FURP.ORG / PUBLIC DATA EXPLORER

UFCW-HAWAII FOOD EMPLOYERS HEALTH AND WELFARE TR FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UFCW-HAWAII FOOD EMPLOYERS HEALTH AND WELFARE TR FUND (EIN 01-0757287)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-24
IRS object ID
201102369349300720
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)
Timestamp2011-08-24T18:55:52-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

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 AVE SUITE 336AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code968144012ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010757287EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UFCW - HAWAII FOOD EMPLOYERSBusinessNameLine1
Business Name Line2HEALTH & WELFARE TRUST FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUFCWNameControl
Phone8088417575Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 N VINEYARD BLVD STE 100 NO 200AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICK LOO CARL RAMNITZName
TitleMANAGEMENT TRUSTEE/ LABOR TRUSTEETitle
Phone8088417575Phone
Date Signed2011-08-24DateSigned
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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1200 N VINEYARD BLVD STE 100 NO 200AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18965091GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2002YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS.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 Year9245694ProgramServiceRevenuePriorYear
Program Service Revenue CY9129110ProgramServiceRevenueCY
Investment Income Prior Year114181InvestmentIncomePriorYear
Investment Income Current Year91798InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year53665OtherRevenueCurrentYear
Total Revenue Prior Year9359875TotalRevenuePriorYear
Total Revenue Current Year9274573TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year7813820BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY9403856BenefitsPaidToMembersCY
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 Year266095OtherExpensePriorYear
Other Expenses Current Year330157OtherExpensesCurrentYear
Total Expenses Prior Year8079915TotalExpensesPriorYear
Total Expenses Current Year9734013TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1279960RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-459440RevenuesLessExpensesCY
Total Assets BOY12849184TotalAssetsBOY
Total Assets EOY12394830TotalAssetsEOY
Total Liabilities BOY12154TotalLiabilitiesBOY
Total Liabilities EOY17240TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12837030NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12377590NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7124956Expense
DescriptionPROVIDING MEDICAL SELF-INSURED BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS (HMA $5,798,060, HMSA SUPPLEMENTAL DRUG $40,940, CATALYST $1,285,956).Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1402343Expense
DescriptionPROVIDING MEDICAL INSURANCE PREMIUMS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS (KAISER PERMANENTE $1,130,922, HMSA $271,421).Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense876557Expense
DescriptionPROVIDING DENTAL, CHIRO, VISION, AND LIFE INSURANCE PREMIUMS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS (HAWAII DENTAL SERVICE $649,561, DCCH $58,833, PACIFIC GUARDIAN LIFE $32,860, CHIROPLAN $28,751, VISION SERVICE PLAN $106,552).Description
FieldValueIRS element (for citing)
Total Program Service Expense9403856TotalProgramServiceExpense
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 Liabilities0ReportOtherLiabilities
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 With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
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 Address0OfficerMailingAddress
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 Line1HAWAII BENEFIT ADMINISTRATORS INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8088417575TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 N VINEYARD BLVD STE 100AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code96817ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
FRANK JORGENSEN
EMPLOYER TRUSTEE1.00X000
PATRICK K LOO
UNION TRUSTEE1.00X000
CARL RAMNITZ
EMPLOYER TRUSTEE1.00X000
LYLE SETTER
UNION TRUSTEE1.00X000
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 (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HMA INC
1440 KAPIOLANI BLVDHONOLULUHI96814CLAIMS ADMINISTRATOR368105
HAWAII BENEFIT ADMINISTRATORS INC
200 N VINEYARD BLVD STE 100HONOLULUHI96817THIRD PARTY ADMINISTRATOR108379
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS90009989631808963180
SELF PAY & COBRA CONTR900099165930165930
FieldValueIRS element (for citing)
Total Program Service Revenue9129110TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column91490TotalRevenueColumn
Exclusion$91,490ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities9690826Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities9690518Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities308Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column308TotalRevenueColumn
Related Or Exempt Function Income308RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionNET UNREALIZED GAINSDescription
Business Code900099BusinessCode
Total Revenue Column53665TotalRevenueColumn
Exclusion$53,665ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue53665TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9274573TotalRevenueColumn
Related Or Exempt Function Income9129418RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$145,155ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total9403856Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total101896Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total36004Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total23537Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total17773Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20273Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4220Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11524Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total34272Total

Insurance Insurance

FieldValueIRS element (for citing)
Total7740Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
CONSULTANT FEES67497
BANK FEES5421

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9734013Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY12025847BOY
EOY11602236EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY797340BOY
EOY790145EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2501BOY
EOY2449EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY23496BOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12849184BOY
EOY12394830EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12154BOY
EOY17240EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12154BOY
EOY17240EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY12837030BOY
EOY12377590EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12837030BOY
EOY12377590EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12849184BOY
EOY12394830EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-459440ReconcilationRevenueExpenses
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
Total Revenue9274573TotalRevenue
Total Expenses9734013TotalExpenses
Excess Or Deficit For Year-459440ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-459440ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9256800TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal9256800RevenueSubtotal
Investment Expenses Not Included17773InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt17773RevenueNotRptdOnFinStmt
Total Revenue Per Form9909274573TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9716240TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9716240ExpensesSubtotal
Investment Expenses Not Included217773InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt17773ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909734013TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11ONE 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.
POLICY IS REVIEWED BY THE BOARD OF TRUSTEES ANNUALLY.FORM 990, PART VI, SECTION B, LINE 12C
DOCUMENTS ARE AVAILABLE TO PUBLIC INSPECTION UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 18
DOCUMENTS ARE AVAILABLE TO PUBLIC INSPECTION UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.FORM 990, PART XI, LINE 2C