2012-07-06T19:56:35-05:00 2011-08-31 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVENUE SUITE 336 HONOLULU HI 968144012 990 2010-09-01 996009135 TEAMSTERS HEALTH & WELFARE TRUST FUND TEAM 8085230199 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 RONAN KOZUMA ROBERT YU 8085230199 2012-05-23 1 TERRY TAKAKI 8085336254 2010 2016-02-24 21:20:13Z RONAN KOZUMA ROBERT YU 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 49219367 0 X N/A X 1957 HI TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 4 4 0 0 0 0 0 0 26365020 29437031 512240 406412 -39447 -71116 26837813 29772327 0 0 27231194 30241400 0 0 0 0 0 379950 437244 27611144 30678644 -773331 -906317 18612255 17723768 76952 94782 18535303 17628986 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 16053143 TO 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). 13441024 TO 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). 747233 TO PAY FOR ADMINISTRATIVE FEES FOR SELF-INSURED CLAIMS PROCESSING (HMA $634,248, CATALYST $112,985). 30241400 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 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 0 X BENEFIT RISK & MANAGEMENT SERVICES 8085230199 560 N NIMITZ HIGHWAY STE 209 HONOLULU HI 96817 X MICHAEL COAD 1.00 X 0 0 0 RONAN KOZUMA 1.00 X 0 0 0 DARREL TAJIMA 1.00 X 0 0 0 ROBERT YU 1.00 X 0 0 0 MILLIE DOWNEY 1.00 X 0 0 0 KELVIN YAMANOUCHI 1.00 X 0 0 0 MIKE COSTA 1.00 X 0 0 0 0 0 0 0 0 0 0 HMA INC 1440 KAPIOLANI BLVD HONOLULU HI 96814 MEDICAL CLAIMS ADMINISTRATOR 634248 BENEFIT & RISK MANAGEMENT SERVICES 560 N NIMITZ HWY STE 209 HONOLULU HI 96817 THIRD PARTY ADMINISTRATOR 204875 CATALYST RX 9525 HILLWOOD DRIVE LAS VEGAS NV 89134 DRUG CLAIMS ADMINISTRATOR 112985 BENEFIT PLAN SOLUTIONS INC 680 IWILEI ROAD SUITE 528 HONOLULU HI 96817 CONSULTANT 101000 4 EMPLOYERS' CONTRIB 900099 29245621 29245621 EMPLOYEES' CONTRIB 900099 191410 191410 29437031 443704 443704 19409748 19447040 -37292 -37292 -37292 EXPERIENCE REFUNDS AND 900099 184027 184027 OTHER 900099 172 172 UNREALIZED GAINS/ (LOS 900099 -255315 -255315 -71116 29772327 29621230 0 151097 30241400 204875 17291 33788 50636 22869 453 3764 CONSULTANT FEES 101000 BANK SERVICE CHARGES 2324 MISCELLANEOUS 244 30678644 165542 166616 3059204 2469082 2558373 2701502 2284 6325 12811196 12369266 15656 10977 18612255 17723768 9347 8869 67605 85913 76952 94782 X 18535303 17628986 0 0 0 0 18535303 17628986 18612255 17723768 -906317 0 X X 0 1 1 X 0 0 DUE TO BROKER 85913 85913 29772327 30678644 -906317 0 -906317 29537664 0 29537664 50636 184027 234663 29772327 30443981 0 30443981 50636 184027 234663 30678644 PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPERIENCE REFUNDS AND REBATES PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPERIENCE RATING REFUNDS FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATOR DISSEMINATES THE FORM 990 TO THE TRUSTEES FOR THEIR REVIEW AND EXECUTION. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EXECUTE A STATEMENT OF COMPLIANCE WHICH IS KEPT ON FILE. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII MICHAEL 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 XI, LINE 2C 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.