2023-10-31T17:34:47-05:00 2022-12-31 562552172 INEICH & COMPANY LLP 950 TOWER LANE SUITE 780 FOSTER CITY CA 94404 990 2022-01-01 946081299 SAN MATEO HOTEL EMPLOYEES AND RESTAURANT EMPLOYEES WELFARE FUND SANM 4082884420 6800 SANTA TERESA BLVD 100 SAN JOSE CA 95119 JAMES BEARD TRUSTEE 4082884400 2023-10-31 1 JAMES BEARD 999009999 0 MICHAEL T SAVASTA P01259186 6505738007 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JAMES BEARD 6800 SANTA TERESA BLVD SUITE 100 SAN JOSE CA 95119 42823071 0 X N/A X 1954 CA PROVIDING HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS 4 4 0 0 0 0 0 0 15755693 29304104 123428 -206218 777684 1640680 16656805 30738566 0 0 18887500 28923611 0 0 0 0 0 752597 976554 19640097 29900165 -2983292 838401 18338515 21151623 7618854 9976256 10719661 11175367 PROVIDING HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 28923611 PROVIDING HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS 28923611 0 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 1 182 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 CA X UNITED ADMINISTRATIVE SERVICES 4082884420 6800 SANTA TERESA BLVD SUITE 100 SAN JOSE CA 95119 SHERRI CHIESA TRUSTEE 5.00 X 0 0 0 MIKE CASEY TRUSTEE 5.00 X 0 0 0 JAMES BEARD TRUSTEE 5.00 X 0 0 0 RICHARD ROMANSKI TRUSTEE 5.00 X 4800 0 0 4800 0 0 0 0 0 0 0 CONTRIBUTIONS 721110 29304104 29304104 29304104 207204 207204 11671083 12084505 -413422 -413422 -413422 STOP LOSS REIMBURSEMENT 721110 1389338 1389338 SETTLEMENT PROCEEDS 721110 251342 251342 1640680 30738566 30944784 0 -206218 28923611 28923611 24000 24000 111813 111813 51613 51613 49336 49336 29882 29882 ADMINISTRATION 389870 389870 ACTUARY AND CONSULTING 164048 164048 CLAIMS REVIEW 138693 138693 MISCELLANEOUS 11070 11070 6229 6229 29900165 28923611 976554 0 293213 2291319 6436678 6972559 2943401 5296362 2616 35001 8662607 6556382 18338515 21151623 16126 8267 7602728 9967989 7618854 9976256 X 0 0 0 0 10719661 11175367 10719661 11175367 18338515 21151623 838401 -382695 0 X 0 0 0 0 HEALTH CLAIMS & PREMIUMS PAYABLE 6849687 ACCUMULATED ELIGIBILITY CREDITS 3118302 9967989 30304258 -382695 -382695 30686953 51613 51613 30738566 27483291 -2365261 -2365261 29848552 51613 51613 29900165 PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN ACCRUED BENEFIT OBLIGATION FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE FORM 990 IS PREPARED BY THE PLAN'S AUDITOR (CPA FIRM) BASED ON THE PLAN'S FINANCIAL STATEMENT AUDIT. THE COMPLETED FORM 990 IS E-MAILED TO THE TRUSTEES. THE PLAN AUDITOR E-FILES THE FORM 990 AFTER RECEIVING SIGNED AUTHORIZATION FROM THE TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE PLAN DOES NOT HAVE A WRITTEN CONFLICT OF INTEREST POLICY. THE PLAN IS SUBJECT TO ERISA, AND AS SUCH THE TRUSTEES ARE SUBJECT TO THE CONFLICT OF INTEREST PROVISIONS CONTAINED WITHIN ERISA. 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