Community Benefit Insight - Tax-exempt hospital

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Shannon Medical Center

Shannon Medical Center

120 East Harris Avenue
San Angelo, TX 76903

Bed count	441	Medicare provider number	450571	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 752559845

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

8.26%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 20,744,839 3.89 %
Medicaid as % of operating expenses	$ 0 0 %
Costs of other means-tested government programs as % of operating expenses	$ 140,402 0.03 %
Health professions education as % of operating expenses	$ 1,315,291 0.25 %
Subsidized health services as % of operating expenses	$ 20,744,839 3.89 %
Research as % of operating expenses	$ 290,994 0.05 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 753,510 0.14 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 71,971 0.01 %
Community building* as % of operating expenses	$ 151,463 0.03 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 151,463 0.03 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 148,866 98.29 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 2,597 1.71 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 75,691,453 14.19 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 435573616 including grants of $ 65000) (Revenue $ 615454479)
PROVIDING TOTAL MEDICAL CARE TO THE CITIZENS OF WEST TEXAS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SCHEDULE H, PART V, SECTION B, LINE 5
INPUT FROM COMMUNITY REPRESENTATIVES: COMMUNITY INPUT WAS PROVIDED THROUGH NINE KEY STAKEHOLDER INTERVIEWS WITH KEY INFORMANTS WHO REPRESENT A BROAD INTERESTS OF THE COMMUNITY, POPULATION OF NEED, PERSONS WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS. INDIVIDUALS THAT PARTICIPATED REPRESTENTED THE FOLLOWING ORGANIZATIONS AND AGENCIES: CITY OF SAN ANGELO MUNICIPAL GOVERNMENT, KEEPRS OF HOPE, LA ESPARANZA CLINIC, MHMR CONCHO VALLEY, REGION 15 EDUCATION SERVICES CENTER, SAN ANGELO DIABETES COALITION, SHANNON MEDICAL CENTER, TOM GREEN COUNTY INDIGENT HEALTH AND WEST TEXAS COUNSELING GUIDANCE.

SCHEDULE H, PART V, SECTION B, LINE 11
NEEDS ADDRESSED AND NOT ADDRESSED: The implementation strategy for fiscal years ending September 30, 2020 and September 30, 2022, focused on four identified health needs. Action plans and activities for each of the strategies are summarized below. Based on Shannon's evaluation for the fiscal year (FY) ending September 30, 2021, Shannon has either met their goals or is still in the process of meeting their goals for each strategy listed. Shannon continues to track activities and evaluate progress to reach Implementation Strategy goals through the end of FY 2022. THE BELOW CHNA ACTION PLAN INCLUDES DETAILS ON HOW SHANNON MEDICAL CENTER IS ADDRESSING SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA CONDUCTED IN 2019. THE NEEDS ARE CATEGORIZED IN THE FOLLOWING PRIORITY AREAS: IMPROVE ACCESS TO CARE, ADULT OBESITY, LACK OF HEALTH KNOWLEDGE/EDUCATION, LACK OF MENTAL HEALTH PROVIDERS, SHORTAGE OF PRIMARY CARE PHYSICIANS AND HEALTHY BEHAVIORS/LIFESTYLE. PRIORITY 1: IMPROVE ACCESS TO CARE (INCLUDING SHORTAGE OF PRIMARY CARE PHYSICIANS) SHANNON MEDICAL CENTER PLANS TO CONNECT PATIENTS WITH APPROPRIATE HEALTH SERVICES TO IMPROVE THE CONTINUUM OF CARE AND WILL IMPROVE COMMUNITY AWARENESS OF AVAILABLE HEALTH SERVICES, EDUCATION AND SUPPORT.IN FISCAL YEAR 2022, THE CARE COORDINATION PROGRAM EXPANDED SERVICES TO SERVE MORE PATIENTS WITH CHRONIC ILLNESSES AND COVID-19. 506 PATIENTS WERE PROVIDED TRANSPORTATION SERVICES AND 300 PATIENTS WERE PROVIDED WITH OTHER HEALTH CARE SUPPORT SERVICES. $59,828,033 WAS PAID IN CHARITY CARE AND $23,092,348 IN SUBSIDIZED HEALTH SERVICES. PRIORITY 2: HEALTHY BEHAVIORS/LIFESTYLE THE MEDICAL CENTER WILL PROVIDE OPPORTUNITIES TO PROMOTE HEALTHY LIVING IN THE COMMUNITY AND PARTICIPATE AT COMMUNITY OUTREACH EVENTS TO SUPPORT HEALTH LIFESTYLES. IN FISCAL YEAR 2022, SHANNON STAFF SERVED ON 8 COMMUNITY COALITIONS/BOARDS AND DEDICATED OVER 176 SERVICE HOURS TO COMMUNITY BUILDING EFFORTS. DONATIONS WERE GIVEN TO SUPPORT 12 COMMUNITY INITIATIVES THAT PROMOTE HEALTH EDUCATION AND PHYSICAL ACTIVITY. SHANNON ALSO PARTNERED WITH 15 ORGANIZATION TO OFFER HEALTH EDUCATION TO MORE THAN 74,457 COMMUNITY MEMBERS. PRIORITY 3: ADULT OBESITY THE MEDICAL CENTER WILL INCREASE PUBLIC AWARENESS OF THE IMPORTANCE OF HEALTH EATING, NUTRITION AND PHYSICAL ACTIVITY. IN FISCAL YEAR 2022, SHANNON PROVIDED HEALTH INFORMATION MATERIALS AND BROCHURES ABOUT HEALTH SERVICES AND RESOURCES AT 18 COMMUNITY EVENTS AND PARTICIPATED AT DIABETES EDUCATIONAL SEMINARS. PRIORITY 4: HEALTH EDUCATION/KNOWLEDGE THE MEDICAL CENTER WILL PROVIDE GREATER HEALTH EDUCATION TO CHILDREN, FAMILIES AND VULNERABLE POPULATIONS. THE CENTER PLANS TO IMPROVE COMMUNITY OUTREACH EFFORTS THAT WILL PROVIDE MORE HEALTH EDUCATION OPPORTUNITIES WITH LOCAL BUSINESSES. THE IMPLEMENTATION STRATEGY WILL ASSURE HEALTHCARE AND SOCIAL SERVICE PROVIDERS IN THE COMMUNITY HAVE THE MOST UP-TO-DATE KNOWLEDGE. IN FISCAL YEAR 2022, SHANNON PROVIDED THE HEALTHBEAT TV SEGMENTS THAT REACHED OVER 32,300 VIEWERS AND A HEALTHBEAT MAGAZINE THAT REACHED 30,000 COMMUNITY MEMBERS. THE HOSPITAL ALSO PARTNERED WITH 32 EMPLOYER GROUPS TO PROVIDE HEALTH EDUCATION TO WORKFORCE MEMBERS, AS WELL AS OTHER COMMUNITY ORGANIZATIONS TO DISTRIBUTE INFORMATION AND RESOURCES TO 74,457 COMMUNITY MEMBERS. SHANNON PARTNERED WITH 10 COLLEGES AND UNIVERSITIES TO OFFER EDUCATION TO 748 STUDENTS. IN ADDITION, SHANNON PROVIDED SUPPORT, RESOURCES AND TRAININGS TO 30 PARTNERS IN THE REGION. EXPLANATION OF NEEDS NOT ADDRESSED THERE ARE NEEDS THAT SHANNON WILL NOT ADDRESS IN THE CURRENT IMPLEMENTATION STRATEGY THAT ARE CLEARLY IMPORTANT TO IMPROVING THE HEALTH OF THE COMMUNITY. LACK OF MENTAL HEALTH PROVIDERS IS ONE NEED NOT SPECIFICALLY ADDRESSED IN THE ASSESSMENT. WHILE SHANNON IS NOT INCORPORATING STRATEGIES TO IMPROVE ACCESS TO MENTAL HEALTH PROVIDERS, THE COMMUNITY HAS SEEN IMPROVEMENT AND GROWTH IN THE ACCESSIBILITY OF MENTAL HEALTH PROVIDERS AND AVAILABLE MENTAL HEALTH SERVICES OVER RECENT YEARS. FURTHERMORE, SHANNON WILL CONTINUE TO EXPLORE POTENTIAL PARTNERSHIPS AND INTERNAL STRATEGIES TO FIND A WAY TO PROVIDE THESE ESSENTIAL HEALTH SERVICES TO OUR PATIENTS AND COMMUNITY.

SCHEDULE H, PART V, SECTION B, LINES 7A & 10A
CHNA & IMPLEMENTATION STRATEGY AVAILABLE ON HOSPITAL FACILITY'S WEBSITE: https://www.shannonhealth.com/about-us/community-health-needs-assessment/

SCHEDULE H, PART V, SECTION B LINE 16A, 16b & 16c
The Financial Assistance Policy, Application and Plain Language summary can be found at the following web address: https://www.shannonhealth.com/patients-and-visitors/financial-assistance/

Supplemental Information

Schedule H (Form 990) Part VI

SCHEDULE H, PART I, LINE 3C
METHOD TO DETERMINE ASSISTANCE ELIGIBILITY: SHANNON MEDICAL CENTER ALSO USES INSURANCE STATUS AND UNDERINSURANCE STATUS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE.

SCHEDULE H, PART III, SECTION A, LINE 2 & 3
Bad Debt METHODOLOGY LINE 2: AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE ORGANIZATION'S INTERNAL FINANCIALS. LINE 3: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT FOOTNOTE: SEE PAGE 17 OF THE ATTACHED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, SECTION B, LINE 8
COSTING METHODOLOGY: THE COST REPORT USES COST TO CHARGE RATIOS FOR ANCILLARY DEPARTMENTS, PLUS IN THE ROOM AND BOARD AREAS IT IS A PER DIEM.

SCHEDULE H, PART III, SECTION C, LINE 9B
WRITTEN DEBT COLLECTION POLICY CHARITY CARE AND DISCOUNTING FOR UNINSURED PATIENTS WHO ARE NOT ELIGIBLE FOR GOVERNMENT HEALTH CARE PROGRAMS AND WHOSE FINANCIAL CONDITION IS SUCH THAT THEY ARE NOT ABLE TO PAY FOR HOSPITAL SERVICES MAY BE ELIGIBLE FOR ASSISTANCE UNDER THE SHANNON MEDICAL CENTER CHARITY CARE PROGRAM. PATIENTS WHO ARE UNINSURED, DO NOT QUALIFY FOR COVERAGE UNDER GOVERNMENT HEALTH CARE PROGRAMS, MAY BE ELIGIBLE FOR A 50% DISCOUNT OFF THE TOTAL BILL FOR HOSPITAL SERVICES, IF THE SERVICES ARE PAID FOR WHEN RECEIVED OR WITHIN 30 DAYS OF DISCHARGE. COLLECTION OF ACCOUNTS RECEIVABLE PATIENTS / GUARANTOR WILL BE RESPONSIBLE FOR PAYMENT OF SERVICES RECEIVED AT SHANNON MEDICAL CENTER. PATIENTS / GUARANTORS WILL BE RESPONSIBLE FOR FULL CHARGES, OR PATIENT PORTION NOT COVERED BY INSURANCE. PAYMENT WILL BE REQUESTED PRIOR TO OR ON THE DATE OF SCHEDULED ELECTIVE SERVICES. FULL CHARGES OR PATIENT PORTION NOT COVERED BY INSURANCE FOR URGENT / EMERGENT SERVICES WILL BE COLLECTED UPON DISCHARGE. PATIENTS WHO ARE UNABLE TO PAY THE FULL AMOUNT OF THEIR RESPONSIBILITY AT THE TIME OF SERVICE CAN MAKE PAYMENT ARRANGEMENTS UNDER THE FOLLOWING GUIDELINES: A. BALANCE OF OUTPATIENT SERVICES MUST BE PAID WITHIN SIX (6) MONTHS FROM THE DATE OF SERVICE UNLESS INDIGENT STATUS IS PROVEN B. BALANCE OF INPATIENT SERVICES MUST BE PAID WITHIN TWELVE (12) MONTHS FROM THE DATE OF DISCHARGE UNLESS INDIGENT STATUS IS PROVEN. MONTHLY STATEMENTS WILL BE SENT THROUGHOUT THE COLLECTION CYCLE. COLLECTION LETTERS WILL BE UTILIZED AT THE DISCRETION OF THE PATIENT ACCOUNT REPRESENTATIVE. ACCOUNTS WILL BE REVIEWED FOR OUTSIDE COLLECTION AGENCY PLACEMENT ANYTIME FOLLOWING 90 DAYS FROM THE DATE OF SERVICE. MEDICARE ACCOUNTS WILL NOT BE CONSIDERED FOR PLACEMENT UNTIL 120 DAYS FROM THE FIRST NOTICE OF PATIENT RESPONSIBILITY IN ACCORDANCE WITH MEDICARE REGULATIONS. ANY OVERPAYMENT OF AN ACCOUNT WILL BE REVIEWED FOR REFUND WITHIN 30 DAYS FROM THE DATE THE CREDIT BALANCE IS CREATED BY THE OVERPAYMENT. CREDIT BALANCES ON MEDICARE ACCOUNTS WILL BE PROCESSED THROUGH THE NORMAL CREDIT BALANCE PROCESS AND REPORTED ON A QUARTERLY BASIS IN COMPLIANCE WITH MEDICARE REGULATIONS.

SCHEDULE H, PART VI, LINE 2
THE CHNA PROCESS INVOLVED: AN EVALUATION OF THE IMPLEMENTATION STRATEGY FOR NEEDS ASSESSMENT COMPLETED IN 2021, WHICH WAS ADOPTED BY SHANNON BOARD OF DIRECTORS. COLLECTION AND ANALYSIS OF A LARGE RANGE OF DATA, INCLUDING DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH STATISTICS, AND HEALTH CARE RESOURCES. INTERVIEWS WITH KEY INFORMANTS WHO REPRESENT A) BROAD INTERESTS OF THE COMMUNITY, B) POPULATION OF NEED, OR C) PERSON WHITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. NINE KEY STAKEHOLDERS PARTICIPATED IN STAKEHOLDER INTERVIEWS. THE COMMUNITY SERVED BY SHANNON WAS DEFINED BY UTILIZING INPATIENT AND OUTPATIENT DATA. POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED USING THIRD PARTIES. THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY COUNTY HEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE: FINANCIAL ASSISTANCE BROCHURES THAT OUTLINE ACCESS TO INFORMATION ABOUT ASSISTANCE PROGRAMS ARE AVAILABLE IN EACH OF THE REGISTRATION AREAS. WE ALSO HAVE CONTRACTED ELIGIBILITY WORKERS WHO SCREEN PATIENTS FOR ALL SOCIAL SERVICE PROGRAMS AND ASSIST WITH THE APPLICATION PROCESS IF NEEDED.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: SHANNON MEDICAL CENTER IS LOCATED IN SAN ANGELO, TEXAS. THE CITY OF SAN ANGELO SERVES AS THE COUNTY SEAT AND POPULATION CENTER OF TOM GREEN COUNTY, WITH AN ESTIMATED POPULATION IN 2022 OF 118,892. TOM GREEN COUNTY'S POPULATION IN 2021 OF 119,250. THE ESTIMATED POPULATION FOR SHANNON'S SERVICE AREA AS OF 2022, INCLUDING TOM GREEN COUNTY, IS 347,713 (U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS). THE COUNTIES INCLUDED IN THE SHANNON SERVICE AREA ARE BROWN, COKE, CONCHO, COLEMAN, CROCKETT, HOWARD, IRION, KIMBLE, MASON, MCCULLOCH, MENARD, MILLS, MITCHELL, NOLAN, PECOS, REAGAN, RUNNELS, SAN SABA, SCHLEICHER, STERLING, SUTTON, TERRELL, TOM GREEN, UPTON, AND VAL VERDE. A BREAKDOWN OF TOM GREEN COUNTY DEMOGRAPHICS IS AS FOLLOWS. (SOURCE: U.S. CENSUS BUREAU, STATE AND COUNTY QUICKFACTS, THE COUNTY INFORMATION PROJECT, TEXAS ASSOCIATION OF COUNTIES.) TOM GREEN COUNTY AGE DISTRIBUTION 1. UNDER 18 YEARS OLD - 23.9% (28,415) 2. 18-64 YEARS OLD - 60.0% (71,335) 3. 65 YEARS AND OLDER - 16.1% (19,142) TOM GREEN COUNTY ETHNIC DISTRIBUTION (MORE THAN ONE CATEGORY MAY BE SELF-REPORTED) 1. CAUCASIAN - 51.1% (60,754) 2. HISPANIC - 42.0% (49,935) 3. BLACK - 4.5% (5,350) 4. OTHER - 2.4% (2,853) TOM GREEN COUNTY (HOUSEHOLD) 1. MEDIAN HOUSEHOLD INCOME - $62,052 (TEXAS: $67,321, US: $69,021) 2. PERSONS LIVING IN POVERTY LEVEL - 13.2% (TEXAS: 14.2%, US: 11.6%) TOM GREEN COUNTY HEALTH INDEX 1. TOM GREEN COUNTY UNINSURED - 17.5% (TEXAS: 20.4%, US: 9.8%)

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS

SCHEDULE H, PART I, LINE 7, COLUMN F
"COMMUNITY BENEFIT EXPENSE: Bad debt expense of $75,691,453 was included on form 990, part ix, line 25, column (A), but was subtracted from total expense for the calculation of ""percent of total expense"" in this column."

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. COST COMPUTED ON IRS WORKSHEETS 4, 5 & 7 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT PROCESS. Worksheet 8 was completed using the organization internal accounting system.

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES: Shannon actively participates in various community-based boards. Shannon contributes planning and financial assistance to community building efforts as part of its annual marketing budget. This past fiscal year, Shannon donated to other community organizations including San Angelo Independent School District, Angelo State University Foundation, San Angelo Stock Show and Rodeo, West Texas Rehabilitation Center, YMCA of San Angelo, Laura Bush Institute for Women's Health, and many others. Shannon actively participates in various community coalitions and other collaborative efforts with the community to address health and safety issues.

SCHEDULE H, PART VI, LINE 5
"PROMOTION OF COMMUNITY HEALTH: IN A COUNTY WITH NO HOSPITAL TAXING AUTHORITY, A HOSPITAL WHOSE MISSION REFLECTS COMMITMENT TO TREATING PATIENTS WITHOUT REGARD TO ABILITY TO PAY IS A HIGHLY DESIRABLE AND PIVOTAL POINT OF COMMUNITY HEALTH CARE. FOR MORE THAN 88 YEARS, SHANNON HAS EMBRACED SUCH A MISSION AND FOLLOWS THROUGH ON THE WISHES OF OUR BENEFACTOR, MARGARET SHANNON, IN PROVIDING CARE FOR THE PEOPLE OF WEST TEXAS. OUR CHARITY CARE FIGURE OF MORE THAN $59,828,033 WOULD BE A BURDEN TO THE TAXPAYERS OF TOM GREEN COUNTY, AND MANY OTHER COUNTIES WHOSE CITIZENS DIRECTLY BENEFIT FROM HER GENEROSITY. THE SHANNON CARE COORDINATION PROGRAM IS DESIGNED TO ASSIST IN THE HEALTHCARE OF CHRONICALLY ILL PATIENTS WITH MULTIPLE DISEASE PROCESSES. THE PROGRAM MANAGES HIGH-RISK PATIENTS WITH MULTIPLE DISEASE PROCESSES, ADDRESSES SOCIAL AND HEALTHCARE BARRIERS, AND SUPPORTS PATIENTS' GOALS OF INDEPENDENCE IN THEIR HEALTH CARE MANAGEMENT. THE SHANNON CARE COORDINATION PROGRAM WAS DEVELOPED AS A PATIENT-CENTRIC STRATEGY TO IMPACT PATIENT CARE BEYOND THE FOUR WALLS OF THE HOSPITAL. THE SHANNON CARE COORDINATION PROGRAM IS DESIGNED TO IMPROVE PATIENT OUTCOMES BY UTILIZING A TEAM TO FOCUS ON POPULATION HEALTH EFFORTS AS IT RELATES TO CHRONIC DISEASE. THE PROGRAM'S STRUCTURE AND ABILITY TO UTILIZE A TEAM TO FOCUS ON POPULATION HEALTH EFFORTS AS IT RELATES TO CHRONIC DISEASE HAS PROVIDED SHANNON HEALTH THE OPPORTUNITY TO IDENTIFY POSSIBLE AREAS FOR PATIENT CARE-ALL IN SERVICE OF PROVIDING CARE TO PATIENTS IN THE COMMUNITY. THE PROGRAM SERVES PATIENTS DISCHARGING FROM THE HOSPITAL WITH CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, AS WELL AS PATIENTS AT HIGH-RISK FOR READMISSION, WHICH INCLUDES COVID-19 PATIENTS. KEY AREAS OF THE PROGRAM INCLUDE: MEDICATION MANAGEMENT, ADDRESSING SOCIAL BARRIERS, AND HELPING THE PATIENT MANAGE THEIR CHRONIC CONDITION AT HOME. SHANNON PROVIDED $485,716 FOR THE OPERATION OF THIS PROGRAM. SHANNON PROVIDED ACCESS AND SUPPORT SERVICES FOR INDIGENT PATIENTS, INCLUDING $15,052 IN TRANSPORTATION VOUCHERS AND $10,836 FOR DURABLE MEDICAL EQUIPMENT, OUTPATIENT OXYGEN, OUTPATIENT PRESCRIPTION ASSISTANCE, AND MOTEL EXPENSES FOR COVID-19 POSITIVE PATIENTS DISCHARGED FROM THE HOSPITAL. SHANNON PROVIDES A HOST OF COMMUNITY EDUCATION EVENTS RELATED TO TOPICS SUCH AS DIABETES MANAGEMENT AND PREVENTION, SUMMER SAFETY FOR CHILDREN, FITNESS AND NUTRITION, CHILDBIRTH AND CHILDCARE, STRESS MANAGEMENT, CANCER PREVENTION AND MANAGEMENT, AND ALZHEIMER'S. THROUGH EDUCATIONAL EVENTS AND VARIOUS COMMUNITY EVENTS, HEALTH PROFESSIONALS RELAY CURRENT HEALTH INFORMATION TO THE PUBLIC. REPRESENTATIVES FROM DIFFERENT DEPARTMENTS PROVIDE SUPPORT AND PARTICIPATE IN LOCAL HEALTH FAIRS AND HEALTH-RELATED COMMUNITY EVENTS WHERE THEY PROVIDE EDUCATIONAL MATERIAL. IN ADDITION TO PUBLIC OUTREACH EVENTS, SHANNON PUBLISHES THE HEALTHBEAT NEWSLETTER MAGAZINE WHICH IS DELIVERED TO 30,000 HOUSEHOLDS AND PRODUCES HEALTHBEAT TELEVISION SPOTS THAT AIR DURING THE 6 AND 10 P.M. NEWS HOURS ON TWO LOCAL STATIONS. SHANNON CONTRIBUTED $163,307 FOR THESE PROGRAMS. SHANNON DONATED FUNDS TO SOCIAL SERVICES AND COMMUNITY-BASED EFFORTS, SUCH AS HOSTING VITALANT BLOOD DRIVES. THIS SUPPORT IS PROVIDED AT A COST OF $6,971. SHANNON CONTRIBUTES PLANNING AND FINANCIAL ASSISTANCE TO COMMUNITY BUILDING EFFORTS. THIS PAST FISCAL YEAR, $144,473 WAS DONATED TO OTHER COMMUNITY ORGANIZATIONS INCLUDING SAN ANGELO INDEPENDENT SCHOOL DISTRICT, ANGELO STATE UNIVERSITY FOUNDATION, SAN ANGELO STOCK SHOW AND RODEO, WEST TEXAS REHABILITATION CENTER, YMCA OF SAN ANGELO, LAURA BUSH INSTITUTE FOR WOMEN'S HEALTH, AND MANY OTHERS. SHANNON HAS RECOGNIZED A COMMUNITY NEED TO OFFER SUPPORTIVE SERVICES TO PARENTS AND FAMILIES SUFFERING FROM EARLY PREGNANCY LOSS, STILLBIRTH, OR NEWBORN DEATH. THE WHITE ROSE SUPPORT GROUP AT SHANNON HOSTS A 5-PART SESSION CALLED ""GRIEVING THE CHILD I NEVER KNEW"" TO OFFER INSIGHT, ENCOURAGEMENT, HEALING, HOPE, AND SHARING FOR FAMILIES EXPERIENCING PERINATAL LOSS. FURTHERMORE, THE WHITE ROSE SUPPORT GROUP HOSTS A WALK TO REMEMBER AND CANDLELIGHT EVENT FOR THOSE WHO HAVE SUFFERED. THESE EVENTS ARE PROVIDED AT A COST OF $25,094 TO SHANNON. SHANNON PARTNERS WITH THE AMERICAN HEART ASSOCIATION TO EDUCATE, RAISE AWARENESS AND PREVENT HEART DISEASE AND STROKE. SHANNON UNDERSTANDS THAT CONTINUED EDUCATION AND AWARENESS IS CRUCIAL FOR WOMEN AND MEN TO FIGHT THIS DEADLY DISEASE. THIS SPONSORSHIP IS PROVIDED AT A COST OF $10,000 TO SHANNON. SHANNON IS THE ONLY PROVIDER THAT OPERATES THE SEXUAL ASSAULT NURSE EXAMINER PROGRAM (SANE) IN THE SHANNON SERVICE ARE. SANE TRAINED NURSES WORK WITH THE CHILDREN'S ADVOCACY CENTER, THE CONCHO VALLEY RAPE CRISIS CENTER AND OTHER COMMUNITY-BASED ORGANIZATIONS TO PROVIDE TRAINING AND SERVICES RELATED TO SEXUAL ASSAULT CRISES."

SCHEDULE H, PART VI, LINE 6
Affiliated health care system: SHANNON, A NON-PROFIT HEALTH SYSTEM ESTABLISHED IN THE 1930'S. SHANNON MEDICAL CENTER IS PROUD TO BE THE LARGEST, LOCALLY-BASED HEALTH CARE PROVIDER FOR THE CONCHO VALLEY AND SURROUNDING REGION IN WEST TEXAS. FOR MORE THAN 87 YEARS, THE SHANNON MISSION HAS FOCUSED ON PROVIDING EXCEPTIONAL HEALTHCARE FOR ITS FAMILY, FRIENDS AND NEIGHBORS. SHANNON SERVES A 25-COUNTY REGION AND PROVIDES ACCESS TO MORE THAN 350 PROVIDERS IN 40 MEDICAL SPECIALTIES ACROSS 25 LOCATIONS. SHANNON'S SERVICES INCLUDE: - NATIONALLY-RECOGNIZED CARDIAC AND STROKE PROGRAMS - AIRMED1 ROTOR AND FIXED WING AIR AMBULANCE SERVICE - LEVEL III TRAUMA FACILITY WHICH HAS BEEN NAMED TOP TRAUMA FACILITY IN THE STATE - BLUE CROSS BLUE SHIELD DESIGNATED BARIATRIC SURGERY PROGRAM - DESIGNATED ORTHOPEDIC CENTER OF EXCELLENCE - DEDICATED WOMEN'S & CHILDREN'S HOSPITAL

Operating expenses	$ 533,474,194
Total amount spent on community benefits as % of operating expenses	$ 44,061,846 8.26 %