2015-10-15T14:34:51-05:00 2014-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2014-01-01 946080365 SOUTH BAY HOTEL EMPLOYEES RESTAURANT EMPLOYEES WELFARE TRUST FUND SOUT 2064417574 PO BOX 34203 SEATTLE WA 98124 ENRIQUE FERNANDEZ CHAIRMAN 2064417574 2015-10-16 1 LORI SCOTT P01452038 9252779100 2014 2016-02-25 16:41:14Z ENRIQUE FERNANDEZ PO BOX 34203 SEATTLE WA 98124 30027560 0 X WWW.SOUTHBAYHERETRUST.COM X 1958 CA PROVIDE HEALTH AND WELFARE BENEFITS 8 0 0 0 0 0 0 0 24738234 25914943 73771 675035 20231 40910 24832236 26630888 0 0 20435807 22614557 0 0 0 0 0 636660 711192 21072467 23325749 3759769 3305139 12824152 16326006 4526856 5162071 8297296 11163935 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 8 0 1 0 0 0 0 0 0 0 X 8 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 2815 SECOND AVENUE SUITE 300 SEATTLE WA 98121 X DOUG CORNFORD SECRETARY 0.50 X 0 0 0 JOHN SOUTHWELL TRUSTEE 0.50 X 0 0 0 ROBERT THOMAS TRUSTEE - PAST 0.50 X 0 0 0 ROY TRUITT TRUSTEE 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 KELLY COSGROVE TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATI 0.50 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 340263 AETNA 515 S FLOWER STREET SUITE 505 LOS ANGELES CA 90071 CLAIMS PROCESSING 117964 2 EMPLOYER CONTRIBUTIONS 900099 25080985 25080985 EMPLOYEE CONTRIBUTIONS 900099 781373 781373 FORMULARY REBATES 900099 46439 46439 STOP LOSS REIMBURSEMENTS 900099 6146 6146 25914943 76519 76519 3995188 3396672 598516 598516 598516 OTHER INCOME 900099 40910 40910 40910 26630888 25955853 0 675035 22614557 430088 15149 27164 15000 66000 58989 3600 239 12173 18526 ACA REINSURANCE PROGRAM 56407 DUES REGISTRATION - SUB 7857 23325749 6821364 9937148 2168896 2317975 7467 7924 3826425 4062959 12824152 16326006 25856 84071 4501000 5078000 4526856 5162071 X 0 0 0 0 8297296 11163935 8297296 11163935 12824152 16326006 3305139 -438500 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 4164000 CLAIMS PAYABLE AND IBNR 914000 5078000 X 26177388 -438500 -438500 26615888 15000 15000 26630888 22733749 0 22733749 15000 577000 592000 23325749 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, 2014, 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 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 577,000. 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 11 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 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 SERVICES, 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 INDPENDENT ACCOUNTANT. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 DECEMBER 31, 2014, THERE ARE APPROXIMATELY 34 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. BAY 101 CLUB BALANCE POINT CAMBRIAN BOWL, INC. COMPASS LOCKHEED MARTIN ARAMARK - SANTA CLARA CONVENTION NO MORE DIRT, INC. FAIRMONT HOTEL OF SAN JOSE FOURTH STREET BOWL DOLCE INTERNATIONAL - SAN JOSE DOUBLETREE HOTEL HERE UNION LOCAL 19 HYATT PLACE SAN JOSE HOST INTERNATIONAL, INC. AIRPORT GARDEN HOTEL JOE'S CAFE, INC. HOLIDAY INN SJ AIRPORT MADONNA INN MARRIOTT SAN JOSE MCGOVERN & ASSOCIATES CONSULTING, INC. MOONLITE LANES ORIGINAL JOE'S/T. MULFORD THE VISALIA MARRIOTT SAINTE CLAIRE HOTEL, LLC. ARAMARK - SAN JOSE ARENA SAN JOSE HILTON & TOWERS SODEXO, INC. LA QUINTA INN SANTA CLARA HILTON TEAM SAN JOSE VAHL'S/NICHOLS RICK WELFARE PENSION & ADMINISTRATION SERVICE, INC. 4 POINTS BY SHERATON WORLD DUTY FREE GROUP SAN JOSE ARENA-ARAMARK