2019-02-14T18:22:16-06:00 2018-03-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-04-01 941645611 SAN FRANCISCO CULINARY BARTENDERS & SERVICE EMPLOYEES WELFARE FUND SANF 2067263271 2323 EASTLAKE AVE E SEATTLE WA 98102 TRUSTEE TRUSTEE TRUSTEE 2067263271 2019-02-14 1 MELISSA EVJENTH P01781096 9094664410 174.215.38.124 2019-02-14 18:18:53 PS P 6A119F164E6EB55EF1F9B46B97FA75FDA10D5472 79ACAE867A9DB9871DCF109F9EDC9C017100E02E 2017 2019-02-21 02:37:17Z X 2323 EASTLAKE AVE E SEATTLE WA 98102 236240899 0 X N/A X 1958 CA SEE PART III LINE 4A 8 8 22 0 0 0 0 0 162376628 169630369 1893133 2228165 37386 28263 164307147 171886797 0 0 149805254 134746644 357607 361522 0 0 0 1973514 2006932 152136375 137115098 12170772 34771699 137789083 154447754 43632334 25717570 94156749 128730184 NONE 0 0 TO PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION & EMPLOYERS. 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 211 0 34 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 X NORTHWEST ADMINISTRATORS INC 2067263271 2323 EASTLAKE AVE E SEATTLE WA 98102 MICHAEL CASEY TRUSTEE 5.00 X 0 0 0 DOUGLAS CORNFORD TRUSTEE 5.00 X 0 0 0 ANAND SINGH TRUSTEE 5.00 X 0 0 0 ROBERT BERGER TRUSTEE 5.00 X 0 0 0 KIM WIRSHING TRUSTEE 5.00 X 0 0 0 DEAN LEHR TRUSTEE 5.00 X 0 0 0 IAN LEWIS TRUSTEE 5.00 X 0 0 0 RICHARD SAWHILL TRUSTEE 5.00 X 0 0 0 LOUISE RUSH EXECUTIVE DIRECTOR 40.00 X 110000 0 27500 110000 0 27500 1 0 0 0 NORTHWEST ADMINISTRATORS 2323 EASTLAKE AVE E SEATTLE WA 98102 CONTRACT ADMINISTRATOR 721872 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATOR 447279 RAEL & LETSON PO BOX 740722 LOS ANGELES CA 90074 ACTUARY 109250 ASCENDANT HEALTHCARE 1755 INDIAN WOODS CIRCLE SUITE 100 MAUMEE OH 43537 DATA WAREHOUSING 105134 4 EMPLOYER CONTRIBUTIONS 900099 168934736 168934736 EMPLOYEE CONTRIBUTIONS 900099 695633 695633 169630369 2116966 2116966 64465301 64354102 111199 111199 111199 LIQUIDATED DAMAGES 900099 23893 23893 OTHER INCOME 900099 4370 4370 28263 171886797 169769831 0 2116966 134746644 110000 251522 721872 22729 42537 168850 48891 20623 20637 CLAIMS ADMINISTRATION 449014 BENEFIT CONSULTANTS 267786 SOFTWARE LICENSING FEE 105134 PRINTING AND POSTAGE 84043 54816 137115098 18140134 5324786 34168873 49871031 12692952 13034377 8546 21983 72591257 50029212 0 22348406 187321 13817959 137789083 154447754 1163474 251788 42468860 25465782 43632334 25717570 X 0 0 0 0 94156749 128730184 94156749 128730184 137789083 154447754 34771699 -198264 0 X X 0 1 X 1 0 0 103-12 ENTITIES 22348406 F 22348406 ACCRUED INTEREST 223727 DUE FROM OTHER FUNDS 138887 DUE FROM BROKER 13455345 13817959 GROUP INSURANCE PREMIUMS PAYABLE 21146700 SELF-FUNDED BENEFIT CLAIMS PAYABLE 2729243 CLAIMS INCURRED BUT NOT REPORTED 1120000 DUE TO OTHER FUNDS 469839 25465782 X 171688533 -198264 -198264 171886797 0 171886797 137115098 0 137115098 0 137115098 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST ADMINISTRATOR BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CONTROL OF MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES TO THE CONTRACT ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CHAIR AND CO-CHAIR ARE PROVIDED A COPY OF THE FORM 990 TO REVIEW PRIOR TO SIGNING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. SAN FRANCISCO CULINARY BARTENDERS AND SERVICE EMPLOYEES PENSION FUND 1182 MARKET STREET SAN FRANCISCO CA 94102 946118925 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A 0 SAN FRANCISCO CULINARY BARTENDERS & SERVICE EMPLOYEES LEGAL SERVICES FUND 1182 MARKET STREET SAN FRANCISCO CA 94102 946625180 TO PROVIDE GROUP LEGAL SERVICES BENEFITS TO ELIGIBLE PARTICIPANTS CA 501C 0 SAN FRANCISCO HOTEL RESTAURANT LABOR MANAGEMENT EDUCATION FUND 1182 MARKET STREET SAN FRANCISCO CA 94102 237103043 TO PROVIDE TRAINING AND EDUCATION PROGRAMS TO ELIGIBLE PARTICIPANTS CA 501C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.