2014-07-08T18:16:23-05:00 2013-08-31 300702322 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2012-09-01 996014749 HAWAII LABORERS HEALTH AND WELFARE PLAN HAWA 8084418600 1440 KAPIOLANI BLVD NO 800 HONOLULU HI 96814 TRUSTEE 8084418600 2014-07-08 1 4158364000 2012 2015-11-30 17:44:51Z TRUSTEE 1440 KAPIOLANI BLVD NO 800 HONOLULU HI 96814 142031462 0 X N/A X 1967 HI SEE PART III LINE 4A 10 10 0 0 0 0 0 0 20730674 22447573 2127568 2024228 213585 499176 23071827 24970977 0 0 25103522 27316780 0 0 0 0 0 2380869 2384787 27484391 29701567 -4412564 -4730590 97943963 93671420 15841094 18541841 82102869 75129579 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 0 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 1 613 0 0 0 0 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 5.00 X 0 0 0 PETER GANABAN 5.00 X 0 0 0 JOBY NORTH II 5.00 X 0 0 0 ANACLETO ALCANTRA 5.00 X 0 0 0 ISMAEL SOLIS 5.00 X 0 0 0 MARK MATSUMOTO 5.00 X 0 0 0 RUSSELL NONAKA 5.00 X 0 0 0 LARRY LUM 5.00 X 0 0 0 RON PRESCOTT 5.00 X 0 0 0 ROBERT TASAKA 5.00 X 0 0 0 0 0 0 0 0 0 0 PACIFIC ADMINISTRATORS INC 1440 KAPIOLANI BLVD SUITE 800 HONOLULU HI 96814 PLAN ADMINISTRATION 1472174 PACIFIC ADMINISTRATORS INC 1440 KAPIOLANI BLVD SUITE 800 HONOLULU HI 96814 PAYROLL AUDITOR 123020 EXPRESS SCRIPTS ONE EXPRESS WAY ST LOUIS MO 63121 CLAIMS PROCESSING 119228 MILLIMAN 650 CALIFORNIA ST 17TH FLOOR SAN FRANCISCO CA 94108 CONSULTANT 110012 4 EMPLOYER CONTRIBUTIONS 900099 21327279 21327279 PARTIC. CONTRIBUTIONS 900099 970126 970126 COBRA CONTRIBUTIONS 900099 150168 150168 22447573 2562926 2562926 116521787 117060485 -538698 -538698 -538698 STOP LOSS REIMBURSEMENT 900099 385482 385482 LIQUIDATED DAMAGES 900099 88255 88255 OTHER INCOME 900099 25439 25439 499176 24970977 22408051 0 2562926 27316780 1658733 130304 159721 140479 110012 86294 10867 19990 NATIONAL HEALTH FUND 67187 OTHER 1200 29701567 22737730 23588312 1906047 2103133 22024 22732 72356812 66929006 921350 1028237 97943963 93671420 60297 113291 15780797 18428550 15841094 18541841 X 0 0 0 0 82102869 75129579 82102869 75129579 97943963 93671420 -4730590 -2242700 0 X X 0 1 X 1 0 0 CLAIMS INCURRED BUT NOT REPORTED 2350415 ACCUMULATED ELIGIBILITY CREDITS 16078135 18428550 22728277 -2242700 -2242700 24970977 0 24970977 29701567 0 29701567 0 29701567 FORM 990, PART IV, LINE 34 THE TRUST FUND HAS A SPECIFIC PROCEDURE IN PLACE FOR THIS NEW DISCLOSURE REQUIREMENT ON THE SCHEDULE R. THE ADMINISTRATOR HAS SENT OUT A QUESTIONNAIRE TO OBTAIN THE REQUIRED INFORMATION FROM THE CONTRIBUTING EMPLOYERS. THE ABOVE INFORMATION REPRESENTS WHAT THE TRUST FUND HAS RECEIVED TO DATE. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATOR PERFORMS A REVIEW OF THE 990 FOR REASONABLENESS BASED ON THE PRIOR YEAR RETURN AND AUDITED FINANCIAL STATEMENTS; 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. 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