2021-06-16T13:36:14-05:00 2020-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2019-09-01 996009135 TEAMSTERS HEALTH & WELFARE TRUST FUND TEAM 8085230199 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 WAYNE KAULULAAU JENNY LEMAOTA UNION TRUSTEE/ EMPLOYER TRUSTEE 8085230199 2021-06-10 TERRY TAKAKI P00036112 8085336254 2019 2022-09-23 18:48:47Z WAYNE KAULULAAU JENNY L 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 57403716 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 42782740 43969119 236434 435004 2706347 2268374 45725521 46672497 0 0 42225952 44941140 0 0 0 0 0 1001261 676277 43227213 45617417 2498308 1055080 24223313 25250488 43861 15956 24179452 25234532 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 35199352 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $34,862,190, DENTAL $81,951, CHIROPRACTIC CARE $51,847, MEDICARE PREMIUM REIMBURSEMENTS $3,680, LIFE INSURANCE $17,924, AND VISION $181,760). 7721208 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL $1,030,829, DRUG $4,929,849, AND DENTAL $1,760,530). 286807 TO PAY FOR PLAN ADMINISTRATIVE FEES. 43207367 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 8 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 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 1.00 X 0 0 0 WAYNE KAULULAAU UNION TRUSTEE 1.00 X 0 0 0 JOHN KIM EMPLOYER TRUSTEE (ALT) 1.00 X 0 0 0 RYAN YOSHIDA UNION 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 286807 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 DENTAL CLAIMS ADMINISTRATOR 113788 BENEFIT PLAN SOLUTIONS INC 615 PIIKOI STREET SUITE 301 HONOLULU HI 96814 BENEFIT CONSULTANT 101770 3 EMPLOYERS' CONTRIB 900099 42564420 42564420 EMPLOYEES' CONTRIB 900099 1376163 1376163 LIQUIDATED DAMAGES 900099 28536 28536 43969119 397745 397745 10768478 10731219 37259 37259 37259 DRUG REBATES 900099 2020580 2020580 UNREALIZED GAINS/ (LOSSES) 900099 244201 244201 OTHER 900099 3593 3593 2268374 46672497 46274752 0 397745 44941140 16886 62561 39859 286807 13851 19737 17999 ADMINISTRATIVE FEES - M 116807 CONSULTANT FEES 101770 45617417 100 5205658 7018279 5150603 4885460 13754505 13220373 112447 126376 24223313 25250488 43861 15956 43861 15956 X 24179452 25234532 0 0 0 0 24179452 25234532 24223313 25250488 1055080 0 X X 0 1 X 1 0 0 X 44612058 0 44612058 39859 2020580 2060439 46672497 43556978 0 43556978 39859 2020580 2060439 45617417 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 2020 AND 2019 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: EXPERIENCE REFUNDS AND REBATES PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPERIENCE REFUNDS AND 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 SELECT 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 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: 1. ALOHA PETROLEUM TERMINAL OPERATORS 2. ALOHA PETROLEUM, LTD. 3. HC&D, LLC 4. B & C TRUCKING CO LTD. 5. BAKER COMMODITIES, INC. 6. YOUNG'S MARKET COMPANY (HILO/KONA) 7. YOUNG'S MARKET COMPANY (MAUI) 8. YOUNG'S MARKET COMPANY (OAHU) 9. CITY MILL COMPANY LTD. 10. AIRGAS USA, LLC 11. GOLDEN STATE FOODS CORP 12. HAWAII TRANSFER COMPANY 13. HAWAIIAN CEMENT 14. HONOLULU WOOD TREATING LLC 15. HONSADOR LUMBER CORPORATION 16. LOCAL 996 UNION EMPLOYEES 17. MARTIN WAREHOUSING & DIST. 18. MCKESSON DRUG CO 19. MERCANTILE TRUCKING SERVICE - TRUCKERS 20. MERCANTILE TRUCKING SERVICE - WAREHOUSE 21. OTS CLERICAL 22. OTS NON CLERICAL 23. OTS NON CLERICAL DISABILITY 24. OTS PARATRANSIT HANDIVAN - FT 25. OTS PARATRANSIT HANDIVAN - PT 26. OTS SALARY NON CLERICAL 27. OTS PARATRANSIT HANDIVAN - FT (MAINTENANCE & CLERICAL WORKERS) 28. PARADISE BEVERAGES KAUAI 29. UNICOLD CORPORATION 30. YELLOW TRANSPORTATION (FULL TIME) 31. ST. FRANCIS HEALTHCARE SYSTEM HAWAII 32. ST. FRANCIS MEDICAL CENTER 33. DON QUIJOTE