2013-08-01T14:08:34-05:00 2012-12-31 910189318 MOSS ADAMS LLP 6100 UPTOWN BLVD NE STE 400 ALBUQUERQUE NM 87110 990 2012-01-01 201358178 TRICORE LABORATORY SERVICES CORP TRIC 5059388888 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 MICHAEL J CROSSEY MD 5059388888 2013-07-31 1 ANTHONY W ROYLE P00627895 5058787200 2012 2016-02-24 21:20:13Z MICHAEL J CROSSEY MD 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 74386402 0 X WWW.TRICORE.ORG X 2004 NM THE ORGANIZATION WAS ORGANIZED AND IS OPERATED AS A COOPERATIVE HOSPITAL SERVICE ORGANIZATION. 8 7 0 8 0 0 7542 10225 71927365 74376177 -80842 -92158 0 0 71854065 74294244 0 0 0 0 36869322 38663404 0 0 0 33447539 35630840 70316861 74294244 1537204 0 15023000 15047175 1277604 1301779 13745396 13745396 THE ORGANIZATION PERFORMS LABORATORY SERVICES EXCLUSIVELY FOR ITS MEMBERS, EACH OF WHOM IS A HOSPITAL DESCRIBED IN SECTION 501(E)(1)(B) OF THE INTERNAL REVENUE CODE, AND FOR NO ONE ELSE. 0 0 61359268 74376177 THE ORGANIZATION PERFORMS LABORATORY SERVICES EXCLUSIVELY FOR ITS MEMBERS, EACH OF WHOM IS A HOSPITAL DESCRIBED IN SECTION 501(E)(1)(B) OF THE INTERNAL REVENUE CODE, AND FOR NO ONE ELSE. 61359268 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X RENEE ENNIS 5059388914 1001 WOODWARD PL NE ALBUQUERQUE NM 87102 ROBERT GARCIA 1.00 1.00 X 0 0 0 PAUL BRIGGS 1.00 1.00 X 0 0 0 ROBIN DIVINE 1.00 1.00 X 0 0 0 ERIN DOLES 1.00 1.00 X 0 0 0 ANDREW HORVATH MD 1.00 1.00 X 0 0 0 RICHARD LARSON MD PHD 1.00 1.00 X 0 0 0 STEVE MCKERNAN 1.00 1.00 X 0 0 0 THOMAS WILLIAMS MD 1.00 1.00 X 0 0 0 CATHY-ANNE PETTI 19.00 21.00 X 0 395778 3167 JESSIE L SALK 19.00 21.00 X 0 376032 16199 DOROTHY R ENNIS 19.00 21.00 X 0 263016 19102 DAVID H JENKINS 19.00 21.00 X 0 127370 4872 CHERRI L COLLINS 19.00 21.00 X 0 161837 14938 NORMAN A STITELER 19.00 21.00 X 0 155831 8352 MARIT J PETERS 19.00 21.00 X 0 139410 6896 ERIC K CARBONNEAU 19.00 21.00 X 0 129961 14568 MARCIA WOOLLEY 19.00 21.00 X 0 127453 9576 MICHAEL H KNELLINGER 0.00 0.00 X 0 168326 1567 0 2045014 99237 0 1 1 0 UNM MEDICAL GROUP INC PO BOX 27200 ALBUQUERQUE NM 87125 PATHOLOGY CONSULT 1520949 PATHOLOGY ASSOCIATES OF ALBUQUERQUE 1100 CENTRAL AVE SE ALBUQUERQUE NM 87106 PATHOLOGY CONSULT 1246290 MEDTREK 2709 VASSAR PLACE NE SUTE C ALBUQUERQUE NM 87107 FREIGHT SERVICE 218787 AUREUS RADIOLOGY LLC 13609 CALIFORNIA ST STE 200 OMAHA NE 68154 CONTRACT LABOR 157806 4 10225 10225 10225 SALES, NET OF DISCOUNT 621500 74376177 74376177 74376177 92158 -92158 -92158 -92158 74294244 74376177 0 -92158 X 578657 578657 28856763 23318207 5538556 854951 674357 180594 5496214 4280269 1215945 2876819 2307519 569300 74182 1663 72519 191296 191296 8874709 7979832 894877 1234 870 364 1086777 429464 657313 1799952 1455308 344644 1013788 333117 680671 257623 76197 181426 451802 451802 2920514 1927293 993221 141568 141568 SUPPLIES 16296197 16296197 EQUIPMENT EXPENSES 2097443 2042345 55098 FEES 241647 218485 23162 MISCELLANEOUS OPERATING 134876 10643 124233 47232 7502 39730 74294244 61359268 12934976 0 9003739 4546939 1050558 1305398 13687408 8947313 4968703 4740095 0 4454743 15023000 15047175 1160606 1301779 116998 0 1277604 1301779 X 13745396 13745396 13745396 13745396 15023000 15047175 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18960 5899 13061 1395809 296048 1099761 11259601 8241316 3018285 1013038 404050 608988 4740095 DUE FROM MEMBERS 4454743 4454743 X 74294244 0 74294244 0 74294244 74294244 0 74294244 0 74294244 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CORPORATION IS A TAX-EXEMPT, COOPERATIVE HOSPITAL SERVICE ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ACCORDINGLY, NO PROVISION FOR FEDERAL OR STATE INCOME TAX HAS BEEN MADE. AS OF DECEMBER 31, 2012, THE INTERNAL REVENUE SERVICE HAS NOT PROPOSED ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL CHANGE TO THE CORPORATION'S FINANCIAL POSITION. THE CORPORATION IS NO LONGER SUBJECT TO U.S. FEDERAL OR STATE INCOME TAX EXAMINATION BY TAX AUTHORITIES FOR THE YEARS 2008 AND PRIOR. THE CORPORATION WOULD RECOGNIZE ACCRUED INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THERE WAS NO SUCH INTEREST OR PENALTIES RECORDED FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. X X X X X X 1 0 0 1 1 0 1 0 0 CATHY-ANNE PETTI 0 348528 0 47250 0 0 0 0 0 3167 0 398945 0 0 JESSIE L SALK 0 301032 0 75000 0 0 0 9577 0 6622 0 392231 0 0 DOROTHY R ENNIS 0 228589 0 34427 0 0 0 10489 0 8613 0 282118 0 0 CHERRI L COLLINS 0 129784 0 32053 0 0 0 6325 0 8613 0 176775 0 0 NORMAN A STITELER 0 155831 0 0 0 0 0 0 0 8352 0 164183 0 0 MICHAEL H KNELLINGER 0 168326 0 0 0 0 0 1299 0 268 0 169893 0 0 PART I, LINE 4A SEVERANCE PAYMENTS WERE MADE TO THE FOLLOWING PERSONS: CATHY-ANNE PETTI: $232,718; MICHAEL KNELLINGER: $169,893 PART I, LINE 5 A PORTION OF THE BONUS PAID TO OFFICERS AND HIGHEST COMPENSATED EMPLOYEES IS BASED UPON ACHIEVEMENT OF REVENUE GOALS. PART I, LINE 6 A PORTION OF THE BONUS PAID TO OFFICERS AND HIGHEST COMPENSATED EMPLOYEES IS CONTINGENT ON NET EARNINGS GOALS OF THE RELATED ORGANIZATION. TRICORE REFERENCE LABORATORIES TRICORE REFERENCE LABORATORIES IS OWNED BY THE SAME PATRON HOSPITALS. OPERATIONS X 9003739 4546939 0 1 1 4546939 PATHOLOGY ASSOCIATES OF ALBUQUERQUE ANDREW HORVATH, DIRECTOR, IS A BOARD MEMBER OF BOTH ORGANIZATIONS 1246290 INDEPENDENT CONTRACTOR ARRANGEMENT 0 FORM 990, PART V, LINE 2A OFFICERS AND EMPLOYEES RECEIVE COMPENSATION FROM A RELATED ORGANIZATION. THE FILING ORGANIZATION THEN REIMBURSES THE RELATED ORGANIZATION FOR ITS PORTION OF THE SALARIES AND PAYROLL EXPENSES. ACCORDINGLY, ALTHOUGH THE FILING ORGANIZATION DOES NOT ISSUE FORMS W-2, IT DOES REPORT THE REIMBURSED SALARIES AND RELATED PAYROLL EXPENSES ON FORM 990, PART IX STATEMENT OF FUNCTIONAL EXPENSES. FORM 990, PART VI, SECTION A, LINE 2 ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER THROUGH THEIR INVOLVEMENT WITH TRICORE REFERENCE LABORATORIES, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 TRICORE REFERENCE LABORATORIES (TRL) ACTS AS AGENT FOR TRICORE LABORATORY SERVICES CORPORATION (TLSC). UNDER WRITTEN AGREEMENT, TRL MAY PROVIDE MANAGEMENT, ADMINISTRATIVE RESOURCES AND SHARED EMPLOYEES TO TLSC, WHO MAY ACCEPT SUCH SERVICES. ACCORDINGLY, THE ORGANIZATION, AS PRINCIPAL, PAYS TRL, AS AGENT, SPECIFIC AND ALLOCATED EXPENSES. FORM 990, PART VI, SECTION A, LINE 6 AS AN IRC SECTION 501(E) ORGANIZATION TLSC IS ORGANIZED AND OPERATED SOLELY TO PERFORM, ON A CENTRALIZED BASIS, FOR ITS MEMBERS AND ONLY FOR ITS MEMBERS, LABORATORY SERVICES AND NO OTHERS, EXCEPT THOSE SERVICES REFERRED TO IN TREAS. REG. 1.501(E)-1(B)(4) THAT ARE INCIDENTAL TO THE CONDUCT OF THE CORPORATIONS TAX-EXEMPT FUNCTION AND PURPOSE. ACCORDINGLY, THE UNIVERSITY OF NEW MEXICO HOSPITAL (UNMH), A HOSPITAL OWNED AND OPERATED BY THE UNIVERSITY OF NEW MEXICO AND PRESBYTERIAN, A TAX EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3), ARE EQUAL VOTING MEMBERS AND PATRON HOSPITALS OF TLSC. FORM 990, PART VI, SECTION A, LINE 7A AS THE ORIGINAL AND ONLY VOTING MEMBERS OF TLSC, PRESBYTERIAN AND UNMH EFFECTIVELY CONTROL TLSC THROUGH THEIR RESPECTIVE RIGHTS TO APPOINT AN EQUAL NUMBER OF DIRECTORS TO THE CORPORATIONS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE OFFICERS ARE SUBJECT TO AN AUTHORITY MATRIX (WRITTEN POLICY) WHICH IS UPDATED ANNUALLY. CERTAIN ACTIONS OF THE OFFICERS ARE SUBJECT TO BOARD APPROVAL AND ARE PRESENTED AT EACH BOARD MEETING. THE BOARD IS COMPOSED OF 4 INDIVIDUALS FROM EACH MEMBER (UNMH AND PRESBYTERIAN HEALTH SERVICES), SO THEY REPRESENT THE MEMBER HOSPITALS DIRECTLY IN THEIR ACTIONS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 AND SUPPORTING SCHEDULES ARE DELIVERED TO THE FINANCE COMMITTEE, AS APPOINTED BY THE BOARD OF DIRECTORS, IMMEDIATELY PRECEDING FILING, FOR REVIEW AND DISCUSSION. THE FINANCE COMMITTEE THEN FORWARDS A COPY OF THE FORM 990 TO BOARD MEMBERS FOR REVIEW AND DISCUSSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST (COI) STATEMENT IS DISTRIBUTED AT THE ANNUAL MEETING OF THE BOARD TO THE OFFICERS, BOARD MEMBERS, AND SUB-COMMITTEE BOARD MEMBERS. THE CEO'S ADMINISTRATIVE ASSISTANT FOLLOWS UP WITH ALL THE OFFICERS, BOARD MEMBERS, AND SUB-COMMITTEE BOARD MEMBERS TO MAKE SURE THAT THE COI IS RECEIVED BACK WITHIN 4 WEEKS. A SIGNED COPY OF ALL COI'S ARE SENT TO THE BOARD MEMBERS AND OFFICERS FOR REFERENCE. IF THERE IS A COI STATED, THE BOARD MAKES THE DECISION ON A CASE-BY-CASE BASIS IF THE MEMBER IS DISALLOWED FROM VOTING ON THE MATTER INVOLVED. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION DETERMINATIONS AND REVIEWS ARE INDEPENDENTLY PERFORMED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. APPROVAL IS REQUIRED BY THE COMPENSATION COMMITTEE AND BOARD OF DIRECTORS. DELIBERATIONS AND DECISIONS ARE BASED ON THE ADVICE OF AN INDEPENDENT CONSULTANT AS WELL AS COMPENSATION SURVEYS. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION OF ALL DELIBERATIONS AND DECISIONS. ALL OTHER OFFICER, KEY EMPLOYEE AND MANAGEMENT COMPENSATION DETERMINATIONS ARE PERFORMED IN HOUSE. APPROVAL IS REQUIRED BY THE CEO AND/OR EXECUTIVE MANAGEMENT TEAM AND HUMAN RESOURCES. THE COMPENSATION DETERMINATIONS ARE ANALYZED AGAINST SALARY SOURCES. THESE SALARY SOURCES MAY INCLUDE, BUT ARE NOT LIMITED TO COMPARABILITY DATA FROM OTHER HEALTHCARE ORGANIZATIONS, DEPARTMENT OF LABOR STUDIES AND SPECIALIZED COMPENSATION SURVEYS. THE PHILOSOPHY OF THE ORGANIZATION IS TO HAVE COMPENSATION WHICH IS MARKET DRIVEN. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION OF ALL COMPENSATION DECISIONS. THIS OCCURS AS PART OF THE REGULAR RECRUITING AND HIRING PROCESS. THIS PROCESS WAS LAST UNDERTAKEN FOR ALL CURRENT EMPLOYEES IN DECEMBER 2010 AND IS SCHEDULED TO TAKE PLACE AGAIN IN 2013. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 AND FORM 1023 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO PUBLIC. OTHER FEES FORM 990, PART IX, LINE 11G SHARED PERSONNEL - PRESBYTERIAN: PROGRAM SERVICE EXPENSES 1,503,008. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,503,008. SHARED PERSONNEL - UNIVERSITY OF NM HOSPITAL: PROGRAM SERVICE EXPENSES 2,324,739. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,324,739. PATHOLOGY GROUP PROFESSIONAL AND CONSULTING : PROGRAM SERVICE EXPENSES 3,636,294. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,636,294. CONSULTING: PROGRAM SERVICE EXPENSES 65,687. MANAGEMENT AND GENERAL EXPENSES 258,077. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,764. OTHER CONTRACT LABOR: PROGRAM SERVICE EXPENSES 450,104. MANAGEMENT AND GENERAL EXPENSES 636,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,086,904. TRICORE REFERENCE LABORATORIES 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 850444170 LABORATORY TESTING NM N/A C 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0