2025-11-17T09:02:25-06:00 2024-12-31 430765316 RUBINBROWN LLP 7676 FORSYTH BLVD SUITE 2100 SAINT LOUIS MO 63105 990 2024-01-01 776235574 HAWAII MEDICAL SERVICE ASSOCIATION RETIREE HEALTH BENEFITS TRUST HAWA 8089485145 PO BOX 860 HONOLULU HI 96808 JENNY SMITH TRUSTEE 8089485145 2025-11-14 1 1 KIMBERLY A RYAN P00829977 3142903300 2024 2025-03-06 01:10:19Z JENNY SMITH PO BOX 860 HONOLULU HI 96808 75783 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 75783 0 0 0 0 0 1728289 75783 0 0 1728289 75783 0 0 2446752 2499582 0 0 0 0 0 249557 169021 2696309 2668603 -968020 -2592820 56186757 60752376 657723 334354 55529034 60418022 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 2499582 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 12/31/2024, THERE WERE:490 RETIRED OR SEPARATED PARTICIPANTS RECEIVING BENEFITS114 RETIRED OR SEPARATED PARTICIPANTS ENTITLED TO FUTURE BENEFITS 2499582 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 0 0 1 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 3489518 113199 XUEJUN SMITH TRUSTEE 1.00 40.00 X 0 1334684 40784 ELIZABETH HOKADA TRUSTEE 1.00 1.00 X 0 0 0 BANK OF HAWAII INSTITUTIONAL TRUSTEE 0.01 X 100588 100588 0 100588 4924790 153983 0 0 1 0 0 75783 75783 75783 0 75783 0 2499582 100588 TAX EFFECT OF UNREALIZE 59322 STATE INCOME TAX EXPENS 9111 2668603 3473 22976 228696 104435 0 600427 1675821 1935309 53825519 58089229 453248 0 56186757 60752376 657723 334354 657723 334354 X 33085169 33085169 0 0 22443865 27332853 55529034 60418022 56186757 60752376 -2592820 7481808 0 X 0 1 X 1 0 0 GREAT WEST LIFE 58089229 F 58089229 DEFERRED INCOME TAXES 343517 INCOME TAXES PAYABLE -9163 334354 X 7457003 7481808 7481808 -24805 100588 100588 75783 2568015 0 2568015 100588 100588 2668603 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, 2024 AND 2023, 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. 0 1 0 MARK MUGIISHI TRUSTEE 0 1238654 0 2250864 0 0 0 112479 0 720 0 3602717 0 0 XUEJUN SMITH TRUSTEE 0 553846 0 780838 0 0 0 40784 0 0 0 1375468 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 2499582 MEDICAL INSURANCE PREMIUM 0 BANK OF HAWAII INSTITUTIONAL TRUSTEE 100588 INVESTMENT 0 MICHAEL A GOLD FORMER TRUSTEE 8624 MEDICAL INSURANCE 0 MICHAEL STOLLAR FORMER TRUSTEE 9520 MEDICAL INSURANCE 0 GINA MARTING FORMER TRUSTEE 1203906 COMPENSATION 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. 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 3100000 SEE PART VII HAWAII MEDICAL SERVICE ASSOCIATION P 410611 SEE PART VII PART V LINE 2 (1) $3,100,000 PAYMENT TO RELATED ORGANIZATION FOR MEDICAL PREMIUMS AS DETERMINED BY THE ACTUARY PART V LINE 2 (2) $410,611 REIMBURSEMENT TO RELATED ORGANIZATION FOR FEDERAL TAXES PAID ON BEHALF OF FILING ENTITY