2022-07-07T15:11:12-05:00 2021-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2020-09-01 996009135 TEAMSTERS HEALTH & WELFARE TRUST FUND TEAM 8085230199 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 KEVIN HOLU JENNY LEMAOTA UNION TRUSTEE/ EMPLOYER TRUSTEE 8085230199 2022-07-05 KEVIN HOLU JENNY LEMAOTA 999009999 TERRY TAKAKI P00036112 8085336254 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KEVIN HOLU JENNY LEMAOT 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 58057316 0 X N/A X 1957 HI TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 4 0 0 0 0 0 0 0 43969119 44187332 435004 287655 2268374 1890374 46672497 46365361 0 0 44941140 43176365 0 0 0 0 0 676277 702825 45617417 43879190 1055080 2486171 25250488 27503384 15956 0 25234532 27503384 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 34610355 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $34,203,951, DENTAL $58,043, CHIROPRACTIC CARE $47,654, MEDICARE PREMIUM REIMBURSEMENTS $3,809, LIFE INSURANCE $22,497, AND VISION $274,401). 6678957 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL REFUNDS <$27,550>, DRUG $4,861,067, AND DENTAL $1,845,440). 120480 TO PAY FOR SELF-FUNDED BENEFIT ADMINISTRATIVE FEES. 41409792 0 0 0 0 0 0 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 1 0 1 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 HI X BENEFIT RISK & MANAGEMENT SERVICES 8085230199 560 N NIMITZ HIGHWAY STE 209 HONOLULU HI 96817 X RONAN KOZUMA UNION TRUSTEE 1.00 X 0 0 0 FRED LIVA UNION TRUSTEE (ALT) 1.00 X 0 0 0 JENNY LEMAOTA EMPLOYER TRUSTEE 1.00 X 0 0 0 PEARL LARA EMPLOYER TRUSTEE (FORMER) 1.00 X 0 0 0 WAYNE KAULULAAU UNION TRUSTEE 1.00 X 0 0 0 JOHN KIM EMPLOYER TRUSTEE (FORMER ALT) 1.00 X 0 0 0 RYAN YOSHIDA UNION TRUSTEE (ALT) 1.00 X 0 0 0 ROBERT YU EMPLOYER TRUSTEE 1.00 X 0 0 0 EILEEN MORI-MISHINA EMPLOYER TRUSTEE (ALT) 1.00 X 0 0 0 0 0 0 0 0 0 0 BENEFIT & RISK MANAGEMENT SERVICES 560 N NIMITZ HWY STE 209 HONOLULU HI 96817 THIRD PARTY ADMINISTRATOR/CLAIMS REPRICI 295872 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 DENTAL CLAIMS ADMINISTRATOR 117991 BENEFIT PLAN SOLUTIONS INC 615 PIIKOI STREET SUITE 301 HONOLULU HI 96814 BENEFIT CONSULTANT 105499 3 EMPLOYERS' CONTRIB 900099 42620639 42620639 EMPLOYEES' CONTRIB 900099 1557573 1557573 LIQUIDATED DAMAGES 900099 9120 9120 44187332 352028 352028 11627582 11691955 -64373 -64373 -64373 DRUG REBATES 900099 1887053 1887053 OTHER 900099 3321 3321 1890374 46365361 46013333 0 352028 43176365 10511 43880 56650 295872 38298 10283 20944 ADMINISTRATIVE FEES - D 120480 CONSULTANT FEES 105907 43879190 7018279 8351331 4885460 4684634 13220373 14328266 126376 139153 25250488 27503384 15956 15956 0 X 25234532 27503384 0 0 0 0 25234532 27503384 25250488 27503384 2486171 -217319 0 X X 0 1 X 1 0 0 X 44204339 -217319 -217319 44421658 56650 1887053 1943703 46365361 41935487 0 41935487 56650 1887053 1943703 43879190 PART X, LINE 2: THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING DISCLOSURE PERTAINING TO FIN 48 (ASC 740) "THE TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE IRS DATED MARCH 1, 1996, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE IRC. HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2021 AND 2020 FOR UNRELATED BUSINESS TAXABLE INCOME." IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: DRUG REBATES PART XII, LINE 4B - OTHER ADJUSTMENTS: DRUG REBATES FORM 990, PART VI, SECTION B, LINE 11B THE ADMINISTRATOR DISSEMINATES THE FORM 990 TO UNION AND EMPLOYER TRUSTEE REPRESENTATIVES FOR THEIR REVIEW AND EXECUTION. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EXECUTE A STATEMENT OF COMPLIANCE WHICH IS KEPT ON FILE. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C NO CHANGE IN REVIEW PROCESS FROM PRIOR YEAR. BOARD OF TRUSTEES SELECTS AN INDEPENDENT AUDITOR. ADMINISTRATOR FORMALLY REVIEWS AND APPROVES THE FINANCIAL STATEMENTS. BOARD OF TRUSTEES REVIEW AND APPROVE THE FINANCIAL STATEMENTS. 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, IV THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER PLAN THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. THE ADMINISTRATOR'S OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS INCLUDING THE NAMES, ADDRESSES, AND OTHER CONTACT INFORMATION. HOWEVER, THE LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC) FOR EACH CONTRIBUTING EMPLOYERS 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: 1. ALOHA PETROLEUM TERMINAL OPERATORS 2. ALOHA PETROLEUM, LTD. 3. HC&D, LLC 4. B & C TRUCKING CO LTD 5. BAKER COMMODITIES INC. 6. ISLAND PUMPING SERVICES, INC. 7. YOUNG'S MARKET COMPANY - HILO/KONA 8. YOUNG'S MARKET COMPANY - MAUI 9. YOUNG'S MARKET COMPANY - OAHU 10. CITY MILL COMPANY LTD. 11. AIRGAS USA, LLC 12. GOLDEN STATE FOODS CORP 13. HAWAII TRANSFER COMPANY 14. HAWAIIAN CEMENT 15. HONOLULU WOOD TREATING LLC 16. HONSADOR LUMBER CORPORATION 17. LOCAL 996 UNION EMPLOYEES 18. MARTIN TRANSPORTATION SERVICES 19. MCKESSON DRUG CO 20. MERCANTILE TRUCKING SERVICE (TRUCKERS) 21. MERCANTILE TRUCKING SERVICE (WAREHOUSE) 22. OTS CLERICAL 23. OTS NON CLERICAL 24. OTS PARATRANSIT HANDIVAN 25. OTS SALARY NON CLERICAL 26. PARADISE BEVERAGES KAUAI 27. UNICOLD CORPORATION 28. YELLOW TRANSPORTATION 29. ST. FRANCIS HEALTHCARE SYSTEM HAWAII 30. ST. FRANCIS MEDICAL CENTER 32. DON QUIJOTE