2013-03-27T17:50:19-05:00 2012-05-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-06-01 910590441 HOTEL EMPLOYEES RESTAURANT EMPLOYEES HEALTH TRUST PLAN HOTE 2064417574 2815 SECOND AVENUE NO 300 SEATTLE WA 98121 RICHARD SAWYER 2064417574 2013-03-27 1 LORI L SCOTT P01452038 9252779100 2011 2016-02-25 16:41:14Z RICHARD SAWYER 2815 SECOND AVE STE 300 SEATTLE WA 98121 34799677 0 X N/A X 1976 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 10 4 134 0 0 0 0 0 24953552 25542077 1602884 1394205 1371 3820 26557807 26940102 0 0 20644132 20101207 0 0 0 0 0 1551218 1621603 22195350 21722810 4362457 5217292 38665842 43403617 7121440 5855012 31544402 37548605 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 0 1 X 1167 0 1 134 1 0 0 0 0 0 0 X 10 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WELFARE AND PENSION ADMIN SERVICE 2064417574 2815 SECOND AVENUE SUITE 300 SEATTLE WA 98121 X RICHARD SAWYER 0.50 X 0 0 0 ERIK VAN ROSSUM 0.50 X 0 0 0 HOWARD COHEN 0.50 X 0 0 0 SARAH WARREN 0.50 X 0 0 0 LEE KAUFMAN 0.50 X 0 0 0 DOUG RIGONI 0.50 X 0 0 0 ENRIQUE FERNANDEZ 0.50 X 0 0 0 STEFAN MORITZ 0.50 X 0 0 0 JEANNE CAMERON 0.50 X 0 0 0 BRENDAN COFFEY 0.50 X 0 0 0 KARLY EDWARDS 0.50 X 0 0 0 ELIZABETH SLAUGHTER 0.50 X 0 0 0 0 0 0 0 0 0 0 WELFARE & PENSION ADMINISTRATION SERVICE 2815 2ND AVE STE 300 SEATTLE WA 98121 ADMINISTRATION 977391 FIRST CHOICE HEALTH NETWORK INC 600 UNIVERISTY ST STE 1400 SEATTLE WA 98101 ADMINISTRATION 241069 2 EMPLOYER CONTRIBUTIONS 900099 25179040 25179040 PARTICIPANT CONTRIBUTI 900099 130207 130207 FORMULARY REBATE 900099 130074 130074 STOP LOSS INCOME 900099 99668 99668 ARRA COBRA REIMURSEMEN 900099 3088 3088 25542077 1293780 1293780 7960000 7859575 100425 100425 100425 MISCELLANEOUS INCOME 900099 3820 3820 3820 26940102 25545897 0 1394205 20101207 919379 25200 47547 29273 412785 136752 28663 22004 21722810 249464 1236711 5864118 4908144 2324975 2279588 3982 3715 30223303 34975459 38665842 43403617 35440 96705 7086000 5758307 7121440 5855012 X 0 0 0 0 31544402 37548605 31544402 37548605 38665842 43403617 X 5217292 786911 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 3704000 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 2054307 5758307 26940102 21722810 5217292 786911 -1327693 -540782 4676510 27697740 786911 786911 26910829 29273 29273 26940102 23021230 0 23021230 29273 -1327693 -1298420 21722810 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, 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 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, 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 AND PENION 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 786,911. 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. HOTEL EMPLOYEES RESTAURANT EMPLOYEES PENSION PLAN 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 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 MAY 31, 2012, THERE ARE 37 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.