2012-06-06T19:13:43-05:00 2011-07-31 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVENUE SUITE 336 HONOLULU HI 968144012 990 2010-08-01 996009435 PAMCAH-UA LOCAL 675 HEALTH & WELFARE FUND PAMC 8085364408 1109 BETHEL ST NO 403 HONOLULU HI 96813 KENT MATSUZAKI - MGT TRUSTEE 8085364408 2012-05-18 1 DIANE HOSOKAWA 8085336254 2010 2016-02-24 21:20:13Z KENT MATSUZAKI - MGT TRUS 1109 BETHEL ST NO 403 HONOLULU HI 96813 48792893 0 X N/A X 1961 HI TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPATING EMPLOYEES AND THEIR BENEFICIARIES. 6 6 0 0 0 0 0 0 926539 1894824 802693 3780008 2458884 -975097 4188116 4699735 0 0 11932318 12361343 0 0 0 0 0 1501107 1416959 13433425 13778302 -9245309 -9078567 34405613 24131946 1602341 407241 32803272 23724705 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 10951951 PROVIDING SELF-INSURED BENEFITS TO ELIGIBLE PARTICIPANTS BY PAYING FOR INCURRED CLAIMS AND CLAIMS ADMINISTRATIVE FEES (MEDICAL CLAIMS $7,685,190, DRUG CLAIMS $2,359,048, VISION CLAIMS $240,043, INSURANCE STOP LOSS FEES $188,256, MEDICAL CLAIMS ADMINISTRATION FEES $455,171, AND VISION CLAIMS ADMINISTRATION FEES $24,243). 2077062 PROVIDING HEALTH AND WELFARE BENEFITS BY PAYING FOR MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (HAWAII DENTAL SERVICE $1,581,576, PACIFIC GUARDIAN LIFE $408,931, AND HAWAII MEDICAL SERVICE ASSOCIATION $86,555). 13029013 0 0 0 0 0 0 0 0 1 1 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 0 1 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 1 1 X PAMCAH-UA LOCAL 675 ADMINISTRATIVE 8085364408 1109 BETHEL ST 403 HONOLULU HI 96813 X REGINALD V CASTANARES JR 1.00 X 0 0 0 VALENTINO CERIA 1.00 X 0 0 0 DONOVAN LEWIS 1.00 X 0 0 0 KENT A MATSUZAKI 1.00 X 0 0 0 MARK SUZUKI 1.00 X 0 0 0 SAMUEL FUJIKAWA 1.00 X 0 0 0 GREGG SERIKAKU 1.00 X 0 0 0 0 0 0 0 0 0 0 HAWAII MEDICAL SERVICE ADMINISTRATION 818 KEEAUMOKU STREET HONOLULU HI 96814 MEDICAL CLAIMS ADMINISTRATOR 455171 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 CLAIMS PROCESSOR 131092 2 PREMIUM SUBSIDY 900099 949671 949671 EMPLOYER CONTRIBUTION 900099 942026 942026 COBRA CONTRIBUTIONS 900099 3127 3127 1894824 552035 552035 140132 14490 125642 125642 125642 47306641 44078668 3227973 3227973 3227973 OTHER INCOME 900099 24790 24790 UNREALIZED GAINS/LOSSE 900099 -1125529 -1125529 -1100739 4699735 1894824 0 2804911 12361343 58423 46859 115005 4297 30444 14734 ADMINISTRATIVE FEE - ME 455171 ADMINISTRATIVE FEE 289892 INSURANCE - STOP LOSS 188256 CONSULTANT FEES 92502 TAXES FICA & FUTA 28980 92396 13778302 5960757 2429292 501278 1148743 18862 16209 39067 8066 28203 31001 25501191 18352361 2212936 2025017 182386 129323 34405613 24131946 742103 66612 860238 340629 1602341 407241 X 32803272 23724705 0 0 0 0 32803272 23724705 34405613 24131946 -9078567 0 X X 0 1 1 X 0 39067 8066 31001 31001 REAL ESTATE - IWILEI PROPERTY 1422817 F REAL ESTATE - KAPOLEI PROPERTY 602200 F 2025017 BANK OVERDRAFT 332941 SECURITY DEPOSIT 7688 340629 4699735 13778302 -9078567 0 -9078567 4523109 0 4523109 148961 27665 176626 4699735 13601676 0 13601676 148961 27665 176626 13778302 PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 27665. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 27665. FORM 990, PART VI, SECTION B, LINE 11 ALL DOCUMENTS ARE REVIEWED BY UNION AND MANAGEMENT TRUSTEE REPRESENTATIVES BEFORE SIGNING AND FILING. 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 POLICIES ARE MADE AVAILABLE UPON REQUEST. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII REGINALD V. CASTANARES JR. - 1109 BETHEL ST BASEMENT, HONOLULU, HI 96813. VALENTINO CERIA - 1109 BETHEL ST BASEMENT, HONOLULU, HI 96813. DONOVAN LEWIS - 1109 BETHEL ST BASEMENT, HONOLULU, HI 96813. KENT A. MATSUZAKI - 1029 ULUPONO STREET, HONOLULU, HI 96819. MARK SUZUKI - 1820 COLBURN STREET, HONOLULU, HI 96819. SAMUEL FUJIKAWA - 2149 PUUHALE PLACE, HONOLULU, HI 96819. GREGG SERIKAKU - 1314 S KING STREET #961, HONOLULU, HI 96814. FORM 990, PART XII, LINE 2C: BOARD OF TRUSTEES SELECT THE INDEPENDENT AUDITOR AND APPOINTS THE ADMINISTRATIVE OFFICE TO REVIEW THE FINANCIAL STATEMENTS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PAMCAH-UA LOCAL 675 ANNUITY PLAN 1109 BETHEL STREET 403 HONOLULU HI 96813 990221545 TO PROVIDE ANNUITY BENEFITS TO ELIGIBLE MEMBERS HI 401(A) N/A 0 PAMCAH-UA LOCAL 675 COOPERATION FUND 1109 BETHEL STREET 403 HONOLULU HI 96813 990266164 TO PROMOTE THE INDUSTRY AND IMPROVE RELATIONSHIPS BETWEEN LABOR AND MGMT. HI 501(C)(5) N/A 0 PAMCAH-UA LOCAL 675 TRAINING PLAN 1109 BETHEL STREET 403 HONOLULU HI 96813 996009433 TO PROVIDE EDUCATIONAL BENEFITS TO ELIGIBLE MEMBERS AND EMPLOYERS HI 501(C)(5) N/A 0 PAMCAH-UA LOCAL 675 VACATION & HOLIDAY PLAN 1109 BETHEL STREET 403 HONOLULU HI 96813 996009438 TO PROVIDE VACATION AND HOLIDAY BENEFITS TO ELIGIBLE MEMBERS HI 501(C)(9) N/A 0 PAMCAH-UA LOCAL 675 PENSION PLAN 1109 BETHEL STREET 403 HONOLULU HI 96813 996024083 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS HI 401(A) N/A 0 PAMCAH-UA LOCAL 675 ADMINISTRATIVE OFFICE 1109 BETHEL STREET 403 HONOLULU HI 96813 990110375 TO ALLOCATE COMMON EXPENSES AMOUNG THE PAMCAH TRUST FUNDS HI N/A C 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 PAMCAH-UA LOCAL 675 ADMINISTRATIVE OFFICE O 381571