401k Plan data: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND plan

FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 401k Plan overview

Plan Name	FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND
Plan identification number	002

FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

FOUNDATION SURGICAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: FOUNDATION SURGICAL HOSPITAL

Employer identification number (EIN): 731487633

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2013-01-01 BRAD OTTWELL BRAD OTTWELL 2014-10-14
002 2012-01-01 AMBER PAYNE PRIS RICKS 2013-10-14
002 2011-01-01 PRIS RICKS
002 2010-01-01 PRIS RICKS
002 2007-01-01 PRIS RICKS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2013-01-01	BRAD OTTWELL	BRAD OTTWELL	2014-10-14
002	2012-01-01	AMBER PAYNE	PRIS RICKS	2013-10-14
002	2011-01-01	PRIS RICKS
002	2010-01-01	PRIS RICKS
002	2007-01-01	PRIS RICKS

Plan Statistics for FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND

401k plan membership statisitcs for FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND

Measure Date Value
2013: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2013 401k membership
Total participants, beginning-of-year 2013-01-01 877
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 843
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 105
Total of all active and inactive participants 2013-01-01 951
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 951
Number of participants with account balances 2013-01-01 768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 31
2012: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2012 401k membership
Total participants, beginning-of-year 2012-01-01 762
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 791
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 84
Total of all active and inactive participants 2012-01-01 877
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 877
Number of participants with account balances 2012-01-01 700
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 62
2011: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,351
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 687
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 74
Total of all active and inactive participants 2011-01-01 762
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 762
Number of participants with account balances 2011-01-01 591
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 201
2010: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2010 401k membership
Total participants, beginning-of-year 2010-01-01 646
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,351
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 1,351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 1,351
Number of participants with account balances 2010-01-01 695
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 4
2007: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2007 401k membership
Total participants, beginning-of-year 2007-01-01 1,243
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 1,263
Number of retired or separated participants receiving benefits 2007-01-01 30
Number of other retired or separated participants entitled to future benefits 2007-01-01 248
Total of all active and inactive participants 2007-01-01 1,541
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
Total participants 2007-01-01 1,541
Number of participants with account balances 2007-01-01 903
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 26
Number of employers contributing to the scheme 2007-01-01 0

Measure	Date	Value
2013: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2013 401k membership
Total participants, beginning-of-year	2013-01-01	877
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	843
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	105
Total of all active and inactive participants	2013-01-01	951
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	951
Number of participants with account balances	2013-01-01	768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	31
2012: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2012 401k membership
Total participants, beginning-of-year	2012-01-01	762
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	791
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	84
Total of all active and inactive participants	2012-01-01	877
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	877
Number of participants with account balances	2012-01-01	700
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	62
2011: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,351
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	687
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	74
Total of all active and inactive participants	2011-01-01	762
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	762
Number of participants with account balances	2011-01-01	591
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	201
2010: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2010 401k membership
Total participants, beginning-of-year	2010-01-01	646
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,351
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	1,351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1,351
Number of participants with account balances	2010-01-01	695
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	4
2007: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2007 401k membership
Total participants, beginning-of-year	2007-01-01	1,243
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	1,263
Number of retired or separated participants receiving benefits	2007-01-01	30
Number of other retired or separated participants entitled to future benefits	2007-01-01	248
Total of all active and inactive participants	2007-01-01	1,541
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	1,541
Number of participants with account balances	2007-01-01	903
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	26
Number of employers contributing to the scheme	2007-01-01	0

Financial Data on FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND

Measure	Date	Value
2013 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$5,153,293
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,971,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,973,928
Expenses. Certain deemed distributions of participant loans	2013-12-31	$-16,935
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,948,918
Value of total assets at end of year	2013-12-31	$18,765,989
Value of total assets at beginning of year	2013-12-31	$15,584,057
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$14,368
Total interest from all sources	2013-12-31	$57,248
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$626,650
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$626,650
Administrative expenses professional fees incurred	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,769,109
Participant contributions at end of year	2013-12-31	$559,250
Participant contributions at beginning of year	2013-12-31	$479,517
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$347,719
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$1,644
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$3,181,932
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$18,765,989
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$15,584,057
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$16,471,467
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$13,572,535
Value of interest in pooled separate accounts at end of year	2013-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$16,071
Interest earned on other investments	2013-12-31	$41,177
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest in common/collective trusts at beginning of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,735,272
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$1,532,005
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,520,477
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$832,090
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,973,928
Contract administrator fees	2013-12-31	$12,724
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	ROBISON GARY JOHNSON & ASSOCIATES
Accountancy firm EIN	2013-12-31	461765638
2012 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$966,465
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$3,618,146
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$2,163,283
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,137,818
Expenses. Certain deemed distributions of participant loans	2012-12-31	$3,841
Value of total corrective distributions	2012-12-31	$4,685
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,150,215
Value of total assets at end of year	2012-12-31	$15,584,057
Value of total assets at beginning of year	2012-12-31	$13,162,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$16,939
Total interest from all sources	2012-12-31	$56,187
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$319,303
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$319,303
Administrative expenses professional fees incurred	2012-12-31	$4,333
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,483,699
Participant contributions at end of year	2012-12-31	$479,517
Participant contributions at beginning of year	2012-12-31	$450,630
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$64,549
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$1,052
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,454,863
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$15,584,057
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$13,162,729
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$13,572,535
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$11,438,199
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$16,876
Interest earned on other investments	2012-12-31	$39,311
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$1,532,005
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,273,900
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,092,441
Net investment gain/loss from pooled separate accounts	2012-12-31	$0
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$601,967
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$2,137,818
Contract administrator fees	2012-12-31	$11,554
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	HENLEY & JOHNSON
Accountancy firm EIN	2012-12-31	731486733
2011 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$1,930,584
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$5,307,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$5,254,971
Expenses. Certain deemed distributions of participant loans	2011-12-31	$17,208
Value of total corrective distributions	2011-12-31	$5,350
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$2,325,292
Value of total assets at end of year	2011-12-31	$13,162,729
Value of total assets at beginning of year	2011-12-31	$16,539,475
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$29,801
Total interest from all sources	2011-12-31	$58,507
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$288,061
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$288,061
Administrative expenses professional fees incurred	2011-12-31	$13,320
Was this plan covered by a fidelity bond	2011-12-31	No
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,501,021
Participant contributions at end of year	2011-12-31	$450,630
Participant contributions at beginning of year	2011-12-31	$576,192
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$263,172
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$2,319,489
Other income not declared elsewhere	2011-12-31	$-56,135
Administrative expenses (other) incurred	2011-12-31	$55
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-3,376,746
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$13,162,729
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$16,539,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$11,438,199
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$14,784,686
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$38,061
Interest on participant loans	2011-12-31	$20,801
Interest earned on other investments	2011-12-31	$37,706
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,273,900
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,140,536
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-685,141
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$561,099
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$2,935,482
Contract administrator fees	2011-12-31	$16,426
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	HENLEY & JOHNSON PLLC
Accountancy firm EIN	2011-12-31	731486733
2010 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$6,648,828
Total transfer of assets from this plan	2010-12-31	$55,081
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$2,822,179
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,488,585
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,451,194
Expenses. Certain deemed distributions of participant loans	2010-12-31	$7,130
Value of total corrective distributions	2010-12-31	$6,797
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,938,859
Value of total assets at end of year	2010-12-31	$16,539,475
Value of total assets at beginning of year	2010-12-31	$8,612,134
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$23,464
Total interest from all sources	2010-12-31	$32,445
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$284,454
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$284,454
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,306,905
Participant contributions at end of year	2010-12-31	$576,192
Participant contributions at beginning of year	2010-12-31	$390,864
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$60,422
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$-122,798
Administrative expenses (other) incurred	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$1,333,594
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$16,539,475
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$8,612,134
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$14,784,686
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$8,221,270
Value of interest in pooled separate accounts at end of year	2010-12-31	$38,061
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$0
Interest on participant loans	2010-12-31	$4,121
Interest earned on other investments	2010-12-31	$28,324
Value of interest in common/collective trusts at end of year	2010-12-31	$0
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,140,536
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$-69,211
Net investment gain/loss from pooled separate accounts	2010-12-31	$758,430
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$571,532
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,451,194
Contract administrator fees	2010-12-31	$23,464
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Qualified
Accountancy firm name	2010-12-31	HENLEY AND JOHNSON, PLLC
Accountancy firm EIN	2010-12-31	731486733

Form 5500 Responses for FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND

2013: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2007: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2007 form 5500 responses
2007-01-01	Type of plan entity	Mulitple employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes

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FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND [EIN = 352330205]

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Company Name:	FOUNDATION SURGICAL HOSPITAL
Employer identification number (EIN):	731487633
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)