2011-03-15T10:58:43-05:00 2010-05-31 Lindquist LLP 5000 Executive Parkway Suite 400 San Ramon CA 94583 990 2009-06-01 910590441 Hotel Employees Restaurant Employees Health Trust Plan HOTE 2064417574 2815 second avenue No 300 Seattle WA 98121 RICHARD SAWYER 2064417574 2011-03-15 1 9252779100 2009 2016-02-24 21:20:13Z Richard Sawyer 2815 Second Ave Ste 300 seattle WA 98121 72033057 0 X N/A X 1976 WA to provide Health and Welfare Benefits to eligible participants and their dependents 9 9 210 0 0 0 0 27311384 26932417 -1361494 2867023 709 0 25950599 29799440 0 22796892 23639146 0 0 0 1765026 1727326 24561918 25366472 1388681 4432968 29899697 34355981 7044587 7370077 22855110 26985904 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 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 1432 0 1 210 1 0 0 0 0 0 9 9 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 brad hutton 0.50 X 0 0 0 elizabeth freeman 0.50 X 0 0 0 lee kaufman 0.50 X 0 0 0 enrique fernandez 0.50 X 0 0 0 Matt Murphy 0.50 X 0 0 0 Karly Edwards 0.50 X 0 0 0 Michael Fleming 0.50 X 0 0 0 0 0 0 0 0 0 0 Welfare And pension administration Servi 2815 2nd ave ste 300 Seattle WA 98121 Administration 1106302 First Choice health Network inc 600 univeristy st ste 1400 seattle WA 98101 Administration 203131 2 Employer Contributions 900099 26111881 26111881 Stop Loss Income 900099 406793 406793 Participant Contributi 900099 214816 214816 ARRA COBRA REIMURSEMEN 900099 116097 116097 FORMULARY REBATE 900099 82830 82830 26932417 1015029 1015029 44085611 42233617 1851994 1851994 1851994 29799440 26932417 0 2867023 23639146 1024129 25849 48485 43372 404487 138054 20654 22296 25366472 194082 277215 8663656 2790665 2596967 2858674 3751 3453 6522158 28425974 11919083 29899697 34355981 43160 57077 7001427 7313000 7044587 7370077 X 0 0 0 0 22855110 26985904 22855110 26985904 29899697 34355981 X 0 1 1 X 0 0 Accumulated Eligibility Credits 4104000 Claims Payable and Incurred but not Reported 3209000 7313000 29799440 25366472 4432968 -302174 311573 9399 4442367 29453894 -302174 -302174 29756068 43372 43372 29799440 25011527 0 25011527 43372 311573 354945 25366472 Part XI, Line 8 - Other Adjustments: INCREASE IN BENEFIT OBLIGATIONS Part XIII, Line 4b - Other Adjustments: Increase in Benefit Obligations 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. Form 990, Part XI, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILTY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT AUDITORS. FORM 990, PART V, LINE 2A: WHILE THE PLAN DOES NOT HAVE EMPLOYEES, PARTICIPANTS WHO RECEIVED DISBABILITY BENEFITS WHICH ARE TAXABLE WERE ISSUED FORM W-2. 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 Hotel Employees Restaurant employees UNION LOCAL 9 PENSION PLAN PO BOX 34203 Seattle WA 981241203 936054285 PROVIDE PENSION BENEFITS FOR ELIGible employees OR 501(A) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0