2023-11-01T15:37:18-05:00 2022-12-31 910189318 MOSS ADAMS LLP 6565 AMERICAS PARKWAY NE STE 600 ALBUQUERQUE NM 87110 990 2022-01-01 201358178 TRICORE LABORATORY SERVICES CORP TRIC 5059388888 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 ROBIN DIVINE CEO 5059388888 2023-10-31 1 ROBIN DIVINE 999009999 1 PAMELA ALEXANDERSON P01218925 5058787200 2023-10-31 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROBIN DIVINE 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 131180332 0 X WWW.TRICORE.ORG X 2004 NM THE ORGANIZATION WAS ORGANIZED AND IS OPERATED AS A COOPERATIVE HOSPITAL SERVICE ORGANIZATION. 8 8 0 8 0 0 0 0 118588499 131180332 0 -10560 0 0 118588499 131169772 0 0 0 0 48040221 53624986 0 0 0 70548278 77544786 118588499 131169772 0 0 18254406 26648666 4817491 13211751 13436915 13436915 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 111051716 131180332 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. 111051716 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X X ELLA WATT 5059388926 1001 WOODWARD PL NE ALBUQUERQUE NM 87102 JILL KLAR BOARD CHAIR 1.00 1.00 X 0 0 0 BONNIE WHITE BOARD VICE CHAIR 1.00 1.00 X 0 0 0 CHRIS SPENCER FINANCE COMMITTEE CHAIR 1.00 1.00 X 0 0 0 NANCY JOSTE MD BOARD MEMBER 1.00 1.00 X 0 0 0 DALE MAXWELL BOARD MEMBER 1.00 1.00 X 0 0 0 ALEXEI BAKHIREV MD BOARD MEMBER 1.00 1.00 X 0 0 0 RICHARD LARSON MD BOARD MEMBER 1.00 1.00 X 0 0 0 JASON MITCHELL MD BOARD MEMBER 1.00 1.00 X 0 0 0 JAMES SPIGEL MD BOARD MEMBER (THROUGH 6/22) 1.00 1.00 X 0 0 0 ROBIN DIVINE CHIEF EXECUTIVE OFFICER 22.00 18.00 X 0 454303 31056 NICHOLAS DAYAN CHIEF PEOPLE OFFICER 22.00 18.00 X 0 358689 16626 MICHAEL CROSSEY MD INTERIM CMO (THOUGH 4/22) 22.00 18.00 X 0 197027 19041 ERIC CARBONNEAU CHIEF OPERATING OFFICER 22.00 18.00 X 0 276736 27718 ELLA WATT CHIEF FINANCIAL OFFICER 22.00 18.00 X 0 344586 14641 DAVID GRENACHE CHIEF SCIENTIFIC OFFICER 22.00 18.00 X 0 350998 26983 ARAND PIERCE CHIEF MEDICAL OFFICER 22.00 18.00 X 0 287292 9149 KATHRYN FORT OPERATIONS CONTROLLER 19.00 21.00 X 0 220775 16357 KARISSA MCCALL CULBREATH CHIEF MEDICAL DIRECTOR 15.00 25.00 X 0 229480 10258 HONGYAN XIE SCIENTIFIC DIRECTOR CYTOGENICS 25.00 15.00 X 0 203450 12701 AARON FRANKEL DIRECTOR INFORMATION SECURITY 19.00 21.00 X 0 188655 18784 MICHELLE NEEL SENIOR DIRECTOR, COMPLIANCE 19.00 21.00 X 0 189108 22255 0 3301099 225569 0 0 1 0 TRIAGE LLC 12020 PACIFIC STREET OMAHA NE 68154 STAFFING AGENCY 5659669 PATHOLOGY ASSOCIATES OF ALBUQUERQUE 1100 CENTRAL AVE SE ALBUQUERQUE NM 87106 PATHOLOGY CONSULTANTS 1289172 UNM MEDICAL GROUP INC PO BOX 27200 ALBUQUERQUE NM 87125 PATHOLOGY CONSULTANTS 915402 SOLIANT HEALTH LLC 5500 PEACHTREE PARKWAY STE 500 PEACHTREE CORNERS GA 30092 STAFFING AGENCY 116317 HEALTHCARE CONNECTIONS INC 2770 UNIVERSITY DRIVE STE 2770 CORAL SPRINGS FL 33071 STAFFING AGENCY 108235 5 SALES, NET OF DISCOUNTS 621500 131180332 131180332 131180332 10560 -10560 -10560 -10560 131169772 131180332 0 -10560 X 1376772 1376772 38439679 33731283 4708396 1468366 1054146 414220 8713993 6381638 2332355 3626176 3133949 492227 158975 158975 102911 102911 18051536 17064009 987527 88170 88170 2521284 2174638 346646 8288359 1496144 6792215 1762324 1126964 635360 147437 89477 57960 129844 129844 2098984 1665728 433256 308785 308785 SUPPLIES 41112886 41112886 EQUIPMENT EXPENSES 2445111 1735525 709586 FEES 188005 121823 66182 140175 33662 106513 131169772 111051716 20118056 0 3149852 2782891 18843287 15132016 3315217 3711271 11789337 20154504 18254406 26648666 2824908 4174086 1992583 9037665 4817491 13211751 X 13436915 13436915 13436915 13436915 18254406 26648666 0 0 X X 0 1 X 1 0 X 18960 18540 420 2501230 2208704 292526 14696645 11912820 2783825 1626452 991952 634500 3711271 DUE FROM MEMBERS 13226960 ROU ASSETS 6631691 OTHER RECEIVABLES 295853 20154504 DUE TO TRICORE REFERENCE LABORATORIES AND TRICORE, INC. 2359760 LEASE LIABILITIES 6677905 9037665 X 131169772 0 131169772 0 131169772 131169772 0 131169772 0 131169772 PART X, LINE 2: THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL OR STATE INCOME TAX HAS BEEN MADE. AS OF DECEMBER 31, 2022, THE INTERNAL REVENUE SERVICE HAS NOT PROPOSED ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL CHANGE TO THE CORPORATION'S FINANCIAL POSITION. X X X X 0 0 0 0 0 1 1 0 0 ROBIN DIVINE CHIEF EXECUTIVE OFFICER 0 404878 0 48645 0 780 0 15250 0 15806 0 485359 0 0 DAVID GRENACHE CHIEF SCIENTIFIC OFFICER 0 306033 0 43485 0 1480 0 15250 0 11733 0 377981 0 0 NICHOLAS DAYAN CHIEF PEOPLE OFFICER 0 306802 0 51887 0 0 0 11248 0 5378 0 375315 0 0 ELLA WATT CHIEF FINANCIAL OFFICER 0 301033 0 42773 0 780 0 9263 0 5378 0 359227 0 0 ERIC CARBONNEAU CHIEF OPERATING OFFICER 0 257085 0 19456 0 195 0 13802 0 13916 0 304454 0 0 ARAND PIERCE CHIEF MEDICAL OFFICER 0 274209 0 12563 0 520 0 0 0 9149 0 296441 0 0 KARISSA MCCALL CULBREATH CHIEF MEDICAL DIRECTOR 0 202216 0 27214 0 50 0 10258 0 0 0 239738 0 0 KATHRYN FORT OPERATIONS CONTROLLER 0 206513 0 14262 0 0 0 10979 0 5378 0 237132 0 0 HONGYAN XIE SCIENTIFIC DIRECTOR CYTOGENICS 0 203450 0 0 0 0 0 8128 0 4573 0 216151 0 0 MICHAEL CROSSEY MD INTERIM CMO (THOUGH 4/22) 0 143635 0 53342 0 50 0 9779 0 9262 0 216068 0 0 MICHELLE NEEL SENIOR DIRECTOR, COMPLIANCE 0 175897 0 12431 0 780 0 9399 0 12856 0 211363 0 0 AARON FRANKEL DIRECTOR INFORMATION SECURITY 0 175996 0 12159 0 500 0 9193 0 9591 0 207439 0 0 PART I, LINE 3 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. AS SUCH, THE ORGANIZATION IS ANSWERING SCHEDULE J AS THOUGH THE COMPENSATION IS COMING FROM THE ORGANIZATION. PART I, LINE 6 BONUS COMPENSATION IS PAID BASED ON A COMPARISON OF ACTUAL NET INCOME TO BUDGETED NET INCOME FOR EACH QUARTER. FORM 990, PART V, LINE 2B: 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 AND TRICORE INC., WHICH ARE BOTH RELATED ORGANIZATIONS. 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, WHICH MAY ACCEPT SUCH SERVICES. ACCORDINGLY, THE ORGANIZATION, AS PRINCIPAL, PAYS TRL, AS AGENT, SPECIFIC AND ALLOCATED EXPENSES. ALL OF THE OFFICERS LISTED ON THE 990, PART VII, SECTION A, WERE COMPENSATED BY TRL IN THE AMOUNTS SHOWN ON THAT SCHEDULE. 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 NOT OTHERS, EXCEPT THOSE SERVICES REFERRED TO IN TREAS. REG. 1.501(E)-1(B)(4) THAT ARE INCIDENTAL TO THE CONDUCT OF THE CORPORATION'S 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 CORPORATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE OFFICERS ARE SUBJECT TO AN AUTHORITY MATRIX (WRITTEN POLICY), WHICH IS REVIEWED ANNUALLY AND UPDATED IF NECESSARY. 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 OF THE ORIGINAL MEMBERS (UNMH AND PRESBYTERIAN HEALTH SERVICES), SO THEY REPRESENT THE MEMBER HOSPITALS DIRECTLY IN THEIR ACTIONS. FORM 990, PART VI, SECTION B, LINE 11B 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 ANNUALLY TO THE OFFICERS, BOARD MEMBERS, AND BOARD SUB-COMMITTEE MEMBERS. THE CEO'S ADMINISTRATIVE ASSISTANT ENSURES THAT THE OFFICERS, BOARD MEMBERS, AND SUB-COMMITTEE MEMBERS RETURN THEIR SIGNED COI TIMELY FOR REVIEW BY THE CHIEF PEOPLE OFFICER (CPO). IF THERE IS A COI STATED, THE CPO ADVISES THE BOARD OF DIRECTORS. THE BOARD THEN DETERMINES ON A CASE-BY-CASE BASIS IF THE MEMBER IS DISALLOWED FROM VOTING ON THE MATTER INVOLVED. COPIES OF THE SIGNED COI'S ARE MAINTAINED IN THE BOARD FILES. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION DETERMINATIONS AND REVIEWS ARE INDEPENDENTLY PERFORMED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS, THE BOARD OF DIRECTORS, AND THE CHIEF PEOPLE OFFICER. DELIBERATIONS AND DECISIONS ARE BASED UPON THE ADVICE OF AN INDEPENDENT CONSULTANT(S) AS WELL AS EXTERNAL 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 CAPITAL MANAGEMENT (HCM). THE COMPENSATION DETERMINATIONS ARE ANALYZED AGAINST SALARY SOURCES. THESE SALARY SOURCES MAY INCLUDE, BUT ARE NOT LIMITED TO, COMPARABLE DATA FROM OTHER HEALTH-CARE ORGANIZATIONS, DEPARTMENT OF LABOR STUDIES AND SPECIALIZED COMPENSATION SURVEYS. THE PAY PHILOSOPHY OF THE ORGANIZATION IS TO HAVE COMPENSATION THAT IS MARKET-DRIVEN. THE ORGANIZATION MAINTAINS CONTEMPORANEOUS DOCUMENTATION OF ALL COMPENSATION DECISIONS. THIS OCCURS AS PART OF THE REGULAR RECRUITING AND HIRING PROCESSES. THE OVERALL COMPENSATION STRUCTURE WAS LAST REVIEWED IN DECEMBER 2022 AND WILL BE REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE ON THE NEW MEXICO ATTORNEY GENERAL'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G SHARED PERSONNEL - PRESBYTERIAN: PROGRAM SERVICE EXPENSES 2,788,997. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,788,997. SHARED PERSONNEL - UNIVERSITY OF NM HOSPITAL: PROGRAM SERVICE EXPENSES 4,173,531. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,173,531. PATHOLOGY GROUP PROFESSIONAL AND CONSULTING: PROGRAM SERVICE EXPENSES 2,413,729. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,413,729. SHARED PERSONNEL - OTHER: PROGRAM SERVICE EXPENSES 74,955. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,955. OTHER CONTRACT LABOR AND PATIENT CARE: PROGRAM SERVICE EXPENSES 7,593,548. MANAGEMENT AND GENERAL EXPENSES 785,202. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,378,750. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 19,249. MANAGEMENT AND GENERAL EXPENSES 202,325. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 221,574. FORM 990, PART XII, LINE 2C: NO CHANGE HAS BEEN MADE TO THE OVERSIGHT OR SELECTION PROCESSES. TRICORE INC 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 843909066 MEDICAL REFERENCE & CLINICAL LABORATORIES NM 501(C)(3) LINE 10 0 TRICORE REFERENCE LABORATORIES 1001 WOODWARD PLACE NE ALBUQUERQUE NM 87102 850444170 LABORATORY TESTING NM N/A C 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 0 0