2018-06-14T16:22:01-05:00 2017-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 500 ALA MOANA BLVD BLDG 2 302 HONOLULU HI 96813 990 2016-09-01 996009135 TEAMSTERS HEALTH & WELFARE TRUST FUND TEAM 8085230199 560 n nimitz hwy No 209 HONOLULU HI 96817 RONAN KOZUMA DARREL TAJIMA UNION TRUSTEE/ EMPLOYER TRUSTEE 8085230199 2018-06-02 1 TERRY TAKAKI P00036112 8085336254 2016 2022-09-23 18:48:47Z RONAN KOZUMA DARREL TAJ 560 n nimitz hwy No 209 HONOLULU HI 96817 114571450 0 X N/A X 1957 HI TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 4 4 0 0 0 0 0 0 40079759 41659383 133822 250372 803023 897903 41016604 42807658 0 0 36654362 42318138 0 0 0 0 0 2022976 1772848 38677338 44090986 2339266 -1283328 26236774 24785156 246599 78309 25990175 24706847 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 39675173 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL $ 30,700,819, DRUG $ 6,787,709, DENTAL $2,018,543, AND VISION $ 168,102). TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $1,518,059, DENTAL $105,229, CHIROPRACTIC CARE $50,875, MEDICARE PREMIUM REIMBURSEMENTS $6,179, AND LIFE INSURANCE $8,645). 1246070 TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (MEDICAL $1,080,255, ACA FEES $13,600, DENTAL $121,074, DRUG $14,094, AND VISION $17,047). 40921243 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 1 0 0 1 1 0 1 0 0 0 0 0 0 0 X 4 4 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 DARREL TAJIMA EMPLOYER TRUSTEE 1.00 X 0 0 0 ROBERT YU EMPLOYER TRUSTEE (FORMER) 1.00 X 0 0 0 MILLIE DOWNEY UNION TRUSTEE 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 0 0 0 0 0 0 0 hma inc 1440 kapiolani blvd honolulu HI 96814 medical claims administrator 989045 benefit & risk management services 560 n nimitz hwy STE 209 honolulu HI 96817 third party administrator/CLAIMS REPRICI 293053 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOlulu HI 96813 DENTAL CLAIMS ADMINISTRATOR 121074 BENEFIT PLAN SOLUTIONS 680 IWILEI ROAD 528 Honolulu HI 96817 CONSULTANT 103358 4 EMPLOYERS' CONTRIB 900099 41447595 41447595 EMPLOYEES' CONTRIB 900099 196565 196565 LIQUIDATED DAMAGES 900099 15223 15223 41659383 483543 483543 71530621 71763792 -233171 -233171 -233171 Drug Rebates 900099 953978 953978 OTHER 900099 2130 2130 UNREALIZED GAINS/ (LOSSES) 900099 -58205 -58205 897903 42807658 42324115 0 483543 42318138 11402 43922 33815 13600 22761 20098 4933 ADMINISTRATIVE FEES - M 1487439 CONSULTANT FEES 103358 BANK SERVICE CHARGES 31520 44090986 100 100 6303055 2949050 3992110 4072852 15883834 17687036 57675 76118 26236774 24785156 246574 72905 25 5404 246599 78309 X 25990175 24706847 0 0 0 0 25990175 24706847 26236774 24785156 -1283328 0 X X 0 1 X 1 0 0 Bank Overdraft 5404 5404 X 41819865 0 41819865 33815 953978 987793 42807658 43103193 0 43103193 33815 953978 987793 44090986 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, PAGE 12, 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 (FKA: AMERON) 4 . B & C TRUCKING CO. 5 . BAKER COMMODITIES 6 . BETTER BRANDS (HILO/KONA) 7 . BETTER BRANDS (MAUI) 8 . BETTER BRANDS (OAHU) 9 . CITY MILL COMPANY, LTD. 10 . FRESH START BAKERIES 11 . AIRGAS USA 12 . GOLDEN STATE FOODS 13 . HAWAII TRANSFER COMPANY 14 . HAWAIIAN CEMENT 15 . HONOLULU WOOD TREATING 16 . HONSADOR LUMBER CORP. 17 . LOCAL 996 UNION 18 . MARTIN TRANSPORTATION 19 . MCKESSON DRUG CO. 20 . MEADOW GOLD DAIRIES (HILO) 21 . MEADOW GOLD DAIRIES (OAHU) 22 . MERCANTILE TRUCKING (DRIVERS) 23 . MERCANTILE TRUCKING (WAREHOUSE) 24 . PARADISE BEVERAGES 25 . PARADISE BEVERAGES KAUAI 26 . SERTA MATTRESS COMPANY 27 . THE HERTZ CORPORATION 28 . UNICOLD CORPORATION 29 . YELLOW FREIGHT 30 . ST. FRANCIS 31 . DON QUIJOTE 32 . OAHU TRANSIT SERVICES 33 . OTS - PARATRANSIT