2016-04-04T13:39:47-05:00 2015-05-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2014-06-01 910590441 HOTEL EMPLOYEES RESTAURANT EMPLOYEES HEALTH TRUST PLAN HOTE 2064417574 2815 SECOND AVENUE NO 300 SEATTLE WA 98121 ERIK VAN ROSSUM CHAIRMAN/TRUSTEE 2064417574 2016-04-04 1 KATHLEEN D HAAB P01068129 9252779100 2014 2016-08-17 19:52:53Z ERIK VAN ROSSUM 2815 SECOND AVE STE 300 SEATTLE WA 98121 52334292 0 X N/A X 1976 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 9 2 131 0 0 0 0 0 30875908 33836762 1161428 1315552 135 314 32037471 35152628 0 0 24231931 29041631 0 0 0 0 0 1783523 2390950 26015454 31432581 6022017 3720047 57587606 62797305 8337812 9377496 49249794 53419809 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO 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 X 1198 0 1 131 1 0 0 0 0 0 0 X 9 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WELFARE & PENSION ADMIN SERVICE 2064417574 2815 SECOND AVENUE SUITE 300 SEATTLE WA 98121 X ERIK VAN ROSSUM TRUSTEE - CHAIRMAN 0.50 X 0 0 0 HOWARD COHEN TRUSTEE - SECRETARY 0.50 X 0 0 0 SARAH WARREN TRUSTEE 0.50 X 0 0 0 LEE KAUFMAN TRUSTEE 0.50 X 0 0 0 DOUG RIGONI TRUSTEE 0.50 X 0 0 0 ENRIQUE FERNANDEZ TRUSTEE 0.50 X 0 0 0 STEFAN MORITZ TRUSTEE 0.50 X 0 0 0 DAVID GLASER TRUSTEE 0.50 X 0 0 0 NORMAN HWA TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 WELFARE & PENSION ADMINISTRATION SERVICE 2815 2ND AVE STE 300 SEATTLE WA 98121 ADMINISTRATION 1151171 FIRST CHOICE HEALTH NETWORK INC 600 UNIVERISTY ST STE 1400 SEATTLE WA 98101 ADMINISTRATION 304296 2 EMPLOYER CONTRIBUTIONS 900099 32554899 32554899 STOP LOSS INCOME 900099 1017137 1017137 FORMULARY REBATES 900099 165891 165891 PARTICIPANT CONTRIBUTIONS 900099 98835 98835 33836762 1914929 1914929 16582287 17181664 -599377 -599377 -599377 LITIGATION INCOME 900099 314 314 314 35152628 33837076 0 1315552 29041631 1144491 41131 48415 38984 460444 146279 32052 16819 ACA TRANS. REINSURANCE 456144 PCORI FEE 6191 31432581 129425 1017173 8645555 6796921 2786239 3463140 4315 3775 46022072 51516296 57587606 62797305 45883 137767 8291929 9239729 8337812 9377496 X 0 0 0 0 49249794 53419809 49249794 53419809 57587606 62797305 3720047 449968 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 4712000 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 4527729 9239729 X 35563612 449968 449968 35113644 38984 38984 35152628 30445797 0 30445797 38984 947800 986784 31432581 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 MAY 31, 2015, 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. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2012. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART V, LINE 2A THE TRUST DOES NOT HAVE EMPLOYEES. HOWEVER, THE TRUST ISSUED FORMS W-2 TO PARTICIPANTS THAT RECEIVED TAXABLE DISABILITY BENEFITS. 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 B, LINE 11 A TRUSTEE REVIEWED THE FORM 990 FOR ACCURACY AND COMPLETENESS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IF AND WHEN A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE BOARD OF TRUSTEES WILL INVOLVE THE TRUST'S ATTORNEY TO EVALUATE IF THE MATTER WOULD LIKELY PREVENT AN UNBIASED OR OBJECTIVE DECISION BY A TRUSTEE, AND AS APPROPRIATE, DISCIPLINARY OR CORRECTIVE ACTION WILL BE TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII. SECTION A. LINE 1A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATION 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 ADMINISTRATOR, WELFARE & PENSION ADMINISTRATION SERVICE, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT AUDITORS. THIS PROCESS HAS NOT CHANGED. UNITEHERE NORTHWEST PENSION TRUST FUND PO BOX 34203 SEATTLE WA 981241203 916145131 PROVIDE PENSION BENEFITS FOR ELIGIBLE EMPLOYEES WA 501(A) N/A N/A 0 UNITE HERE LOCAL 8 2800 FIRST AVENUE ROOM 3 SEATTLE WA 98121 910968179 LABOR ORGANIZATION WA 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R. INDENTIFICATION 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 MAY 31, 2015, 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 CORPORATON OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE RESONABLY 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. ALSCO LAUNDRIES ARAMARK ARAMARK PORTLAND - OREGON CONVENTION CTR BENSON HOTEL BEST WESTERN LOYAL INN CENTERPLATE @ SAFECO COAST WENATCHEE CENTER HOTEL COMPASS GROUP CONCESSIONS INT'L DOUBLETREE HOTEL SEATTLE AIRPORT EDGEWATER HOTEL EUREST/THOMPSON DINING EXECUTIVE INN HILTON HOTEL/PORTLAND HILTON SEATTLE HILTON SEATTLE AIRPORT HOST INTERNATIONAL HOTEL MURANO LUDI'S RESTAURANT AND LOUNGE MANOR MANAGEMENT SVC PANCAKE HOUSE, INC. 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