2019-07-05T17:54:03-05:00 2018-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2017-09-01 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 2019-06-14 TERRY TAKAKI P00036112 8085336254 72.253.73.75 2019-06-14 14:44:05 HS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A7C9EC184B2A76AAA9F14E94878FDC8C494D6D3C 2017 2019-02-21 02:37:17Z WAYNE KAULULAAU JENNY L 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 95648280 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 41659383 41511975 250372 304340 897903 678549 42807658 42494864 0 0 42318138 44118229 0 0 0 0 0 1772848 1402338 44090986 45520567 -1283328 -3025703 24785156 21726384 78309 45240 24706847 21681144 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL $ 20,843,973, DRUG $ 7,266,805, DENTAL $2,255,250, AND VISION $ 163,431). TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $12,488,545, DENTAL $100,253, CHIROPRACTIC CARE $51,116, MEDICARE PREMIUM REIMBURSEMENTS $4,835, AND LIFE INSURANCE $18,446). TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (MEDICAL $659,818, PCORI FEES $13,874, DENTAL $123,195, DRUG $11,961, AND VISION $16,343). 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 4 0 1 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 X RONAN KOZUMA UNION TRUSTEE 1.00 X 0 0 0 MILLIE DOWNEY UNION TRUSTEE (FORMER) 1.00 X 0 0 0 TK HANNEMANN 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 0 0 0 0 0 0 0 HMA INC 1440 KAPIOLANI BLVD HONOLULU HI 96814 MEDICAL CLAIMS ADMINISTRATOR 604278 BENEFIT & RISK MANAGEMENT SERVICES 560 N NIMITZ HWY STE 209 HONOLULU HI 96817 THIRD PARTY ADMINISTRATOR/CLAIMS REPRICI 287716 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 DENTAL CLAIMS ADMINISTRATOR 123195 BENEFIT PLAN SOLUTIONS 680 IWILEI ROAD 528 HONOLULU HI 96817 CONSULTANT 111049 4 EMPLOYERS' CONTRIB 900099 40919820 40919820 EMPLOYEES' CONTRIB 900099 581583 581583 LIQUIDATED DAMAGES 900099 10572 10572 41511975 532267 532267 52925489 53153416 -227927 -227927 -227927 DRUG REBATES 900099 925575 925575 OTHER 900099 2802 2802 UNREALIZED GAINS/ (LOSSES) 900099 -249828 -249828 678549 42494864 41962597 0 532267 44118229 37960 45240 34440 13874 19236 23432 17830 ADMINISTRATIVE FEES - M 1076485 CONSULTANT FEES 111049 BANK SERVICE CHARGES 22792 45520567 100 100 2949050 3282390 4072852 3945674 17687036 14399018 76118 99202 24785156 21726384 72905 45240 5404 0 78309 45240 X 24706847 21681144 0 0 0 0 24706847 21681144 24785156 21726384 -3025703 0 X X 0 1 X 1 0 0 X 41534849 0 41534849 34440 925575 960015 42494864 44560552 0 44560552 34440 925575 960015 45520567 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 2017 AND 2016 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. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2014." 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 VII, SECTION A: THE ORGANIZATION WAS UNABLE TO OBTAIN THE COMPENSATION FROM INDIVIDUALS OF RELATED ORGANIZATIONS AFTER MAKING A REASONABLE EFFOR TO SECURE SUCH INFORMATION. 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. YOUNGS MARKET (HILO/KONA) 8. YOUNGS MARKET (MAUI) 9. YOUNGS MARKET (OAHU) 10. CITY MILL COMPANY, LTD. 11. DON QUIJOTE MEAT CUTTERS 12. GOLDEN STATE FOODS 13. HAWAIIAN TRANSFER COMPANY, LTD. 14. HAWAIIAN CEMENT 15. HONOLULU WOOD TREATING 16. HONSADOR LUMBER, LLC 17. MARTIN TRANSPORTATION SERVICES 18. MCKESSON DRUG 19. MEADOW GOLD DAIRIES - OAHU 20. MEADOW GOLD DAIRIES - HILO 21. MERCANTILE TRUCKING (DRIVERS/WAREHOUSE) 22. NATIONAL BEDDING COMPANY, LLC (DBA SERTA MATTRESS) 23. OAHU TRANSIT SERVICES 24. PARADISE BEVERAGES KAUAI 25. ST. FRANCIS MEDICAL CENTER 26. ST. FRANCIS COMMUNITY HEALTH SERVICES 27. TEAMSTERS UNION LOCAL 996 28. UNICOLD CORPORATION 29. YELLOW TRANSPORTATION (FULL/PART-TIME)