2018-11-03T13:41:03-05:00 2017-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2017-01-01 946080365 SOUTH BAY HOTEL EMPLOYEES RESTAURANT EMPLOYEES WELFARE TRUST FUND SOUT 2064417574 PO BOX 34203 SEATTLE WA 98124 ENRIQUE FERNANDEZ CHAIRMAN 2064417574 2018-11-03 1 TODD M STOKES P01451940 9252779100 66.7.226.66 2018-11-03 11:40:53 PD P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2017 2019-02-21 02:37:17Z ENRIQUE FERNANDEZ PO BOX 34203 SEATTLE WA 98124 34936211 0 X WWW.SOUTHBAYHERETRUST.COM X 1958 CA PROVIDE HEALTH AND WELFARE BENEFITS 9 0 0 0 0 0 0 0 29634467 31175854 208721 312783 162 9220 29843350 31497857 0 0 24220012 23677138 0 0 0 0 0 776162 900694 24996174 24577832 4847176 6920025 23431155 31358248 5118774 5366213 18312381 25992035 TO PROVIDE MEDICAL, LIFE, DENTAL, VISION, PRESCRIPTION DRUG, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED MEDICAL, LIFE, DENTAL, VISION, PRESCRIPTION DRUG, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 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 12 0 1 0 0 0 0 0 0 0 X 9 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 X WELFARE & PENSION ADMIN SERVICE 2064417574 7525 SE 24TH STREET STE 200 MERCER ISLAND WA 98040 X DOUG CORNFORD SECRETARY 0.50 X 0 0 0 JOHN SOUTHWELL TRUSTEE 0.50 X 0 0 0 ROY TRUITT TRUSTEE - PAST 0.50 X 0 0 0 ART FERNANDES TRUSTEE 0.50 X 0 0 0 SARAH JULIAN TRUSTEE 0.50 X 0 0 0 ENRIQUE FERNANDEZ CHAIRMAN 0.50 X 0 0 0 ROSA RODRIGUEZ TRUSTEE 0.50 X 0 0 0 GARY HAGEMAN TRUSTEE 0.50 X 0 0 0 RAQUEL ALVAREZ TRUSTEE 0.50 X 0 0 0 JOSE ZARATE TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 WELFARE & PENSION ADMINISTRATIVE SERVICE PO BOX 34203 SEATTLE WA 98124 THIRD PARTY ADMINISTRATIVE SERVICE PROVI 451080 AETNA 515 S FLOWER STREET SUITE 505 LOS ANGELES CA 90071 CLAIMS PROCESSING 114388 2 EMPLOYER CONTRIBUTIONS 900099 30182686 30182686 EMPLOYEE CONTRIBUTIONS 900099 707553 707553 FORMULARY REBATES 900099 161741 161741 STOP LOSS REIMBURSEMENTS 900099 123874 123874 31175854 312783 312783 3438354 3438354 0 OTHER INCOME 900099 9220 9220 9220 31497857 31185074 0 312783 23677138 547211 15000 71707 15000 84808 104429 4288 13822 25048 DUES REGISTRATION - SUB 19381 24577832 9874650 9628128 2923526 4025000 11384 11111 10621595 17694009 23431155 31358248 55774 41313 5063000 5324900 5118774 5366213 X 0 0 0 0 18312381 25992035 18312381 25992035 23431155 31358248 6920025 759629 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 4618000 CLAIMS PAYABLE AND IBNR 288000 INSURANCE PREMIUMS PAYABLE 418900 5324900 X 32242486 759629 759629 31482857 15000 15000 31497857 24300932 0 24300932 15000 261900 276900 24577832 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2014. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 261,900. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH WELFARE & PENSION ADMINISTRATION SERVICE, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF TRUSTEES DOES NOT CURRENTLY HAVE SUB-COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE CHAIRMAN WILL REVIEW THE FORM 990 PRIOR TO BEING FILED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO THE TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD PARTY ADMINISTRATORS, WELFARE & PENSION ADMINISTRATION SERVICE, INC. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. SOUTH BAY HERE TRAINING FUND PO BOX 34203 SEATTLE WA 98124 946535776 TRAINING PROGRAM CA 501(C)(9) N/A N/A 0 SOUTH BAY HERE LEGAL TRUST FUND PO BOX 34203 SEATTLE WA 98124 946535777 LEGAL SERVICES CA 501(C)(9) N/A N/A 0 HOTEL EMPLOYEES RESTAURANT EMPLOYEES LOC 19 2302 ZANKER ROAD SAN JOSE CA 95131 942300756 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2017, THERE ARE APPROXIMATELY 32 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. P G CONCESSIONS BAY 101 CLUB BALANCE POINT COMPASS LOCKHEED MART ARAMARK-S C CONVENCTION ARAMARK @ NVIDIA NO MORE DIRT, INC EUREST AT INTEL FAIRMONT HOTEL FOURTH STREET BOWL 4 POINTS BY SHERATON DOLCE INT'L/SAN JOSE DOUBLETREE HOTEL SJ HERE LOCAL 19 HUDSON GROUP HYATT PLACE SAN JOSE HOST INTERNATIONAL JOES CAF HOLIDAY INN SJ AIRPORT MADONNA INN-C/O SMHERE MARRIOTT SAN JOSE ORIGINAL JOE'S/T. MULFO THE VISALIA MARRIOTT THE WESTIN SAN JOSE SAN JOSE ARENA-ARAMARK SAN JOSE HILTON & TOWNE SODEXO, INC. SANTA CLARA HILTON TEAM SAN JOSE WORLD DUTY FREE GROUP VOLUME SERVICE, INC. WPAS