2023-11-13T18:11:52-06:00 2022-12-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2022-01-01 202076868 ILWU LOCAL 142 HEALTH AND WELFARE TRUST ILWU 8084418600 1440 KAPIOLANI BLVD 800 HONOLULU HI 96814 GUY FUJIMURA-UNION TRUSTEE CARLA THOMAS-MGMT TRUSTEE 8084418600 2023-11-07 GUY FUJIMURA-UNION TRUST 999009999 0 TERRY TAKAKI P00036112 8085336254 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GUY FUJIMURA-UNION TRUSTE 1440 KAPIOLANI BLVD 800 HONOLULU HI 96814 123668332 0 X N/A X 2005 HI TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS IN ACCORDANCE W/PLAN DOCUMENTS. 6 0 0 0 0 0 0 0 42451639 52093598 1304986 882153 0 1774 43756625 52977525 0 0 39885635 41225852 0 0 0 0 0 1854368 1968186 41740003 43194038 2016622 9783487 45783009 53414024 174421 751684 45608588 52662340 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR FAMILIES. 0 0 29434091 TO PROVIDE SELF-FUNDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS IN ACCORDANCE WITH THE TERMS SET FORTH IN THE TRUST AGREEMENTS,RULES AND REGULATIONS OF THE PLAN AND CBA (MEDICAL $23,453,091, DRUG $6,141,372 DRUG REBATES $-2,232,999 AND DENTAL $2,072,627) 11791761 TO PROVIDE INSURED BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS - (MEDICAL $11,440,742 CHIROPRACTIC $78,209, AND VISION $272,810) 1180377 TO PROVIDE SELF-FUNDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS FOR THE CLAIMS ADMINISTRATIVE FEE (MEDICAL $1,180,377, DRUG $3,349 DENTAL $133,628) 42406229 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 1 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X PACIFIC ADMINISTRATORS INC 8084418600 1440 KAPIOLANI BLVD SUITE 800 HONOLULU HI 96814 X GUY FUJIMURA UNION TRUSTEE 1.00 X 0 0 0 CARLA THOMAS EMPLOYER TRUSTEE 1.00 X 0 0 0 ROBERTO ANDRION JR UNION TRUSTEE 1.00 X 0 0 0 ERIC LOTTERMOSER EMPLOYER TRUSTEE 1.00 X 0 0 0 EVANGELINE SOBREPENA EMPLOYER TRUSTEE 1.00 X 0 0 0 ELMER GOROSPE UNION TRUSTEE 1.00 X 0 0 0 JEAN EWING ALTERNATE EMPLOYER TRUSTEE 1.00 X 0 0 0 ROSELYN MOLINA ALTERNATE UNION TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 HAWAII MEDICAL SERVICE ASSOCIATION 818 KEEAUMOKU ST HONOLULU HI 96814 CLAIMS SERVICE FEES AND CASE MANAGEMENT 1043400 PACIFIC ADMINISTRATORS 1440 KAPIOLANI BLVD 800 HONOLULU HI 96814 ADMINISTRATIVE FEES AND PAYROLL AUDIT 288841 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 CLAIMS SERVICE FEES AND CASE MANAGEMENT 133628 3 EMPLOYERS' CONTRIBUTIO 900099 52011575 52011575 EMPLOYEES' CONTRIBUTIO 900099 82023 82023 52093598 878840 878840 70694120 70690807 3313 3313 3313 OTHER INCOME 541100 1774 1774 1774 52977525 52096911 0 880614 41225852 282160 23617 50930 104543 1351860 54741 28201 72134 43194038 5353658 4579988 6709399 7581716 1849835 1707201 31870117 39545119 45783009 53414024 130803 131319 43618 620365 174421 751684 X 45608588 52662340 0 0 0 0 45608588 52662340 45783009 53414024 9783487 -2729735 0 X 0 0 0 0 EMPLOYER CONTRIBUTION OVERPAYMENT 620365 620365 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO THE CO-CHAIRS (MANAGEMENT TRUSTEE AND UNION TRUSTEE) FOR REVIEW AND SIGNATURE PRIOR TO THE FILING OF THE FORM 990 FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES REVIEW POLICY AND DISCUSS ANY ARISING ISSUES/QUESTIONS WITH LEGAL COUNSEL FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST SEE SCHEDULE R SUPPLEMENTAL INFORMATION SEE SCHEDULE R SUPPLEMENTAL INFORMATION SEE SCHEDULE R SUPPLEMENTAL INFORMATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE R, PARTS II, III, AND IV THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER PLAN THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS IN ACCORDANCE WITH THE TERMS SET FORTH IN THE TRUST AGREEMENT, RULES, AND REGULATIONS OF THE PLAN AND COLLECTIVE BARGAINING AGREEMENTS. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF CONTRIBUTING EMPLOYERS INCLUDING THE NAMES, ADDRESSES, AND OTHER CONTACT INFORMATION. HOWEVER, THE LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS COULD NOT BE SEPARATED BY TYPE OF ORGANIZATION. HOWEVER, THEY ARE LISTED BELOW: ALOHILANI RESORT AT WAIKIKI BEACH FKA PACIFIC BEACH HOTEL ANDAZ MAUI AT WAILEA GRAND HYATT KAUAI GRAND WAILEA RESORT HOTEL & SPA HILTON WAIKOLOA VILLAGE HONOLULU AIRPORT HOTEL HYATT REGENCY MAUI KAANAPALI BEACH HOTEL LANAI RESORTS, LLC. (SHUTTLE DRIVERS) LANAI RESORTS, LLC. FKA FOUR SEASONS LANAI MAUNA KEA BEACH HOTEL PRINCEVILLE UTILITIES CO., INC. THE WESTIN MAUI RESORT & SPA TROON GOLF (MAKAI)