 226043 0 79671 0 18190 0 58240 0 9582 0 391726 0 0 0 NORMA CERNA PHYSICIAN/BOARD DIRECTOR 248893 0 68507 0 240 0 46120 0 14217 0 377977 0 0 0 ERIC IGLER PHYSICIAN/BOARD DIRECTOR 273554 0 101437 0 26145 0 52640 0 25676 0 479452 0 20400 0 LAURA ADAMS PHYSICIAN / SECRETARY 444957 0 105226 0 32742 0 59675 0 26234 0 668834 0 24000 0 SARAH JACKSON-VANCE PHYSICIAN/BOARD DIRECTOR 261878 0 66782 0 41006 0 58240 0 11166 0 439072 0 0 0 STEVEN BURGESS PHYSICIAN / BOARD DIRECTOR 259076 0 74235 0 450 0 46120 0 20556 0 400437 0 0 0 JASON FELGER PHYSICIAN / BOARD DIRECTOR 546903 0 46190 0 58524 0 70240 0 26234 0 748091 0 0 0 RUDY HADDAD PHYSICIAN/BOARD DIRECTOR 734674 0 87169 0 270 0 10400 0 21916 0 854429 0 0 0 TIMOTHY HOPKINS PHYSICIAN 1173190 0 513664 0 79869 0 74960 0 9582 0 1851265 0 46257 0 DAVID HUCHTON PHYSICIAN 807932 0 255870 0 30811 0 62688 0 18602 0 1175903 0 30000 0 DAVID CUMMINGS PHYSICIAN 707360 0 252009 0 99210 0 82320 0 11904 0 1152803 0 0 0 STEPHEN COATES PHYSICIAN 735851 0 204588 0 43700 0 60247 0 9312 0 1053698 0 0 0 LUIS DUARTE PHYSICIAN 2654110 0 695348 0 79839 0 74960 0 25634 0 3529891 0 46257 0 JOHN GILBREATH CFO 0 186791 0 42642 0 18896 0 44196 0 8161 0 300686 0 0 GARY BOWEN COO 0 189906 0 43353 0 7447 0 44194 0 14951 0 299851 0 0 GARY GIBIAN SMM EXECUTIVE DIRECTOR 0 307780 0 70833 0 35391 0 56339 0 24416 0 494759 0 0 SCHEDULE J, PART I, LINE 4C SERP DETAIL NAME AMOUNT BRYAN HORNER NONE NONQUALIFIED PLAN PARTICIPANTS NAME AMOUNT JAMES MELOTT $ 16,193 JOHN HARVEY $ 15,898 VIKI FORLANO HALFMANN $ 18,148 WILLIAM WHITEHEAD $ 34,181 ANTHONY DEMORY $ 32,097 LAURA ADAMS $ 32,292 LUIS DUARTE $ 61,649 ERIC IGLER $ 25,695 TIMOTHY HOPKINS $ 61,679 DAVID CUMMINGS $ 81,410 DAVID HUCHTON $ 30,361 JOSEPH ZUBAK $ 33,571 SARAH JACKSON VANCE $ 40,736 STEPHEN COATES $ 43,400 JASON FELGER $ 40,574 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 PRECEDING 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. SCHEDULE J, PART I, LINE 3 METHODS USED TO ESTABLISH COMPENSATION 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. BRANDI WHITEHEAD W. WHITEHEAD'S SPOUSE 36857 SHANNON CLINIC EMPLOYEE false VALARIE BURGESS S. BURGESS SPOUSE 12180 SHANNON CLINIC EMPLOYEE false CHRIS HADDAD R. HADDAD'S BROTHER 861108 SHANNON CLINIC EMPLOYEE false DAVID VANCE S. JACKSON-VANCE'S SPOUSE 454956 SHANNON CLINIC EMPLOYEE false SUSAN SCHULTZ D. SCHULTZ'S SPOUSE 36350 SHANNON CLINIC EMPLOYEE false FORM 990, PART VI, SECTION A, LINE 3 ADMINISTRATIVE SERVICES FOR SHANNON CLINIC ARE CONTRACTED WITH SHANNON MEDICAL MANAGEMENT. FORM 990, PART VI, SECTION A, LINE 6 SHANNON HEALTH SYSTEM, A 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF SHANNON CLINIC. 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 & 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 A, LINE 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. FORM 990, PART VI, SECTION B, LINE 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. FORM 990, PART VI, SECTION B, LINE 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. FORM 990, PART VI, SECTION B, LINE 15A 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. FORM 990, PART VI, SECTION B, LINE 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. 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 XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES TRANSFER TO/FROM AFFILIATES 33,788,885 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 true REGIONAL CANCER TREATMENT CENTER 102 N MAGDALEN 120 San Angelo TX 76902 752225955 RADIOTHERAPY TX NA LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 MANAGEMENT TX NA C-CORPORATION false LEGACY HEALTH SOLUTIONS 2018 PULLIAM ST SAN ANGELO TX 76903 200720762 MED INSURANCE TX NA C-CORPORATION false false false false false false false false false false false false false true true true true true true true SHANNON MEDICAL MANAGEMENT 1M 48405625 BOOK VALUE