Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| 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, 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. ALL OF THE OFFICERS LISTED IN 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 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. ON AUGUST 5, 2013, FIRST CHOICE COMMUNITY HEALTHCARE (FCCH) BECAME A NON-VOTING MEMBER WITH TRANSACTIONS ACCOUNTING FOR APPROXIMATELY 1% OF THE ANNUAL TOTAL. AS A NON-VOTING MEMBER OF THE ORGANIZATION, FCCH DOES NOT HAVE VOTING REPRESENTATION ON TLSC'S BOARD OF DIRECTORS, BUT DOES HAVE THE RIGHT TO BE INFORMED OF THE BOARD'S DECISIONS. |
| 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. THE NEWEST MEMBER OF THE ORGANIZATION, FIRST CHOICE COMMUNITY HEALTHCARE, IS A NON-VOTING MEMBER WITHOUT REPRESENTATION ON THE 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 OF THE ORIGINAL memberS (UNMH and Presbyterian Health Services), so they represent the member hospitals directly in their actions. FCCH IS A NON-VOTING MEMBER WITHOUT VOTING REPRESENTATION ON THE TLSC BOARD OF DIRECTORS. |
| 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 CHAIRMAN OF THE BOARD OF DIRECTORS, THE BOARD OF DIRECTORS AND THE CHIEF HUMAN RESOURCES 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 (HR). THE COMPENSATION DETERMINATIONS ARE ANALYZED AGAINST SALARY SOURCES. THESE SALARY SOURCES MAY INCLUDE, BUT ARE NOT LIMITED TO COMPARABLE DATA FROM OTHER HEALTHCARE ORGANIZATIONS, DEPARTMENT OF LABOR STUDIES AND SPECIALIZED COMPENSATION SURVEYS. THE PAY 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 PROCESSES. THE OVERALL COMPENSATION STRUCTURE WAS LAST REVIEWED IN JANUARY OF 2016 AND WILL BE REVIEWED ON AN ANNUAL BASIS. |
| Form 990, Part VI, Section C, line 19 | NO DOCUMENTS AVAILABLE TO PUBLIC. |
| Form 990, Part IX, line 11g | SHARED PERSONNEL - Presbyterian: Program service expenses 2,123,944. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,123,944. SHARED PERSONNEL - UNIVERSITY OF NM HOSPITAL: Program service expenses 2,125,873. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,125,873. PATHOLOGY GROUP PROFESSIONAL AND CONSULTING: Program service expenses 2,793,509. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,793,509. shared personnel - other: Program service expenses 115,607. Management and general expenses 0. Fundraising expenses 0. Total expenses 115,607. other contract labor and patient care: Program service expenses 250,407. Management and general expenses 964,063. Fundraising expenses 0. Total expenses 1,214,470. Consultant fees: Program service expenses 2,800. Management and general expenses 228,071. Fundraising expenses 0. Total expenses 230,871. |
| Form 990, Part XII, Line 2c: | NO CHANGE HAS BEEN MADE TO THE OVERSIGHT OR SELECTION PROCESSES. |
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