2017-11-07T14:49:21-06:00 2016-12-31 990155373 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVE SUITE 336 HONOLULU HI 96814 990 2016-01-01 996008823 AFL HOTEL & RESTAURANT WORKERS HEALTH & WELFARE PLAN AFLH 8085230199 560 N NIMITZ HWY No 209 HONOLULU HI 96817 ROSARIO BANIAGAJULIE WALKER TRUSTEES 8085230199 2017-10-12 1 TERRY TAKAKI P00036112 8085336254 72.253.73.75 2017-10-12 15:59:04 HS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A7C9EC184B2A76AAA9F14E94878FDC8C494D6D3C 2016 2018-03-14 21:41:22Z ROSARIO BANIAGAJULIE WAL 560 N NIMITZ HWY No 209 HONOLULU HI 96817 314111183 0 X N/A X 1955 HI TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS PRESCRIBED BY THE PLAN 6 6 0 0 0 0 0 0 99937623 102647512 1102425 1202834 -476828 -51829 100563220 103798517 0 0 88948786 93064655 0 0 0 0 0 4204699 4351192 93153485 97415847 7409735 6382670 107986770 114190009 466492 287061 107520278 113902948 TO PROVIDE MEDICAL, DENTAL,PRESCRIPTION DRUG, CHIROPRACTIC CARE, VISION, AND DEATH BENEFITS TO ELIGIBLE MEMBERS 0 0 57349006 TO PROVIDE SELF FUNDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS IN ACCORDANCE WITH TERMS SET FORTH IN THE TRUST AGREEMENTS, RULES AND REGULATIONS OF THE PLAN AND CBA 35715649 PROVIDE INSURED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 93064655 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 3 0 1 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X BENEFIT RISK MANAGEMENT SERVICES 8085230199 560 N NIMITZ HWY NO 209 HONOLULU HI 96817 X eric GILL labor trustee 0.50 X 0 0 0 JULIE NAKAYAMA MANAGEMENT TRUSTEE 0.50 X 0 0 0 MONIQUE PINNEY ALT MANAGEMENT TRUSTEE (FO 0.50 X 0 0 0 LUZ GUTIERREZ MANAGEMENT TRUSTEE 0.50 X 0 0 0 DORYNE JARDINE LABOR TRUSTEE 0.50 X 0 0 0 JULIE WALKER MANAGEMENT TRUSTEE 0.50 X 0 0 0 ROSS BANIAGA LABOR TRUSTEE 0.50 X 0 0 0 KEVIN GLEASON MANAGEMENT TRUSTEE 0.50 X 0 0 0 MORGAN EVANS ALT LABOR TRUSTEE 0.50 X 0 0 0 DANIEL KERWIN ALT LABOR TRUSTEE 0.50 X 0 0 0 MARSHA BRUHN ALT LABOR TRUSTEE 0.50 X 0 0 0 0 0 0 0 0 0 0 HMA INC 1440 KAPIOLANI BLVD STE 1020 HONOLULU HI 96814 MEDICAL CLAIMS ADMINISTRATOR 1869415 BENEFIT RISK & MANAGEMENT SERVICES 560 N NIMITZ HWY STE 209 HONOLULU HI 96817 PLAN ADMINISTRATOR 725208 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 DENTAL CLAIMS ADMINISTRATOR 326033 OPTUMRX PO BOX 27275 NEW YORK NY 10087 DRUG CLAIMS ADMINISTRATOR 284871 FIRST HAWAIIAN BANK 999 BISHOP STREET HONOLULU HI 96813 CUSTODIAN 235949 5 EMPLOYER CONTRIBUTONS 900099 102302234 102302234 PARTICIPANT CONTRIBUTIONS 900099 345278 345278 102647512 1873857 1873857 209641643 210312666 -671023 -671023 -671023 UNREALIZED LOSS 900001 -51829 -51829 -51829 103798517 102647512 0 1151005 93064655 47372 49482 235949 61151 16112 20348 MEDICAL ADMINISTRATIVE 2071470 PLAN ADMINISTRATIVE FEE 652423 DENTAL ADMINISTRATIVE F 326033 PCORI RESEARCH TAX & RE 288110 582742 97415847 1014 12527229 12750388 9371134 10638953 86088407 90799654 107986770 114190009 466492 287061 466492 287061 X 107520278 113902948 0 0 0 0 107520278 113902948 107986770 114190009 6382670 0 X X 0 1 X 1 0 0 X 103562568 0 103562568 235949 235949 103798517 97179898 0 97179898 235949 235949 97415847 Part X, Line 2: THE FINANCIAL STATEMENTS CONTAIN THE FOLLOWING DISCLOSURE PERTAINING TO FIN 48 (ASC 740): "THE TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE IRS DATED JUNE 25, 1996, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE IRC. HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2016 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE THAN LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2013" HAWAII COMMUNITY HEALTH ALLIANCE LLC ORGANIZATION HAS 2 COMMON OFFICERS WITH ENTITY 136400 HEALTH CLAIMS NETWORK PROVIDER 0 Form 990, Part VI, Section B, line 11b ALL DOCUMENTS ARE REVIEWED BY THIRD PARTY ADMINISTRATOR, MANAGEMENT TRUSTEE AND UNION TRUSTEE REPRESENTATIVES BEFORE SIGNING AND FILING Form 990, Part VI, Section B, line 12c POLICY IS EXECUTED ANNUALLY BY TRUSTEES Form 990, Part VI, Section C, line 19 POLICIES ARE MADE AVAILABLE TO MEMBERS UPON REQUEST FORM 990. PART XII, LINE 2C: NO CHANGE IN REVIEW PROCESS FROM PRIOR YEAR. BOARD OF TRUSTEES SELECT AN INDEPENDENT AUDITOR. ADMINISTRATOR FORMALLY REVIEWS AND APPROVES THE FINANCIAL STATEMENTS. BOARD OF TRUSTEES REVIEW AND APPROVE THE FINANCIAL STATEMENTS. HOTEL AND RESTAURANT INDUSTRY EMPLOYMENT AND TRAINING PLAN 560 N NIMITZ HIGHWAY 209 HONOLULU HI 96817 996009966 PROVIDE TRAINING BENEFITS TO ELIGIBLE EMPLOYEES HI 501(C)(5) N/A N/A 0 HOTEL UNION AND HOTEL INDUSTRY OF HAWAII PENSION PLAN 560 N NIMITZ HIGHWAY 209 HONOLULU HI 96817 990155373 PROVIDE RETIREMENT BENEFITS TO ELIGIBLE PARTICIPANTS HI 401(A) N/A N/A 0 HOTEL 401(K) RETIREMENT SAVINGS PLAN 222 S VINEYARD STREET SUITE PH-4 HONOLULU HI 96813 990292187 PROVIDE RETIREMENT BENEFITS TO ELIGIBLE PARTICIPANTS HI 401(A) N/A N/A 0 SEE ATTACHED SUPPLEMENTAL INFORMATION SEE ATTACHED SUPPLEMENTAL INFORMATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE R, PARTS III, IV THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER PLAN THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. THE ADMINISTRATORS OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS INCLUDING THE NAMES, ADDRESSES, AND OTHER CONTACT INFORMATION. HOWEVER, THE LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS COULD NOT BE SEPARATED BY TYPE OF ORGANIZATION. HOWEVER, THEY ARE LISTED BELOW: 1 - Ala Moana Hotel 2 - Hilton Hawaiian Village 3 - Hyatt Corporation 4 - Ilikai Hotel 5 - Imperial Hawaii Resort 6 - Kahala Hotel & Resorts 7 - Kahala Shopping Center 8 - Kyo-Ya Company, LTD. 9 - PearlRidge Mall 10 - Plaza Hotel 11 - Queen Kapiolani Hotel 12 - Ramada Plaza (prev. Holiday Inn) Waikiki 13 - Royal Kona Resort 14 - Sheraton Kauai Resort 15 - Sheraton Maui Hotel 16 - Turtle Bay Resort 17 - Unite Here Local #5 18 - Waikiki Beach Marriott Resort & Spa 19 - Waikiki Resort Hotel 20 - Waikoloa Beach Marriott 21 - Modern Honolulu 22 - Hyatt Corporation - Regency Club