2016-01-21T23:49:49-06:00 2015-06-30 205496781 James P Hasselman CPA LLC PO Box 11149 Honolulu HI 96828 990 2014-07-01 996006907 Roofers Union Local 221 Health and Welfare Plan ROOF 8088417575 200 N Vineyard Blvd No 100 Honolulu HI 96817 Vaughn Chong Trustee 8088417575 2016-01-08 1 James Hasselman P00653759 8087215483 2016-01-08 X 2014 2016-04-25 22:37:26Z Vaughn Chong 200 N Vineyard Blvd No 100 Honolulu HI 96817 4116279 0 X N/A X 1965 HI The purpose of the plan is to provide health and welfare benefits to employees covered by the collective bargaining agreement. 6 5 0 0 0 0 0 0 1186336 1487204 208534 257362 0 3332 1394870 1747898 0 0 1366166 1628835 0 0 0 0 0 195129 210726 1561295 1839561 -166425 -91663 7348928 7326396 851075 1024683 6497853 6301713 The purpose of the Plan is to provide health and welfare benefits to employees covered by the collective bargaining agreement. 0 0 The Plan provided health and welfare benefits to employees covered by the collective bargaining agreement. 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 4 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 5 1 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Hawaii Benefit Administrators Inc 8088417575 200 N Vineyard Blvd Suite 100 Honolulu HI 96817 Tai Ai Trustee/Co-Chairman 1.00 X X 0 0 0 Vaughn Chong Trustee/Co-Chairman 1.00 X X 0 0 0 Enrique Subiono Trustee/Secretary 0.10 X X 0 89730 28047 Nephi Kaonohi Trustee 0.10 X 0 0 0 Dora Fong Trustee 0.10 X 0 0 0 Scott Ai Trustee 0.10 X 0 0 0 Tim Lyons Alternate Trustee 0.10 X 0 0 0 0 89730 28047 0 0 0 0 Hawaii Benefit Administrators Inc 200 N Vineyard Blvd Ste 100 Honolulu HI 96817 Administrative services 112808 1 Employer contributions 900099 1443870 1443870 Participant contributions 900099 25236 25236 Liquidated damages 900099 18098 18098 1487204 260743 260743 2365000 2368381 -3381 -3381 -3381 Other income 900099 3332 3332 3332 1747898 1490536 0 257362 1628835 112808 10575 17466 14543 30182 14264 2905 1362 4651 1970 1839561 30242 6499 451865 292054 116206 155078 1633 1208 6738410 6860505 10572 11052 7348928 7326396 9173 7551 841902 1017132 851075 1024683 X 0 0 0 0 6497853 6301713 6497853 6301713 7348928 7326396 -91663 -104477 0 X X 0 1 X 1 0 0 Plan benefit obligations 1017132 1017132 X 1633261 -104477 -104477 1737738 10160 10160 1747898 1829401 0 1829401 10160 10160 1839561 Part X, Line 2: Accounting principles generally accepted in the United States of America require Fund management to evaluate tax positions taken by the Fund and recognize a tax liability (or asset) if the organization has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Fund administrator has analyzed the tax positions taken by the Fund and has concluded that as of June 30, 2014, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Fund is subject to routine audits by taxing jurisdictions, however there are currently no audits for any tax periods in progress. The Fund administrator believes the Fund is no longer subject to income tax examinations for fiscal years prior to fiscal 2012. Form 990, Part VI, Section A, line 2 Trustee Subiono is an employee of a sister Roofers Trust Fund that has common trustees with this Fund, and thus has a business relationship, as defined in the instructions to form 990, with those trustees. Form 990, Part VI, Section A, line 7a The governing board is appointed by the Local Union No. 221 of the United Union of Roofers, Waterproofers and Allied Workers; and the Roofing Contractors Association of Hawaii. Form 990, Part VI, Section B, line 11 Form 990 is reviewed with the Trustees by the tax preparer prior to filing. Form 990, Part VI, Section B, line 12c The trustees report annually on any instances that could give rise to conflict of interest. Form 990, Part VI, Section C, line 19 The Plan does not make its governing documents, conflict of interest policy or financial statements available to the public. Form 990 Part XII, Line 2c The process for hiring the independent auditor and reviewing the results of the annual audit has not changed from the prior year. Form 990 Part VI, line 3 The board of trustees retains management control over the Fund. The organization utilizes the services of a third party administrator to provide certain administrative services. Roofers Union Local 221 Training Plan 200 N Vineyard Blvd Honolulu HI 96817 237152750 Provides training benefits to unionized employees. HI 501(c)(5) None 0 Roofers Union Local 221 Vacation & Health Trust Fund 200 N Vineyard Blvd Honolulu HI 96817 996005504 Provides vacation & holiday benefits to unionized employees HI 501(c)(9) None 0 Roofers Union Local 221 Pension Plan 200 N Vineyard Blvd Honolulu HI 96817 990208117 Provides retirement benefits to unionized employees HI None 0 Roofers Union Local 221 Annuity Plan 200 N Vineyard Blvd Honolulu HI 96817 990174607 Provides retirement benefits to unionized employees HI None 0 BEACHSIDE ROOFING LLC 91-571 NUKUAWA ST KAPOLEI HI 96707 JOYACE ROOFING LLC PO BOX 822303 PEARL CITY HI 96782 MTN INC LLC 14 INVERNESS DR E A-218 ENGELWOOD CO 80112 OMEGA ROOFING LLC 4321 LIKINI STREET HONOLULU HI 96818 PROTECH ROOFING LLC PO BOX 31226 HONOLULU HI 96820 A TEAM PACIFIC ROOFING 3790 SCHACHT ST FAIRBANKS AK 99701 ALCAL SPECIALTY 946 N MARKET BLVD SACRAMENTO CA 95834 BUCK ROOFING CO INC 47-609 HUI ULILI ST KANEOHE HI 96744 FIDDLER ROOFING PO BOX 894510 MILILANI HI 96789 HAAS INSULATION INC 94-1388 MOANIANI ST 111 WAIPAHU HI 96797 HONOLULU ROOFING COMPANY 2004 KAHAI ST HONOLULU HI 96819 LEEWARD ROOFING & GENERAL PO BOX 886 WAIANAE HI 96797 PACIFIC TECH CONSTRUCTION 1302 WALNUT STREET Kelso WA 98626 ROOFERS TRAINING OFFICE PO BOX 17250 HONOLULU HI 96817 ROOFERS UNION LOCAL 221 PO BOX 17250 HONOLULU HI 96817 STRUCTURAL DYNAMICS INC PO BOX 30106 HONOLULU HI 96820 TROPICAL ROOFING INC 94-078 LEOKANE ST WAIPAHU HI 96797 TYSON'S INC 533 ONEAWA STREET KAILUA HI 96734 ULTIMATE ROOFING INC 519 MANONO ST HILO HI 96720 WESTERN WATERPROOFING CO 1637 NORTHWARSON ROAD ST LOUIS MO 63132 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0