2024-11-15T18:32:59-06:00 2023-12-31 430765316 RUBINBROWN LLP 7676 FORSYTH BLVD SUITE 2100 SAINT LOUIS MO 63105 990 2023-01-01 776235574 HAWAII MEDICAL SERVICE ASSOCIATION RETIREE HEALTH BENEFITS TRUST HAWA 8089485145 PO BOX 860 HONOLULU HI 96808 JENNY SMITH TRUSTEE 8089485145 2024-11-12 1 0 MATTHEW C HALL P01573021 3142903300 2023 2024-10-15 13:58:12Z JENNY SMITH PO BOX 860 HONOLULU HI 96808 2925825 0 X N/A X 2003 HI THE ORGANIZATION IS A TRUST DEFINED UNDER IRS SECTION 501(C)(9) TO PAY HEALTH AND OTHER INSURANCE PREMIUMS, ASSESSMENTS, DUES, CHARGES AND INTEREST FOR THE PURPOSE OF PROVIDING BENEFITS TO PLAN PARTICIPANTS AND BENEFICIARIES. 3 1 0 0 1728289 1526968 0 0 0 0 1776692 1728289 0 0 1776692 1728289 0 0 2150318 2446752 0 0 0 0 0 -357573 249557 1792745 2696309 -16053 -968020 50798677 56186757 978223 657723 49820454 55529034 X THE TRUST WAS ESTABLISHED BY HAWAII MEDICAL SERVICE ASSOCIATION ("EMPLOYER") TO FUND A PORTION OF THE COST OF POST-RETIREMENT MEDICAL BENEFITS UNDER THE HAWAII MEDICAL SERVICE ASSOCIATION "PLAN" (AN ERISA WELFARE BENEFITS PLAN) TO HOLD, INVEST AND DISTRIBUTE ASSETS FOR THE PURPOSE THEREOF. 0 0 2446752 THE PRIMARY EXEMPT PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIRED EMPLOYEES AND THEIR BENEFICIARIES. HEALTH BENEFITS INCLUDE MEDICAL, HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, DRUG, VISION AND COMPLEMENTARY CARE.AS OF 12/31/2023, THERE WERE:480 RETIRED OR SEPARATED PARTICIPANTS RECEIVING BENEFITS112 RETIRED OR SEPARATED PARTICIPANTS ENTITLED TO FUTURE BENEFITS 2446752 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X 3 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X RACHEL NAGLE 8089485145 PO BOX 860 HONOLULU HI 96808 MARK MUGIISHI TRUSTEE 1.00 40.00 X 0 3325224 101518 GINA L MARTING TRUSTEE 1.00 40.00 X 0 1168196 32179 LISA SAKAMOTO TRUSTEE 1.00 1.00 X 0 0 0 BANK OF HAWAII INSTITUTIONAL TRUSTEE 0.01 0.00 X 89865 89865 0 89865 4583285 133697 0 0 1 0 0 125825 125825 2800000 1197536 1602464 1602464 1602464 1728289 0 1728289 0 2446752 89865 FEDERAL INCOME TAX EXPE 304411 STATE INCOME TAX EXPENS 110456 ADMINISTRATIVE EXPENSES 3 TAX EFFECT OF UNREALIZE -255178 2696309 52080 3473 91077 228696 724896 0 3766944 1675821 46163680 53825519 0 453248 50798677 56186757 978223 657723 978223 657723 X 33085169 33085169 0 0 16735285 22443865 49820454 55529034 50798677 56186757 X -968020 7901080 -1224480 X 0 1 X 1 0 0 GREAT WEST LIFE 53825519 F 53825519 DEFERRED INCOME TAXES 265385 INCOME TAXES PAYABLE 392338 657723 X 8315024 7901080 377984 8279064 35960 89865 1602464 1692329 1728289 2606444 0 2606444 89865 89865 2696309 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRED THE PLAN ADMINSTRATOR TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE ("IRS"). THE PLAN ADMINISTRATOR, IN CONSULTATION WITH TAX ADVISORS, HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUEDED THAT AS OF DECEMBER 31, 2023 AND 2022, THERE WERE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A TAX LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BOOK REALIZED GAIN 377,984. PART XI, LINE 4B - OTHER ADJUSTMENTS: TAX REALIZED GAIN 1,602,464. 0 1 0 MARK MUGIISHI TRUSTEE 0 1126462 0 2198762 0 0 0 100798 0 720 0 3426742 0 0 GINA L MARTING TRUSTEE 0 551677 0 616519 0 0 0 32179 0 0 0 1200375 0 0 PART I, LINE 4B THE RELATED ORGANIZATION SPONSORS A SUPPLEMENTAL RETIREMENT PLAN TO PROVIDE BENEFITS FOR EMPLOYEES WHOSE BENEFITS UNDER THE PENSION PLAN ARE RESTRICTED BY THE LIMITATIONS OF IRC SECTIONS 401(A)(17) AND 415. THESE AMOUNTS ARE DISCLOSED IN SCHEDULE J, PAGE 2. HAWAII MEDICAL SERVICE ASSOCIATION >35% CONTROLLED 2446752 MEDICAL INSURANCE PREMIUM 0 BANK OF HAWAII INSTITUTIONAL TRUSTEE 89865 INVESTMENT 0 MICHAEL A GOLD FORMER TRUSTEE 2702 MEDICAL INSURANCE 0 MICHAEL STOLLAR FORMER TRUSTEE 16613 MEDICAL INSURANCE 0 FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, MANAGEMENT MEETS WITH THE TRUSTEE WHO SIGNS THE FINAL FORM TO REVIEW ITS CONTENTS. ALSO REVIEWED ARE THE REPORTING REQUIREMENTS PERTAINING TO COMPENSATION, GOVERNANCE AND MANAGEMENT DISCLOSED IN THE FINAL FORM. ONCE APPROVED AND SIGNED BY THE TRUSTEE THE FINAL FORM 990 IS AVAILABLE TO THE GOVERNING BODY FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM AT THE TIME OF INITIAL APPOINTMENT AND ANNUALLY THEREAFTER. THE DISCLOSURE FORM ALSO INSTRUCTS TRUSTEES TO INFORM THE COMPLIANCE AND ETHICS OFFICE OF ANY NEW RELATIONSHIPS OR CHANGES TO EXISTING RELATIONSHIPS THAT COULD RESULT IN A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR OFFICERS FOR THE RELATED ORGANIZATION IS SET BY THE COMPENSATION AND HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE IS MADE UP OF OUTSIDE INDEPENDENT DIRECTORS WITH EXTENSIVE EXPERIENCE IN PERSONNEL MATTERS. THE COMMITTEE USES THE SERVICES OF A NATIONAL HUMAN RESOURCES CONSULTING FIRM TO ASSIST IN ITS REVIEW OF EXECUTIVE COMPENSATION. THE CONSULTING FIRM DOES A COMPREHENSIVE ASSESSMENT OF COMPETITIVE PAY PRACTICES IN THE HEALTH CARE INDUSTRY AND OTHER LARGE SIMILAR COMPANIES IN HAWAII. EACH YEAR, THE COMMITTEE REVIEWS EXECUTIVE COMPENSATION TO ENSURE IT IS APPROPRIATE AND ALIGNED WITH STRATEGIC CORPORATE GOALS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BOOK REALIZED GAIN 377,984. TAX REALIZED GAIN -1,602,464. HAWAII MEDICAL SERVICE ASSOCIATION 818 KEEAUMOKU ST HONOLULU HI 69814 990040115 HEALTH INSURANCE HI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 HAWAII MEDICAL SERVICE ASSOCIATION P 2900000 SEE PART VII HAWAII MEDICAL SERVICE ASSOCIATION P 419793 SEE PART VII PART V LINE 2 (1) $2,900,000 PAYMENT TO RELATED ORGANIZATION FOR MEDICAL PREMIUMS AS DETERMINED BY THE ACTUARY PART V LINE 2 (2) $419,793 REIMBURSEMENT TO RELATED ORGANIZATION FOR FEDERAL TAXES PAID ON BEHALF OF FILING ENTITY