2020-07-14T22:21:45-05:00 2019-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2018-09-01 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 2020-07-14 TERRY TAKAKI P00036112 8085336254 72.253.73.75 2020-07-14 22:21:41 HS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A7C9EC184B2A76AAA9F14E94878FDC8C494D6D3C 2018 2021-09-10 13:11:23Z WAYNE KAULULAAU JENNY L 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 103940681 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 41511975 42782740 304340 236434 678549 2706347 42494864 45725521 0 0 44118229 42225952 0 0 0 0 0 1402338 1001261 45520567 43227213 -3025703 2498308 21726384 24223313 45240 43861 21681144 24179452 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 26143988 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $25,791,986, DENTAL $91,098, CHIROPRACTIC CARE $48,030, MEDICARE PREMIUM REIMBURSEMENTS $3,968, LIFE INSURANCE $17,617, AND VISION $191,289). 13955302 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL $ 6,199,301, DRUG $ 5,696,154, AND DENTAL $2,059,847). 407051 TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (MEDICAL $260,960, PCORI FEES $18,596, DENTAL $121,904, AND DRUG $5,591). 40506341 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 2 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 TK HANNEMANN FORMER EMPLOYER TRUSTEE (ALT) 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 283359 HMA INC 1440 KAPIOLANI BLVD HONOLULU HI 96814 MEDICAL CLAIMS ADMINISTRATOR 242275 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 DENTAL CLAIMS ADMINISTRATOR 121904 3 EMPLOYERS' CONTRIB 900099 41383940 41383940 EMPLOYEES' CONTRIB 900099 1389914 1389914 LIQUIDATED DAMAGES 900099 8886 8886 42782740 446859 446859 58004735 58215160 -210425 -210425 -210425 DRUG REBATES 900099 2126662 2126662 UNREALIZED GAINS/ (LOSSES) 900099 576497 576497 OTHER 900099 3188 3188 2706347 45725521 45278662 0 446859 42225952 29861 79861 47224 18596 33251 23738 21481 ADMINISTRATIVE FEES - M 664230 CONSULTANT FEES 83019 43227213 100 100 3282390 5205658 3945674 5150603 14399018 13754505 99202 112447 21726384 24223313 45240 43861 45240 43861 X 21681144 24179452 0 0 0 0 21681144 24179452 21726384 24223313 2498308 0 X X 0 0 0 0 X 43551635 0 43551635 47224 2126662 2173886 45725521 41053327 0 41053327 47224 2126662 2173886 43227213 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 2018 AND 2017 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. AIRGAS USA, LLC 2. ALOHA PETROLEUM, LTD. 3. ALOHA PETROLEUM TERMINAL OPERATORS 4. HC&D, LLC (FKA: AMERON) 5. B&C TRUCKING COMPANY, LTD. 6. BAKER COMMODITIES (DBA ISLAND COMMODITIES) 7. YONGS MARKET (MAUI) 8. YOUNGS MARKET (OAHU) 9. CITY MILL COMPANY, LTD. 10. DON QUIJOTE MEAT CUTTERS 11. GOLDEN STATE FOODS 12. HAWAII TRANSFER COMPANY, LTD. 13. HAWAIIAN CEMENT 14. HONOLULU WOOD TREATING 15. HONSADOR LUMBER, LLC 16. MARTIN TRANSPORTATION SERVICES 17. MCKESSON DRUG 18. MEADOW GOLD DAIRIES - OAHU 19. MEADOW GOLD DAIRIES - HILO 20. MERCANTILE TRUCKING 21. OAHU TRANSIT SERVICES 22. OTS - PARATRANSIT SERVICES 23. PARADISE BEVERAGES KAUAI 24. ST. FRANCIS MEDICAL CENTER 25. ST. FRANCIS COMMUNITY HEALTH SERVICES 26. TEAMSTERS UNION LOCAL 996 27. UNICOLD CORPORATION 28. YELLOW TRANSPORTATION