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 208367966 SHANNON MEDICAL MANAGEMENT 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 32447938 false X N/A 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. 5 1 756 0 0 0 122 0 29873369 32445389 8022 2025 3399 524 29884912 32447938 0 0 0 0 20164687 22178737 0 0 0 8275515 8823250 28440202 31001987 1444710 1445951 1195161 630535 1539516 1904877 -344355 -1274342 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 25866553 32445913 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. 25866553 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 false false false false false false false true false false false true 0 0 756 true false false false false false false false false false false false 5 1 false false false false true true false true true false false false true true true true true true true false X SHANNON MED MGMT ATTN 3256581511 ADMINISTRATION 120 E BEAUREGARD SAN ANGELO TX 76903 GARY GIBIAN 40.0 X X 270721 0 65252 JOHN GILBREATH 40.0 X X 165336 0 38339 LEN MERTZ 1.0 X X 0 122800 6872 BRYAN HORNER 5.0 X X 0 457484 69698 KELLY SHANE PLYMELL 5.0 X X 0 240136 42859 GARY BOWEN 40.0 X 163549 0 41150 599606 820420 264170 3 false true false ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60763 STATEMENT PROCESSING 275833 PER-SE TECHNOLOGIES PO BOX 403421 ATLANTA GA 30384 OUTSIDE BILLING 500504 STAT TRANSCRIPTION 6475 CAMDEN AVE 101 SAN JOSE CA 95120 TRANSCRIPTION SVC 353624 MEDI-COMM SVC LUBBOCK 5139 69TH ST LUBBOCK TX 79424 COLLECTION SERVICES 246314 4 0 MEDICAL RECORDS INCOME 900099 65754 65754 LEASE INCOME 531390 6308 6308 MANAGEMENT FEES 900099 32373327 32373327 32445389 2025 2025 0 0 0 0 0 0 MISCELLANEOUS INCOME 900099 524 524 524 32447938 32445913 2025 0 0 0 0 744346 744346 0 16542234 15287754 1254480 916697 819818 96879 2744898 2382109 362789 1230562 1096907 133655 0 4165 4165 20500 20500 0 0 0 1840602 1674908 165694 575 21 554 852243 155489 696754 1190633 32579 1158054 0 3757534 3745647 11887 73272 30444 42828 0 0 0 0 286763 127734 159029 14758 14758 EQUIPMENT COSTS 447123 214187 232936 COLLECTION FEES 256113 256113 EDUCATION 30229 22320 7909 RECRUITING 15470 13023 2447 MEDICAL SUPPLIES 15912 6174 9738 17358 1326 16032 31001987 25866553 5135434 0 -18445 -17914 436287 0 65239 52398 4170912 3646829 639920 524083 72160 71968 1195161 630535 1161692 1519071 377824 385806 1539516 1904877 X -344355 -1274342 -344355 -1274342 1195161 630535 X false true true X false X 0 122 0 122 26735623 29873369 32445389 89054381 26735623 29873491 32445389 89054503 26405175 29509560 32048848 87963583 26405175 29509560 32048848 87963583 1090920 51120 8022 2025 61167 51120 8022 2025 61167 4998 3399 524 8921 26791741 29884912 32447938 89124591 X 4170912 3646829 524083 524083 PENSION FUND 71968 71968 0 PENSION PLAN LIABILITY 83272 HEALTH CLAIM PAYABLE 302534 385806 32447938 31001987 1445951 1445951 32447938 32447938 32447938 31002034 47 47 31001987 31001987 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 XIII, Line 2d OTHER $47 X X X X false true false false false false false false false GARY GIBIAN 242674 0 0 0 28047 0 47839 0 17413 0 335973 0 JOHN GILBREATH 159725 0 0 0 5611 0 27206 0 11133 0 203675 0 BRYAN HORNER 0 457484 0 0 0 0 0 30380 0 39318 0 527182 KELLY SHANE PLYMELL 0 225252 0 0 0 14884 0 28210 0 14649 0 282995 GARY BOWEN 161569 0 0 0 1980 0 29350 0 11799 0 204698 0 NAMES, AMOUNTS, AND DETAILS OF ARRANGEMENTS PART 1, QUESTION 4 NONQUALIFIED PLAN PARTICIPANTS NAME AMOUNT BRYAN HORNER NONE GARY GIBIAN $19,469 JOHN GILBREATH $12,730 GARY BOWEN $12,896 FOR EXECUTIVES & OFFICERS - PARTICIPANTS IN THE 457F RETIREMENT ALLOWANCE PLAN ARE EMPLOYEES 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. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 SHANNON HEALTH SYSTEM IS THE SOLE MEMBER OF SHANNON MEDICAL MANAGEMENT. 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 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. 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 BOARD 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 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. REVIEW OF COMPENSATION FORM 990, PART VI, QUESTION 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. EXPLANATION OF COMMITTEE THAT ASSUMES RESPONSIBILITY FORM 990, PART XI, QUESTION 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. NUMBER OF 1099'S FORM 990, PART V, QUESTION 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. RELATED COMPENSATION HOURS WORKED FORM 990, PART VII AVG HOURS WORKED FOR RELATED ORG LEN MERTZ 22 BRYAN HORNER 39 KELLY SHANE PLYMELL 34 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. 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 CLINIC 120 E HARRIS AVE SAN ANGELO TX 76903 752600873 HEALTHCARE TX 501(C)(3) 9 NA SHANNON BUSINESS SERVICES INC 120 E HARRIS AVE SAN ANGELO TX 76903 432038769 SUPPORT SVCS TX 501(C)(3) 11B NA SHANNON MEDICAL CENTER 120 E HARRIS AVE SAN ANGELO TX 76903 752559845 SUPPORT SVCS TX 501(C)(3) 3 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 MED INSURANCE TX NA C-CORPORATION 0 0 0.00000 LEGACY MANAGEMENT SERVICES 2018 PULLIAM ST SAN ANGELO TX 76903 752544450 UTILIZ. 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