2023-11-08T08:21:57-06:00 2022-12-31 910189318 MOSS ADAMS LLP 6565 AMERICAS PARKWAY NE STE 600 ALBUQUERQUE NM 87110 990 2022-01-01 826735744 FERNANDEZ HOLDINGS HEALTH TRUST C/O FERNANDEZ HOLDINGS INC FERN 3105930798 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 JEREMY JOHNSON PRESIDENT 3105930798 2023-10-24 1 JEREMY JOHNSON 999009999 0 PAMELA ALEXANDERSON P01218925 5058787200 2023-10-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEREMY JOHNSON 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 14203854 0 X N/A X 2017 CA THE HEALTH TRUST WAS ESTABLISHED TO FUND MEDICAL AND PHARMACY BENEFITS FOR EMPLOYEES OF FERNANDEZ HOLDINGS, INC. 1 0 0 0 0 0 0 0 11262417 14203835 9 19 0 0 11262426 14203854 0 0 9369318 11891355 0 0 0 0 0 1265909 2425090 10635227 14316445 627199 -112591 912205 799614 0 0 912205 799614 X THE HEALTH TRUST WAS ESTABLISHED TO FUND MEDICAL AND PHARMACY BENEFITS FOR EMPLOYEES OF FERNANDEZ HOLDINGS, INC., AND OTHER EMPLOYERS IN ITS CONTROLLED GROUP OF COMPANIES THAT PARTICIPATE IN THE FERNANDEZ HOLDINGS HEALTH PLAN, WHICH IS SPONSORED BY FERNANDEZ HOLDINGS, INC., FOR THE BENEFIT OF ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS. 0 0 THE HEALTH TRUST WAS ESTABLISHED TO FUND MEDICAL BENEFITS FOR EMPLOYEES OF FERNANDEZ HOLDINGS, INC., AND OTHER EMPLOYERS IN ITS CONTROLLED GROUP OF COMPANIES THAT PARTICIPATE IN THE FERNANDEZ HOLDINGS HEALTH PLAN, WHICH IS SPONSORED BY FERNANDEZ HOLDINGS, INC., FOR THE BENEFIT OF ELIGIBLE EMPLOYEES AND THEIR ELIGIBLE DEPENDENTS. 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 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X JEREMY JOHNSON 3105711207 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 X KIRK FERNANDEZ TRUSTEE 1.00 39.00 X 0 0 0 0 0 0 0 0 0 0 BENEFIT & RISK MANAGEMENT 80 IRON POINT CIRCLE SUITE 200 FOLSOM CA 95630 CLAIMS PROCESSING 932096 ANTHEM BLUE CROSS LIFE AND HEALTH 3075 VANDERCAR WAY CINCINNATI OH 45209 MEDICAL NETWORK FEES 719620 EDGEWOOD PARTNERS INS CENTER 1390 WILLOW PASS ROAD CONCORD CA 94520 INSURANCE AGENTS AND BROKERS 222000 SOUTHERN SCRIPTS PO BOX 2482 NATCHITOCHES LA 71457 PHARMACY 179925 QUEST DIAGNOSTICS 10101 RENNER BLVD LENEXA KS 66219 CLINICAL LABORATORY 131960 6 PARTICIPANT CONTRIBUTIONS 525100 8233835 8233835 EMPLOYER CONTRIBUTIONS 525100 5970000 5970000 14203835 19 19 14203854 14203835 0 19 X 11891355 5355 43330 2376405 14316445 1808 216922 910397 582692 912205 799614 0 0 X 0 0 0 0 912205 799614 912205 799614 912205 799614 -112591 0 X 0 1 X 1 0 0 X 14203854 0 14203854 0 14203854 14316445 0 14316445 0 14316445 PART X, LINE 2: THE PLAN'S TRUST HAS OBTAINED A FAVORABLE TAX EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE DATED JULY 23, 2019, THAT THE TRUST IS EXEMPT FROM FEDERAL INCOME TAXATION UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE IRC. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS DESIGNED AND IS CURRENTLY BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. IN ACCORDANCE WITH GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE PLAN ADMINISTRATOR HAS EVALUATED THE PLAN'S TAX POSITIONS AND DOES NOT BELIEVE THE PLAN HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE DISCLOSURE OR ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION B, LINE 11B EMPLOYEES WHO ARE APPOINTED TO WORK ON THE PLAN PER THE TRUST DOCUMENT (THE DIRECTOR OF PORTFOLIO HR AND THE VICE PRESIDENT OF FHI) REVIEWED THE 990 WITH THE TRUSTEE FOR ACCURACY AND COMPLETION. FORM 990, PART VI, SECTION B, LINE 12C THE TRUST FOLLOWS THE CONFLICT OF INTEREST POLICY OF FERNANDEZ HOLDINGS, INC. ALL EMPLOYEES REVIEW THE POLICY AND SIGN THEIR ACKNOWLEDGMENT ON AN ANNUAL BASIS. ANYONE DEEMED TO HAVE A CONFLICT ABSTAINS FROM PARTICIPATION AND/OR VOTING ON THE MATTER AT HAND. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST VIA EMAIL. CONFLICT OF INTEREST POLICY IS AVAILABLE VIA THE ANNUAL HANDBOOK REQUIRING SIGNATURE EACH YEAR. FORM 990, PART IX, LINE 11G ADMINISTRATION FEES 1,036,162. WELLNESS VENDORS 186,147. CONSULTING 222,000. CONTRACT ADMINISTRATOR FEES 932,096. FERNANDEZ HOLDINGS INC 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 275560752 HOLDINGS AND INVESTMENT CA N/A C 0 PARC ENVIRONMENTAL 2864 E DOROTHY AVE FRESNO CA 93706 770129910 ENVIRONMENTAL REMEDIATION CA N/A C 0 PARC SPECIALTY CONTRACTORS 2864 E DOROTHY AVE FRESNO CA 93706 943259455 ENVIRONMENTAL REMEDIATION CA N/A C 0 QUINTRON SYSTEMS INC 1290 W MCCOY LANE SANTA MARIA CA 93455 952639464 AV & MANUFACTURING CA N/A C 0 RA ELECTRIC 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 954399249 AV & MANUFACTURING CA N/A C 0 RTS SOLUTIONZ 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 473765043 AV & VIDEO CONFERENCING CA N/A C 0 SOLUTIONZ INC 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 383645853 AV & VIDEO CONFERENCING CA N/A C 0 STERLING ENVIRONMENTAL CORPORATION 10203 E ST OAKLAND CA 94603 943073256 ENVIRONMENTAL REMEDIATION CA N/A C 0 UNITED AG & TURF LLC 6010 WEST BROADWAY ARDMORE OK 73401 741797630 EQUIPMENT DEALERSHIP OK N/A C 0 UNITED AG & TURF NE 216 CENTER ROAD FAIRFIELD ME 04937 844092767 EQUIPMENT DEALERSHIP & SERVICE ME N/A C 0 SUMMIT SOLUTIONZ INC 1029 N SWARTHMORE AVE PACIFIC PALISADES CA 90272 872578730 INFORMATION TECHNOLOGY SERVICES CA N/A C 0 UNITED CONSTRUCTIONS & FORESTRY LLC 216 CENTER ROAD FAIRFIELD ME 04937 871358227 EQUIPMENT DEALERSHIP & SERVICE CA N/A C 0 ARC ABATEMENT LLC 225 S 12TH STREET WACO TX 76701 873435889 ENVIRONMENTAL REMEDIATION CA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1