2014-06-12T13:16:24-05:00 2013-07-31 990155373 LEMKE CHINEN & TANAKA CPA INC 210 WARD AVENUE SUITE 336 HONOLULU HI 968144012 990 2012-08-01 996009435 PAMCAH-UA LOCAL 675 HEALTH & WELFARE FUND PAMC 8085364408 1109 BETHEL ST NO 403 HONOLULU HI 96813 KENT MATSUZAKI - TRUSTEE 8085364408 2014-05-22 1 DIANE HOSOKAWA P00922102 8085336254 2012 2015-11-30 17:44:51Z KENT MATSUZAKI - TRUSTEE 1109 BETHEL ST NO 403 HONOLULU HI 96813 53209910 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 13977520 8280938 741148 2162330 50795 871906 14769463 11315174 0 0 11681168 13642461 0 0 0 0 0 1895174 2021232 13576342 15663693 1193121 -4348519 25359115 21648544 441289 1079237 24917826 20569307 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, THEIR DEPENDENTS, AND RETIREES. 0 0 12964040 PROVIDING SELF-INSURED BENEFITS TO ELIGIBLE PARTICIPANTS BY PAYING FOR INCURRED CLAIMS AND CLAIMS ADMINISTRATIVE FEES (MEDICAL CLAIMS $9,348,076, DRUG CLAIMS $2,066,800, VISION CLAIMS $261,162, INSURANCE STOP LOSS FEES $257,466, MEDICAL CLAIMS ADMINISTRATION FEES $658,647, DRUG CLAIMS ADMINISTRATION FEES $344,795, AND VISION CLAIMS ADMINISTRATION FEES $27,094). 1966423 PROVIDING HEALTH AND WELFARE BENEFITS BY PAYING FOR MONTHLY INSURANCE PREMIUMS TO INSURANCE CARRIERS (HAWAII DENTAL SERVICE $1,656,622, PACIFIC GUARDIAN LIFE $240,001, AND HAWAII MEDICAL SERVICE ASSOCIATION $69,800). 14930463 0 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 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 MATTHEW BRADY 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 658647 NATIONAL BENEFITS ADMINISTRATORS 707 RICHARDS STREET PH6 HONOLULU HI 96813 CLAIMS ADMINISTRATOR 343014 HAWAII DENTAL SERVICE 700 BISHOP STREET 700 HONOLULU HI 96813 CLAIMS PROCESSOR 135107 SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARY/CONSULTANT 111396 4 EMPLOYER CONTRIBUTIONS 900099 7107915 7107915 RETIREE CONTRIBUTIONS 900099 1164725 1164725 LIQUIDATED DAMAGES 900099 8298 8298 8280938 623645 623645 34670 9349 25321 25321 25321 43424072 41885387 1538685 1538685 1538685 UNREALIZED GAINS/LOSSE 900099 690544 690544 INSURANCE AND OTHER RE 900099 142810 142810 OTHER INCOME 900099 13231 13231 846585 11315174 8280938 0 3034236 13642461 84949 50000 85592 17259 36493 11478 ADMINISTRATIVE FEE - ME 658647 ADMINISTRATIVE FEE - DR 344795 ADMINISTRATIVE FEE 281340 INSURANCE - STOP LOSS 257466 193213 15663693 2252966 2228419 2350571 1631194 13939 17779 91358 15897 61253 75461 18473801 15091237 2072305 2382324 134280 222130 25359115 21648544 102683 138040 338606 941197 441289 1079237 X 24917826 20569307 0 0 0 0 24917826 20569307 25359115 21648544 -4348519 0 X X 0 1 X 1 0 91358 15897 75461 75461 REAL ESTATE - IWILEI PROPERTY 1422817 F REAL ESTATE - KAPOLEI PROPERTY 631200 F PLAZA AT MOANALUA 65807 F PLAZA AT PEARL CITY 262500 F 2382324 BANK OVERDRAFT 932443 SECURITY DEPOSIT 8754 941197 11183918 0 11183918 131256 131256 11315174 15532437 0 15532437 131256 131256 15663693 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. MATTHEW BRADY - 1109 BETHEL ST BASEMENT, HONOLULU, HI 96813. FORM 990. PART XII, LINE 2C: BOARD OF TRUSTEES SELECT AN INDEPENDENT AUDITOR. THE ADMINISTRATOR AND MANAGEMENT AND UNION TRUSTEE REPRESENTATIVES REVIEW AND APPROVE 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 0 0 1 0 0 0 0 0 1 0 0 0 PAMCAH-UA LOCAL 675 ADMINISTRATIVE OFFICE P 416845 PERCENTAGE ALLOCATION