2019-07-15T11:52:29-05:00 2018-08-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-09-01 996014749 HAWAII LABORERS HEALTH AND WELFARE PLAN HAWA 8084418600 1440 KAPIOLANI BLVD NO 800 HONOLULU HI 96814 TRUSTEE TRUSTEE TRUSTEE 8084418600 2019-07-15 1 TROY ATKINSON P00739466 9094664410 69.170.7.86 2019-07-15 11:50:16 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 79ACAE867A9DB9871DCF109F9EDC9C017100E02E 2017 2019-02-21 02:37:17Z TRUSTEE 1440 KAPIOLANI BLVD NO 800 HONOLULU HI 96814 185106908 0 X N/A X 1967 HI SEE PART III LINE 4A 10 10 1 0 0 0 0 0 34585825 35270245 4528948 2152696 1307110 3209322 40421883 40632263 0 0 38957702 35414727 114700 113918 0 0 0 3103558 3127306 42175960 38655951 -1754077 1976312 92765470 94130844 27466045 26619991 65299425 67510853 NONE 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES ACCORDING TO THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE EMPLOYERS AND THE UNION. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 0 0 0 1 633 0 1 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X PACIFIC ADMINISTRATORS INC 8084418600 1440 KAPIOLANI BLVD SUITE 800 HONOLULU HI 96814 X ALFONSO OLIVER TRUSTEE 5.00 X 0 0 0 PETER GANABAN TRUSTEE 5.00 X 0 0 0 JOBY NORTH II TRUSTEE 5.00 X 0 0 0 ANACLETO ALCANTRA TRUSTEE 5.00 X 0 0 0 RICHARD NISHIE TRUSTEE 5.00 X 0 0 0 MARK TRAVALINO TRUSTEE 5.00 X 0 0 0 RUSSELL NONAKA TRUSTEE 5.00 X 0 0 0 MARK TAMASHIRO TRUSTEE 5.00 X 0 0 0 RON PRESCOTT TRUSTEE 5.00 X 0 0 0 MARK TAGAMI TRUSTEE 5.00 X 0 0 0 DONNA ROBINSON NURSE 40.00 X 105536 0 8132 105536 0 8132 1 0 0 0 PACIFIC ADMINISTRATORS 1440 KAPIOLANI BLVD SUITE 800 HONOLULU HI 96814 1844667 RENALOGIC 22601 N 19TH AVE SUITE 230 PHOENIX AZ 85027 113918 HAWAII DENTAL SERVICE 700 BISHOP STREET SUITE 700 HONOLULU HI 96813 100012 3 EMPLOYER CONTRIBUTIONS 900099 34223297 34223297 PARTIC. CONTRIBUTIONS 900099 939141 939141 COBRA CONTRIBUTIONS 900099 107807 107807 35270245 2549028 2549028 144078313 144474645 -396332 -396332 -396332 PREMIUM REFUNDS 900099 2148867 2148867 STOP LOSS REIMBURSEMENT 900099 966369 966369 LIQUIDATED DAMAGES 900099 91547 91547 2539 2539 3209322 40632263 38083235 0 2549028 35414727 53328 8132 15225 37233 2398693 76505 41850 163613 249856 91051 13175 24476 NATIONAL HEALTH FUND 57704 PCORI FEE 9356 OTHER 1027 38655951 5010788 388911 0 11375485 3035519 3166489 23413 26990 82724687 76858921 1971063 2314048 92765470 94130844 110299 272779 27355746 26347212 27466045 26619991 X 0 0 0 0 65299425 67510853 65299425 67510853 92765470 94130844 1976312 235116 0 X X 0 1 X 1 0 0 DUE TO BROKER 11489 CLAIMS INCURRED BUT NOT REPORTED 3041138 ACCUMULATED ELIGIBILITY CREDIT 23294585 26347212 X 40867379 235116 235116 40632263 0 40632263 38655951 0 38655951 0 38655951 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST MANAGEMENT BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. FORM 990, PART VI, SECTION B, LINE 11B THE CHAIR AND CO-CHAIR REVIEW THE FORM; THE TRUSTEES ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW PRIOR TO SIGNING AND FILING. FORM 990, PART VI, SECTION B, LINE 12C DURING EACH REGULARLY SCHEDULED BOARD OF TRUSTEE MEETING, THE CONSULTANTS GIVE DETAILED REPORTS ON VARIOUS ASPECTS OF THE FUND'S ACTIVITIES. IN THE COURSE OF THESE REPORTS, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST MAY BE REVEALED. EVERY SITUATION, SHOULD THEY ARISE, IS DEALT WITH IN THE APPROPRIATE MANNER BASED ON THE GUIDELINES SET FORTH IN THE POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL INFORMATION ARE AVAILABLE UPON REQUEST AS STATED IN THE SUMMARY ANNUAL REPORTS THAT ARE DISTRIBUTED EACH PLAN YEAR TO ALL PLAN PARTICIPANTS. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.