2024-08-15T12:59:25-05:00 2023-09-30 Forvis Mazars LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 752542961 990 2022-10-01 208367966 Shannon Medical Management % JULIAN BESERIL SHAN 3256581511 PO Box 22000 San Angelo TX 76902 JULIAN BESERIL CFO 3256581511 2024-08-15 true NOELLE ALBERTO P01704142 9727028262 2022 2024-08-08 14:25:15Z KELLY SHANE PLYMELL PO Box 22000 San Angelo TX 76902 99755144 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 1576 10 0 0 46083 51700 89479870 99700200 0 0 0 3244 89525953 99755144 0 0 0 0 61747601 71022441 0 0 0 23842172 24259868 85589773 95282309 3936180 4472835 266567 602115 5096224 5779385 -4829657 -5177270 TO PROVIDE SUPPORT SERVICES FOR SHANNON MEDICAL CENTER IN SUPPORT OF ITS MISSION TO BE THE PREMIERE HEALTH CARE PROVIDER OF PHYSICIAN SERVICES IN THE COMMUNITIES SERVED. false false 77046783 99703444 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. 77046783 true true false false false false false false false false false 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 1576 true false false false false false false false false false false false false X 3 1 false false false false true true true true true false false true true true true true true false true false X JULIAN BESERIL 3256581511 120 E BEAUREGARD SAN ANGELO TX 76903 X KELLY SHANE PLYMELL PRESIDENT 5.0 35.0 X X 0 1069858 114243 RICARDO VILLAREAL COO/SECRETARY/TREASURER 35.0 5.0 X X 470483 0 65179 JULIAN BESERIL CFO 35.0 5.0 X 350987 0 47610 ANNA PITTMAN CHIEF NURSING OFFICER 40.0 0.0 X 245743 0 47771 STACI WETZ FORMER CFO/CONTROLLER 1.0 39.0 X 0 165100 23814 MARK DUNCAN SPORTS MEDICINE DIRECTOR 40.0 0.0 X 165646 0 17375 SHERYL MOON DIRECTOR OF BUSINESS OFFICE 40.0 0.0 X 146795 0 14518 JULIE MEYER ADMINISTRATIVE DIRECTOR 40.0 0.0 X 150373 0 5671 Roman Rodriguez Director of Oncology 40.0 0.0 X 121159 0 17786 JOSHUA BUTTS Director of Operations 40.0 0.0 X 115144 0 19227 LEN MERTZ CHAIRMAN 1.0 39.0 X X 0 15194 0 1766330 1250152 373194 21 true true false CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 CLEANING SERVICES 275322 Executive Courier LLC 2917 SIERRA CIR SAN ANGELO TX 76904 COURIER SERVICES 180007 SBG HEALTHCARE LLC 7665 Davie Rd Extension Suite 201 HOLLYWOOD FL 33024 STAFFING SERVICES 688574 CHANGE HEALTHCARE TECHNOLOGIES PO BOX 98347 CHICAGO IL 60693 CLAIMS SERVICES 300159 TEXAS HEALTHCARE LINEN LLC 1349 North Arnold Blvd ABILENE TX 79603 LAUNDRY SERVICES 267463 5 51700 51700 Lease Income 532000 1200 1200 Management Fees 900099 99699000 99699000 99700200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER OPERATING REVENUE 900099 3244 3244 3244 99755144 99703444 0 0 0 0 1227774 1227774 0 54150805 48198449 5952356 1431834 1139500 292334 10244995 8923767 1321228 3967033 3304799 662234 0 0 13859 13859 0 0 0 3469964 2755860 714104 215597 215597 917469 235194 682275 2806379 96756 2709623 0 11896269 10467519 1428750 180601 141868 38733 0 21110 17444 3666 0 0 784843 325624 459219 65322 65322 Equipment 2559269 130343 2428926 Collection Fees 427552 427552 Patient Surveys 463458 382969 80489 EDUCATION 89071 14847 74224 349105 268695 80410 95282309 77046783 18235526 0 74083 609586 0 0 0 0 12253 94349 0 0 0 0 0 0 0 0 155759 282486 11201602 12024962 -296881 -823360 0 0 0 0 0 0 0 0 321353 439054 266567 602115 3859695 3976364 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1236529 1803021 5096224 5779385 X -4829657 -5177270 0 0 -4829657 -5177270 266567 602115 X 4472835 -4820448 X X false true X true false X X X 2 SHANNON CLINIC 752600873 10 false 95282309 0 SHANNON MEDICAL CENTER 752559845 3 true 0 0 2 95282309 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 RECEIVED CLASSIFICATION 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11201602 12024962 -823360 -823360 Pension Fund 438113 Due from CHS 941 439054 0 Pension Plan Liability 531271 Health Claims Payable 1271750 1803021 99755144 99755144 99755144 95282309 95282309 95282309 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 RICARDO VILLAREAL COO/SECRETARY/TREASURER 329026 67402 74055 37772 27407 535662 53275 ANNA PITTMAN CHIEF NURSING OFFICER 185962 34886 24895 20345 27426 293514 20491 MARK DUNCAN SPORTS MEDICINE DIRECTOR 154081 10131 1434 4741 12634 183021 0 JULIAN BESERIL CFO 248153 50253 52581 29012 18598 398597 38873 SHERYL MOON DIRECTOR OF BUSINESS OFFICE 133443 12142 1210 5385 9133 161313 0 KELLY SHANE PLYMELL PRESIDENT 764365 217956 87537 96004 18239 1184101 87537 STACI WETZ FORMER CFO/CONTROLLER 153100 12000 0 6362 17452 188914 0 JULIE MEYER ADMINISTRATIVE DIRECTOR 139862 10318 193 5543 128 156044 0 SCHEDULE J, PART I, LINE 3 MANAGEMENT COMPENSATION: THE COMPENSATION OF THE CEO IS DETERMINED AND PAID OUT OF THE RELATED ORGANIZATION, SHANNON MEDICAL CENTER, USING THE FOLLOWING METHODS: - COMPENSATION SURVEY OR STUDY - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE 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 $87,537 $83,805 SMC RICARDO VILLAREAL $42,275 $25,572 SMM JULIAN BESERIL $38,873 $19,094 SMM ANNA PITTMAN $20,491 $13,240 SMM FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: SHANNON HEALTH SYSTEM IS THE SOLE MEMBER OF SHANNON MEDICAL MANAGEMENT. FORM 990, PART VI, SECTION A, LINE 7A & 7B POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY: 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. THE MEMBER ALSO HAS THE POWER TO APPROVE THE ANNUAL BUDGETS, APPROVE THE PURCHASE, SALE OR MORTGAGE OF PROPERTY, UNDERTAKE MERGERS OR ACQUISITIONS AND APPROVE THE ALTERATION OF THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: 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. COPIES OF THE FORM ARE PROVIDED TO THE FINANCE COMMITTEE AND BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED 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, LINES 15A & 15B COMPENSATION REVIEW PROCESS: 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. SHANNON MEDICAL CENTER FINANCE AND BOARD OF TRUSTEES COMPLETED THE REVIEW IN 2022. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: 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 SHANNON CLINIC (86,541,525) TRANSFER FROM SHANNON MEDICAL CENTER 73,829,910 TRANSFER FROM SHANNON REAL ESTATE SERVICES 7,706,801 TRANSFER FROM SHANNON BUSINESS SERVICES 184,366 ------------------ (4,820,448) FORM 990, PART XII, LINE 2C OVERSIGHT OF THE AUDIT: 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 Box 3 of Form 1096: 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. 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 false 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 R 86541525 BOOK VALUE SHANNON REAL ESTATE SERVICES S 7706801 BOOK VALUE SHANNON MEDICAL CENTER S 73829910 BOOK VALUE SHANNON BUSINESS SERVICES S 184366 BOOK VALUE SHANNON CLINIC L 99699000 BOOK VALUE