2012-03-12T11:39:32-05:00 2011-05-31 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2010-06-01 910590441 HOTEL EMPLOYEES RESTAURANT EMPLOYEES HEALTH TRUST PLAN HOTE 2064417574 2815 SECOND AVENUE NO 300 SEATTLE WA 98121 RICHARD SAWYER 2064417574 2012-03-12 1 9252779100 2010 2016-02-24 21:20:13Z RICHARD SAWYER 2815 SECOND AVE STE 300 SEATTLE WA 98121 26557807 0 X N/A X 1976 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 10 10 186 0 0 0 0 0 26932417 24953552 2867023 1602884 0 1371 29799440 26557807 0 0 23639146 20644132 0 0 0 0 0 1727326 1551218 25366472 22195350 4432968 4362457 34355981 38665842 7370077 7121440 26985904 31544402 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 1 0 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 3 0 1 186 1 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 0 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 ELIZABETH SLAUGHTER 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 KARLY EDWARDS 0.50 X 0 0 0 JEANNE CAMERON 0.50 X 0 0 0 BRENDAN COFFEY 0.50 X 0 0 0 MATT MURPHY 0.50 X 0 0 0 MICHAEL FLEMING 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 1015249 FIRST CHOICE HEALTH NETWORK INC 600 UNIVERISTY ST STE 1400 SEATTLE WA 98101 ADMINISTRATION 199017 2 EMPLOYER CONTRIBUTIONS 900099 24570181 24570181 PARTICIPANT CONTRIBUTI 900099 171284 171284 FORMULARY REBATE 900099 134624 134624 ARRA COBRA REIMURSEMEN 900099 60397 60397 STOP LOSS INCOME 900099 17066 17066 24953552 1602884 1602884 MISCELLANEOUS INCOME 900099 1371 1371 1371 26557807 24954923 0 1602884 20644132 905320 25209 49172 18870 384486 123338 22812 22011 22195350 277215 249464 2790665 5864118 2858674 2324975 3453 3982 28425974 30223303 34355981 38665842 57077 35440 7313000 7086000 7370077 7121440 X 0 0 0 0 26985904 31544402 26985904 31544402 34355981 38665842 X 4362457 196041 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 3633000 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 3453000 7086000 26557807 22195350 4362457 196041 -227000 -30959 4331498 26734978 196041 196041 26538937 18870 18870 26557807 22403480 0 22403480 18870 -227000 -208130 22195350 PART XI, LINE 8 - OTHER ADJUSTMENTS: DECREASE IN BENEFIT OBLIGATIONS PART XIII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN BENEFIT OBLIGATIONS FORM 990, PART VI, LINE 2B: WHILE THE PLAN DOES NOT HAVE EMPLOYEES, PARTICIPANTS WHO RECEIVED DISBABILITY BENEFITS WHICH ARE TAXABLE WERE ISSUED FORM W-2. 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 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: 196,041. DECREASE IN BENEFIT OBLIGATIONS PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILTY 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0