2012-11-08T20:27:22-06:00 2011-12-31 990155373 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVE SUITE 336 HONOLULU HI 968144012 990 2011-01-01 010757287 UFCW - HAWAII FOOD EMPLOYERS HEALTH & WELFARE TRUST FUND UFCW 8088417575 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 FRANK JORGENSENPATRICK LOO 8088417575 2012-10-12 1 TERRY TAKAKI P00036112 8085336254 2011 2016-02-24 21:20:13Z FRANK JORGENSENPATRICK L 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 21063095 0 X N/A X 2002 HI TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 4 4 0 0 0 0 0 0 9129110 9145953 91798 120681 53665 149418 9274573 9416052 0 0 9403856 9766677 0 0 0 0 0 330157 725952 9734013 10492629 -459440 -1076577 12394830 11317006 17240 15993 12377590 11301013 TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 7406293 TO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (HMA $6,103,013, CATALYST $1,303,280). 2360384 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (KAISER PERMANENTE $1,205,035, HMSA $170,226, HAWAII DENTAL SERVICE $674,827, DCCH $51,067, PACIFIC GUARDIAN LIFE $122,832 CHIROPLAN $28,356, VISION SERVICE PLAN $108,041). 409681 TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (HMA $369,820, CATALYST $39,861). 10176358 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 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 1 1 1 1 1 1 0 0 0 X HAWAII BENEFIT ADMINISTRATORS INC 8088417575 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 X FRANK JORGENSEN 1.00 X 0 0 0 PATRICK K LOO 1.00 X 0 0 0 CARL RAMNITZ 1.00 X 0 0 0 LYLE SETTER - FORMER 1.00 X 0 0 0 GWEN RULONA - NEW 1.00 X 0 0 0 0 0 0 0 0 0 0 HMA INC 1440 KAPIOLANI BLVD HONOLULU HI 96814 CLAIMS ADMINISTRATOR 369820 HAWAII BENEFIT ADMINISTRATORS INC 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 THIRD PARTY ADMINISTRATOR 103983 2 EMPLOYER CONTRIBUTIONS 900099 9000033 9000033 SELF PAY & COBRA CONTR 900099 145920 145920 9145953 115950 115950 11651774 11647043 4731 4731 4731 EXPERIENCE REBATES 900099 85272 85272 NET UNREALIZED GAINS 900099 63017 63017 MISCELLANEOUS INCOME 900099 1129 1129 149418 9416052 9237085 0 178967 9766677 103983 36003 24052 26345 69969 28549 4466 9047 7681 ADMINISTRATIVE FEES - M 409681 BANK FEES 6106 MISCELLANEOUS 70 10492629 11602236 2337548 790145 918417 2449 1612 8059429 12394830 11317006 17240 15993 17240 15993 X 12377590 11301013 0 0 0 0 12377590 11301013 12394830 11317006 -1076577 0 X X 0 1 1 X 0 0 9416052 10492629 -1076577 -1076577 9304435 0 9304435 26345 85272 111617 9416052 10381012 -85272 -85272 10466284 26345 26345 10492629 PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPERIENCE REBATES 85,272. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPERIENCE REBATES -85,272. FORM 990, PART VI, SECTION B, LINE 11 ONE MANAGEMENT AND ONE LABOR TRUSTEE SIGN THE FORM 990. THE FORM 990 IS ALSO PROVIDED TO THE BOARD OF TRUSTEES AT THE QUARTERLY BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C POLICY IS REVIEWED BY THE BOARD OF TRUSTEES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BOARD OF TRUSTEES SELECT AN INDEPENDENT AUDITOR, AND REVIEW AND APPROVE THE FINANCIAL STATEMENTS.