2017-07-14T13:00:00-05:00 2016-08-31 990155373 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVENUE SUITE 336 HONOLULU HI 968144012 990 2015-09-01 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 2017-07-07 1 TERRY TAKAKI P00036112 8085336254 2015 2021-01-29 14:40:06Z RONAN KOZUMA DARREL TAJ 560 n nimitz hwy No 209 HONOLULU HI 96817 83546425 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 37139541 40079759 123456 133822 174402 803023 37437399 41016604 0 0 34909086 36654362 0 0 0 0 0 2221740 2022976 37130826 38677338 306573 2339266 23940105 26236774 289196 246599 23650909 25990175 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 34685827 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (MEDICAL $ 25,539,279, DRUG $ 6,983,108, DENTAL $1,984,585, AND VISION $ 178,855). 1451579 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (MEDICAL $1,248,929, DENTAL $123,055, CHIROPRACTIC CARE $52,608, MEDICARE PREMIUM REIMBURSEMENTS $14,174, AND LIFE INSURANCE $12,813). 1505264 TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (MEDICAL $1,146,747, ACA FEES $216,927, DENTAL $124,258, AND VISION $17,332). 37642670 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 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 MIKE COSTA UNION TRUSTEE (ALT) 1.00 X 0 0 0 0 0 0 0 0 0 0 hma inc 1440 kapiolani blvd honolulu HI 96814 medical claims administrator 997193 benefit & risk management services 560 n nimitz hwy STE 209 honolulu HI 96817 third party administrator/CLAIMS REPRICI 264892 Hawaii Commmunity Health Alliance 1136 Union Mall Suite 301 Honolulu HI 96813 Claims Repricing/Network Management 129824 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOlulu HI 96813 DENTAL CLAIMS ADMINISTRATOR 124258 4 EMPLOYERS' CONTRIB 900099 39871745 39871745 EMPLOYEES' CONTRIB 900099 201628 201628 LIQUIDATED DAMAGES 900099 6386 6386 40079759 431857 431857 42231786 42529821 -298035 -298035 -298035 Drug Rebates 900099 516956 516956 UNREALIZED GAINS/ (LOSSES) 900099 284475 284475 OTHER 900099 1592 1592 803023 41016604 40596715 0 419889 36654362 46795 42643 32707 216927 23471 9827 4460 ADMINISTRATIVE FEES - M 1533499 CONSULTANT FEES 92168 BANK SERVICE CHARGES 20479 38677338 100 100 5711190 6303055 3407719 3992110 14818096 15883834 3000 57675 23940105 26236774 288142 246574 1054 25 289196 246599 X 23650909 25990175 0 0 0 0 23650909 25990175 23940105 26236774 2339266 0 X X 0 1 X 1 0 0 Bank Overdraft 25 25 X 40466941 0 40466941 32707 516956 549663 41016604 38127675 0 38127675 32707 516956 549663 38677338 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 2015 and 2014 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 2013." 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 11 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 3, PART IV, LINE 11B: 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 ADMINISTRATORS 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. AMERICAN LINEN 4. HC&D, LLC (FKA: AMERON) 5. B & C TRUCKING CO. 6. BAKER COMMODITIES 7. BETTER BRANDS (HILO/KONA) 8. BETTER BRANDS (MAUI) 9. BETTER BRANDS (OAHU) 10. CITY MILL COMPANY, LTD. 11. FRESH START BAKERIES 12. AIRGAS USA 13. GOLDEN STATE FOODS 14. HAWAII TRANSFER COMPANY 15. HAWAIIAN CEMENT 16. HONOLULU WOOD TREATING 17. HONSADOR LUMBER CORP. 18. LOCAL 996 UNION 19. MARTIN TRANSPORTATION 20. MCKESSON DRUG CO. 21. MEADOW GOLD DAIRIES (HILO) 22. MEADOW GOLD DAIRIES (OAHU) 23. MERCANTILE TRUCKING (DRIVERS) 24. MERCANTILE TRUCKING (WAREHOUSE) 25. PARADISE BEVERAGES 26. PARADISE BEVERAGES KAUAI 27. HAWAII COFFEE COMPANY 28. SERTA MATTRESS COMPANY 29. THE HERTZ CORPORATION 30. UNICOLD CORPORATION 31. UNITED PARCEL SERVICE 32. YELLOW FREIGHT 33. SBM SITE SERVICES 34. ST. FRANCIS 35. DON QUIJOTE 36. OAHU TRANSIT SERVICES 37. OTS - PARATRANSIT