FURP.ORG / PUBLIC DATA EXPLORER

TEAMSTERS HEALTH AND WELFARE TRUST FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
TEAMSTERS HEALTH AND WELFARE TRUST FUND (EIN 99-6009135)
Tax period
2010-09-01 to 2011-08-31
Filed
2012-07-06
IRS object ID
201231889349300723
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-07-06T19:56:35-05:00Timestamp
Tax Period End Date2011-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LEMKE CHINEN & TANAKA CPA INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1210 WARD AVENUE SUITE 336AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code968144012ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN996009135EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1TEAMSTERS HEALTH & WELFARE TRUST FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlTEAMNameControl
Phone8085230199Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1560 N NIMITZ HWY NO 209AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRONAN KOZUMA ROBERT YUName
TitleUNION TRUSTEE/ EMPLOYER TRUSTEETitle
Phone8085230199Phone
Date Signed2012-05-23DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRY TAKAKIName
Phone8085336254Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRONAN KOZUMA ROBERT YUNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1560 N NIMITZ HWY NO 209AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode
FieldValueIRS element (for citing)
Gross Receipts49219367GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1957YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year26365020ProgramServiceRevenuePriorYear
Program Service Revenue CY29437031ProgramServiceRevenueCY
Investment Income Prior Year512240InvestmentIncomePriorYear
Investment Income Current Year406412InvestmentIncomeCurrentYear
Other Revenue Prior Year-39447OtherRevenuePriorYear
Other Revenue Current Year-71116OtherRevenueCurrentYear
Total Revenue Prior Year26837813TotalRevenuePriorYear
Total Revenue Current Year29772327TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year27231194BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY30241400BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year379950OtherExpensePriorYear
Other Expenses Current Year437244OtherExpensesCurrentYear
Total Expenses Prior Year27611144TotalExpensesPriorYear
Total Expenses Current Year30678644TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-773331RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-906317RevenuesLessExpensesCY
Total Assets BOY18612255TotalAssetsBOY
Total Assets EOY17723768TotalAssetsEOY
Total Liabilities BOY76952TotalLiabilitiesBOY
Total Liabilities EOY94782TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18535303NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY17628986NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16053143Expense
DescriptionTO PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES (HMA MEDICAL $12,491,791, CATALYST DRUG $3,484,857, HMA VISION $76,495).Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense13441024Expense
DescriptionTO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES BY PAYING MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (KAISER HEALTH FOUNDATION $10,927,203, HMSA $303,516, HAWAII DENTAL SERVICE $1,856,987, GENTLE DENTAL $176,268, PACIFIC GUARDIAN LIFE $34,348, VSP VISION $92,868 AND CHIROPLAN HAWAII $49,834).Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense747233Expense
DescriptionTO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (HMA $634,248, CATALYST $112,985).Description
FieldValueIRS element (for citing)
Total Program Service Expense30241400TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address1OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BENEFIT RISK & MANAGEMENT SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8085230199TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1560 N NIMITZ HIGHWAY STE 209AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MICHAEL COAD
EMPLOYER TRUSTEE (ALT)1.00X000
RONAN KOZUMA
UNION TRUSTEE1.00X000
DARREL TAJIMA
EMPLOYER TRUSTEE1.00X000
ROBERT YU
EMPLOYER TRUSTEE1.00X000
MILLIE DOWNEY
UNION TRUSTEE1.00X000
KELVIN YAMANOUCHI
UNION TRUSTEE (ALT)1.00X000
MIKE COSTA
UNION TRUSTEE (ALT)1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HMA INC
1440 KAPIOLANI BLVDHONOLULUHI96814MEDICAL CLAIMS ADMINISTRATOR634248
BENEFIT & RISK MANAGEMENT SERVICES
560 N NIMITZ HWY STE 209HONOLULUHI96817THIRD PARTY ADMINISTRATOR204875
CATALYST RX
9525 HILLWOOD DRIVELAS VEGASNV89134DRUG CLAIMS ADMINISTRATOR112985
BENEFIT PLAN SOLUTIONS INC
680 IWILEI ROAD SUITE 528HONOLULUHI96817CONSULTANT101000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYERS' CONTRIB9000992924562129245621
EMPLOYEES' CONTRIB900099191410191410
FieldValueIRS element (for citing)
Total Program Service Revenue29437031TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column443704TotalRevenueColumn
Exclusion$443,704ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities19409748Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities19447040Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-37292Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-37292TotalRevenueColumn
Exclusion-$37,292ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EXPERIENCE REFUNDS AND900099184027184027
OTHER900099172172
UNREALIZED GAINS/ (LOS900099-255315-$255,315
FieldValueIRS element (for citing)
Total Other Revenue-71116TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column29772327TotalRevenueColumn
Related Or Exempt Function Income29621230RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$151,097ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total30241400Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total204875Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17291Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total33788Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total50636Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total22869Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total453Total

Insurance Insurance

FieldValueIRS element (for citing)
Total3764Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotal
CONSULTANT FEES101000
BANK SERVICE CHARGES2324
MISCELLANEOUS244

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total30678644Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY165542BOY
EOY166616EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3059204BOY
EOY2469082EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2558373BOY
EOY2701502EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2284BOY
EOY6325EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY12811196BOY
EOY12369266EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY15656BOY
EOY10977EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY18612255BOY
EOY17723768EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9347BOY
EOY8869EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY67605BOY
EOY85913EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY76952BOY
EOY94782EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY18535303BOY
EOY17628986EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18535303BOY
EOY17628986EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18612255BOY
EOY17723768EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-906317ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO BROKERDescription
Amount$85,913Amount
FieldValueIRS element (for citing)
Total Of Amounts85913TotalOfAmounts
Total Revenue29772327TotalRevenue
Total Expenses30678644TotalExpenses
Excess Or Deficit For Year-906317ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-906317ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt29537664TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal29537664RevenueSubtotal
Investment Expenses Not Included50636InvestmentExpensesNotIncluded
Other Revenues Not Included184027OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt234663RevenueNotRptdOnFinStmt
Total Revenue Per Form99029772327TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt30443981TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal30443981ExpensesSubtotal
Investment Expenses Not Included250636InvestmentExpensesNotIncluded2
Other Expenses Not Included184027OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt234663ExpensesNotRptdOnFinStmt
Total Expenses Per Form99030678644TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
PART XII, LINE 4B - OTHER ADJUSTMENTS:EXPERIENCE REFUNDS AND REBATES
PART XIII, LINE 4B - OTHER ADJUSTMENTS:EXPERIENCE RATING REFUNDS

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE ADMINISTRATOR DISSEMINATES THE FORM 990 TO THE TRUSTEES FOR THEIR REVIEW AND EXECUTION.
THE TRUSTEES EXECUTE A STATEMENT OF COMPLIANCE WHICH IS KEPT ON FILE.FORM 990, PART VI, SECTION B, LINE 12C
DOCUMENTS ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETCMICHAEL COAD - 99-1300 HALAWA STREET, AIEA, HI 96701. RONAN KOZUMA - 1817 HART STREET, HONOLULU, HI 96819. DARREL TAJIMA - 925 CEDAR STREET, HONOLULU, HI 96805. ROBERT YU - 811 MIDDLE STREET, HONOLULU, HI 96819. MILLIE DOWNEY - 1817 HART STREET, HONOLULU, HI 96819. KELVIN YAMANOUCHI - 2352 AUHUHU STREET, PEARL CITY, HI 96782. MIKE COSTA - 844 WAHINANI STREET, PEARL CITY, HI 96782.FORM 990, PART VII
BOARD OF TRUSTEES SELECT THE INDEPENDENT AUDITOR AND APPOINTS THE ADMINISTRATOR TO REVIEW THE FINANCIAL STATEMENTS. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.FORM 990, PART XI, LINE 2C