2013-08-09T15:00:07-05:00 2012-09-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2011-10-01 752600873 SHANNON CLINIC % SHANNON CLINIC ATTN SHAN 3256581511 PO BOX 22000 SAN ANGELO TX 76902 BRYAN HORNER 2013-08-15 true M Paige Gerich 7134994600 2011 2016-02-24 21:20:13Z BRYAN HORNER PO BOX 22000 SAN ANGELO TX 76902 114358708 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 0 223 10 0 0 0 0 101441273 114358708 0 0 0 0 101441273 114358708 0 0 0 0 74866569 81073405 0 0 0 56498751 63728440 131365320 144801845 -29924047 -30443137 26891851 30700792 21898425 24998350 4993426 5702442 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 138046506 114358708 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. 138046506 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 false true 105 0 true 223 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 312508 67844 VIKI FORLANO HALFMANN 40.0 X X 297578 66694 HARVEY RUSSWURM 40.0 X 286456 51357 CORNELIUS CHINN 40.0 X 357225 64273 MICHAEL WAGNON 40.0 X 344849 52801 WILLIAM WHITEHEAD 40.0 X 448572 77220 CHRIS COLE 40.0 X X 1043375 57608 JOLIE BAILEY 40.0 X X 384638 75674 ANTHONY DEMORY 40.0 X X 863346 81393 LAURA ADAMS 40.0 X 570334 75911 JOE MIMS 40.0 X 549603 57695 SCOTT GIPSON 40.0 X 394419 71678 CHARLES MARSH 40.0 X 598227 49745 LUIS DUARTE 40.0 X 2656397 104149 IRVIN ZEITLER 5.0 X 444238 61727 ROSS CARMICHAEL 40.0 X X 257355 23406 D'LAINE WESTMORELAND 20.0 X 149152 32417 JOSEPH ZUBAK 40.0 X 500595 84435 MARK MURPHY 40.0 X 281310 41877 BRYAN HORNER 5.0 X 568720 47524 TIMOTHY HARTIN 5.0 X 278111 60164 DOUG SCHULTZ 40.0 X 401649 39975 GARY GIBIAN 5.0 X 342049 81406 TIMOTHY HOPKINS 40.0 X 1446224 88509 KENNETH BREEDLOVE 40.0 X 995436 86686 MICHAEL SICKELS 40.0 X 991254 90023 VICTOR SCHULZE III 40.0 X 1023166 56137 DAVID HUCHTON 40.0 X 1033286 86294 JAMES MELOTT 40.0 X 289051 65442 JAMES BARNETT 40.0 X 418420 72358 STEPHEN CAINELLI 40.0 X 456454 50366 CHARLES JONES 40.0 X 241809 45088 JOHN GILBREATH 5.0 X 221838 45359 GARY BOWEN 5.0 X 225795 58558 17592688 2080751 2171793 164 true true false DELTA LOCUM TENENS 1755 WITTINGTON PLACE STE 800 DALLAS TX 75234 LOCUMS SERVICES 813761 SHANNON MED MGMT 120 E BEAUREGARD SAN ANGELO TX 76903 MANAGEMENT SERVICES 41045847 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 OUTSIDE LAB SERVICES 739232 CARDIOTHORACIC VASCULAR SURGEONS 1010 W 40TH ST AUSTIN TX 78756 PHYS CONTRACT SERV'S 285000 SHANNON MEDICAL CTR 120 E HARRIS SAN ANGELO TX 76903 LAB & LAUNDRY SVC 699297 15 0 Service Revenue 621990 104978340 104978340 Lease Income 532000 3954 3954 HOSPITAL BASED PHYSICIANS' ASSISTANCE 900099 7360000 7360000 MISCELLANEOUS INCOME 900099 2016414 2016414 114358708 0 0 0 0 0 0 0 0 114358708 114358708 0 0 0 0 11873741 11873741 996552 996552 56908217 56369956 538261 7357482 7357482 1534002 1524527 9475 2403411 2403411 39945725 33953866 5991859 4225 4225 41091 41091 0 0 0 5871483 5744042 127441 250568 250568 495927 495927 4198 4198 0 110576 110576 327925 327925 0 0 12495 12495 0 1083354 1083354 42987 42987 Bad Debt 7775574 7775574 0 Medical Supplies 6276293 6276293 Recruiting 446551 446551 Equipment Costs 423857 423857 615611 615611 144801845 138046506 6755339 0 0 0 21958 19201 0 0 13839031 14832617 0 0 0 0 142856 73804 97664 122381 1469448 1428110 12244024 9631115 2951313 2612909 0 0 0 0 0 0 0 0 8369581 11611770 26891851 30700792 10565006 10764082 0 0 0 0 0 0 0 0 0 0 483421 361708 0 0 10849998 13872560 21898425 24998350 X 4993426 5702442 0 0 0 0 4993426 5702442 26891851 30700792 X -30443137 31152153 X X false true true X false X 2078 3271 6349 11698 85042238 91838780 94414909 101441273 114358708 487095908 85044316 91842051 94421258 101441273 114358708 487107606 487107606 0 0 0 0 0 0 0 0 85044316 91842051 94421258 101441273 114358708 487107606 1.00000 0.99920 0.00000 0.00063 X 12244024 9631115 2612909 2612909 RETIREMENT FUND 11611770 11611770 0 PENSION FUND LIABILITY 11611770 Health Claims Payable 217435 Estimated Malpractice Costs 2043355 13872560 114358708 144801845 -30443137 -30443137 66099996 66099996 48258712 48258712 114358708 96543133 96543133 48258712 48258712 144801845 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 INCOME/EXPENSE RECLASSES FROM AUDIT $40,483,140 BAD DEBT 7,775,572 ----------- $48,258,712 false true false false false false false false false JAMES MELOTT 219372 34997 34682 46380 19062 354493 16000 JOHN HARVEY 243365 32824 36319 46380 21464 380352 16000 VIKI FORLANO HALFMANN 227135 31592 38851 46380 20314 364272 16000 HARVEY RUSSWURM 227126 40000 19330 30380 20977 337813 0 CORNELIUS CHINN 282490 33431 41304 46380 17893 421498 16000 MICHAEL WAGNON 287280 28035 29534 34998 17803 397650 14418 WILLIAM WHITEHEAD 374070 29925 44577 55580 21640 525792 23900 CHRIS COLE 875028 48603 119744 30380 27228 1100983 32800 JOLIE BAILEY 219765 128875 35998 50459 25215 460312 20400 ANTHONY DEMORY 508499 304283 50564 54506 26887 944739 24125 LAURA ADAMS 482161 29688 58485 54380 21531 646245 24000 JOE MIMS 464067 46939 38597 30380 27315 607298 0 SCOTT GIPSON 260623 95432 38364 50780 20898 466097 20400 CHARLES MARSH 481007 42500 74720 30380 19365 647972 0 LUIS DUARTE 2403764 76175 176458 76637 27512 2760546 46257 IRVIN ZEITLER 385672 58566 55205 6522 505965 21703 BRYAN HORNER 483959 84761 0 30380 17144 616244 0 TIMOTHY HARTIN 239298 38813 47501 12663 338275 15538 DOUG SCHULTZ 348679 27032 25938 30380 9595 441624 0 TIMOTHY HOPKINS 1271121 57820 117283 76637 11872 1534733 46257 KENNETH BREEDLOVE 878368 48603 68465 63180 23506 1082122 32800 MICHAEL SICKELS 858265 48603 84386 63180 26843 1081277 32800 VICTOR SCHULZE III 860403 48603 114160 30380 25757 1079303 32800 DAVID HUCHTON 911106 37500 84680 60380 25914 1119580 30000 JOHN GILBREATH 169275 30820 21743 36561 8798 267197 12730 GARY BOWEN 171300 31187 23308 40920 17638 284353 12896 JAMES BARNETT 353328 30000 35092 46380 25978 490778 16000 STEPHEN CAINELLI 388496 18996 48962 30380 19986 506820 0 ROSS CARMICHAEL 216650 31350 9355 1950 21456 280761 0 D'LAINE WESTMORELAND 113188 18000 17964 23548 8869 181569 0 CHARLES JONES 199220 22500 20089 29647 15441 286897 0 JOSEPH ZUBAK 431415 41512 27668 63591 20844 585030 0 GARY GIBIAN 264100 48064 29885 50514 30892 423455 19469 MARK MURPHY 184065 78748 18497 32500 9377 323187 0 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART 1, QUESTION 4 SERP DETAIL NAME AMOUNT BRYAN HORNER NONE NONQUALIFIED PLAN PARTICIPANTS NAME AMOUNT JAMES MELOTT $ 16,065 JOHN HARVEY $ 19,658 VIKI FORLANO HALFMANN $ 20,265 ROSS CARMICHAEL NONE HARVEY RUSSWURM NONE D'LAINE WESTMORELAND $ 12,159 CORNELIUS CHINN $ 20,265 MICHAEL WAGNON $ 16,379 WILLIAM WHITEHEAD $ 30,270 CHRIS COLE $ 38,332 JOLIE BAILEY $ 25,837 ANTHONY DEMORY $ 30,556 LAURA ADAMS $ 30,397 JOE MIMS $ NONE SCOTT GIPSON $ 26,421 CHARLES MARSH $ NONE LUIS DUARTE $ 52,266 MARK MURPHY $ NONE IRVIN ZEITLER $ 46,528 BRYAN HORNER $ NONE TIMOTHY HARTIN $ 17,121 DOUG SCHULTZ $ NONE TIMOTHY HOPKINS $ 60,319 KENNETH BREEDLOVE $ 38,130 MICHAEL SICKELS $ 37,551 VICTOR SCHULTZE III $ 32,748 DAVID HUCHTON $ 32,506 JAMES BARNETT $ 19,519 STEPHEN CAINELLI $ NONE CHARLES JONES $ NONE JOSEPH ZUBAK $ 26,130 GARY GIBIAN $ 21,905 JOHN GILBREATH $ 16,132 GARY BOWEN $ 14,695 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. 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 68314 SHANNON CLINIC EMPLOYEE false SCOTT WESTMORELAND D. WESTMORELAND'S SPOUSE 365327 SHANNON CLINIC EMPLOYEE false BRANDI WHITEHEAD W. WHITEHEAD'S SPOUSE 69232 SHANNON CLINIC EMPLOYEE false DENVER MARSH CHARLES MARSH'S BROTHER 493679 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 5 TRANSFER TO/FROM AFFILIATES 31,152,166 OTHER CHANGE (13) ------------ TOTAL 31,152,153 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:IRVIN ZEITLER TITLE:MEDICAL DIRECTOR HOURS:37 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRYAN HORNER TITLE:PRESIDENT HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIMOTHY HARTIN TITLE:SECRETARY/GENERAL COUNCIL HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GARY GIBIAN TITLE:SMM EXECUTIVE DIRECTOR HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN GILBREATH TITLE:CFO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GARY BOWEN TITLE:COO HOURS:40 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 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 true true true true true true true