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.

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): 352330205

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 2017-01-01 STEVE VEST
002 2016-01-01 ARASELY VALDEZ
002 2015-01-01 ARASELY VALDEZ
002 2014-01-01 SARA FOSTER BRAD OTTWELL 2015-10-12
002 2014-01-01 SARA FOSTER BRAD OTTWELL 2015-10-12
002 2014-01-01 SARA FOSTER BRAD OTTWELL 2015-10-12
002 2014-01-01 SARA FOSTER BRAD OTTWELL 2015-10-12

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	STEVE VEST
002	2016-01-01	ARASELY VALDEZ
002	2015-01-01	ARASELY VALDEZ
002	2014-01-01	SARA FOSTER	BRAD OTTWELL	2015-10-12
002	2014-01-01	SARA FOSTER	BRAD OTTWELL	2015-10-12
002	2014-01-01	SARA FOSTER	BRAD OTTWELL	2015-10-12
002	2014-01-01	SARA FOSTER	BRAD OTTWELL	2015-10-12

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
2017: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2017 401k membership
Total participants, beginning-of-year 2017-01-01 653
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2016 401k membership
Total participants, beginning-of-year 2016-01-01 597
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 412
Number of other retired or separated participants entitled to future benefits 2016-01-01 241
Total of all active and inactive participants 2016-01-01 653
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 653
Number of participants with account balances 2016-01-01 580
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 72
2015: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,209
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 719
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 206
Total of all active and inactive participants 2015-01-01 925
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 925
Number of participants with account balances 2015-01-01 884
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 57
2014: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2014 401k membership
Total participants, beginning-of-year 2014-01-01 951
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,119
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 87
Total of all active and inactive participants 2014-01-01 1,209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 1,209
Number of participants with account balances 2014-01-01 984
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 44

Measure	Date	Value
2017: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2017 401k membership
Total participants, beginning-of-year	2017-01-01	653
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2016 401k membership
Total participants, beginning-of-year	2016-01-01	597
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	412
Number of other retired or separated participants entitled to future benefits	2016-01-01	241
Total of all active and inactive participants	2016-01-01	653
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	653
Number of participants with account balances	2016-01-01	580
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	72
2015: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,209
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	719
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	206
Total of all active and inactive participants	2015-01-01	925
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	925
Number of participants with account balances	2015-01-01	884
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	57
2014: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2014 401k membership
Total participants, beginning-of-year	2014-01-01	951
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,119
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	87
Total of all active and inactive participants	2014-01-01	1,209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,209
Number of participants with account balances	2014-01-01	984
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	44

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

Measure	Date	Value
2017 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2017 401k financial data
Total transfer of assets from this plan	2017-05-01	$5,830,132
Total income from all sources (including contributions)	2017-05-01	$732,957
Total of all expenses incurred	2017-05-01	$4,813,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-05-01	$4,752,334
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-05-01	$212,746
Value of total assets at end of year	2017-05-01	$0
Value of total assets at beginning of year	2017-05-01	$9,910,993
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-05-01	$61,484
Total interest from all sources	2017-05-01	$2,041
Total dividends received (eg from common stock, registered investment company shares)	2017-05-01	$27,356
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-05-01	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-05-01	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-05-01	$27,356
Was this plan covered by a fidelity bond	2017-05-01	Yes
Value of fidelity bond cover	2017-05-01	$1,000,000
If this is an individual account plan, was there a blackout period	2017-05-01	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-05-01	$0
Were there any nonexempt tranactions with any party-in-interest	2017-05-01	No
Contributions received from participants	2017-05-01	$131,462
Participant contributions at end of year	2017-05-01	$0
Participant contributions at beginning of year	2017-05-01	$302,972
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-05-01	No
Value of net income/loss	2017-05-01	$-4,080,861
Value of net assets at end of year (total assets less liabilities)	2017-05-01	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-05-01	$9,910,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-05-01	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-05-01	No
Were any leases to which the plan was party in default or uncollectible	2017-05-01	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-05-01	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-05-01	$9,419,922
Interest on participant loans	2017-05-01	$2,041
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-05-01	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-05-01	$188,099
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-05-01	$490,814
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-05-01	No
Was there a failure to transmit to the plan any participant contributions	2017-05-01	No
Has the plan failed to provide any benefit when due under the plan	2017-05-01	No
Contributions received in cash from employer	2017-05-01	$81,284
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-05-01	$4,752,334
Contract administrator fees	2017-05-01	$61,484
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-05-01	No
Did the plan have assets held for investment	2017-05-01	No
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	2017-05-01	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-05-01	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-05-01	Yes
Opinion of an independent qualified public accountant for this plan	2017-05-01	Disclaimer
Accountancy firm name	2017-05-01	ROBISON GARY JOHNSON & ASSOCIATES
Accountancy firm EIN	2017-05-01	461765638
2016 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2016 401k financial data
Total transfer of assets to this plan	2016-12-31	$15,372
Total transfer of assets from this plan	2016-12-31	$10,812,961
Total income from all sources (including contributions)	2016-12-31	$4,279,858
Total of all expenses incurred	2016-12-31	$2,528,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$2,419,674
Expenses. Certain deemed distributions of participant loans	2016-12-31	$22,886
Value of total corrective distributions	2016-12-31	$3,167
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$3,020,561
Value of total assets at end of year	2016-12-31	$9,910,993
Value of total assets at beginning of year	2016-12-31	$18,956,833
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$82,382
Total interest from all sources	2016-12-31	$24,520
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$354,492
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$354,492
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,753,969
Participant contributions at end of year	2016-12-31	$302,972
Participant contributions at beginning of year	2016-12-31	$522,869
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$324,585
Administrative expenses (other) incurred	2016-12-31	$117
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$1,751,749
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$9,910,993
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$18,956,833
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$9,419,922
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$17,041,984
Interest on participant loans	2016-12-31	$24,520
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$188,099
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,391,980
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$880,285
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$942,007
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$2,419,674
Contract administrator fees	2016-12-31	$82,265
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	ROBISON GARY JOHNSON & ASSOCIATES
Accountancy firm EIN	2016-12-31	461765638
2015 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2015 401k financial data
Total transfer of assets to this plan	2015-12-31	$63,455
Total transfer of assets from this plan	2015-12-31	$2,504,503
Total income from all sources (including contributions)	2015-12-31	$2,866,862
Total of all expenses incurred	2015-12-31	$3,078,762
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,994,178
Expenses. Certain deemed distributions of participant loans	2015-12-31	$38,114
Value of total corrective distributions	2015-12-31	$9,319
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$3,123,975
Value of total assets at end of year	2015-12-31	$18,956,833
Value of total assets at beginning of year	2015-12-31	$21,609,781
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$37,151
Total interest from all sources	2015-12-31	$20,661
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$623,204
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$623,204
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$2,001,335
Participant contributions at end of year	2015-12-31	$522,869
Participant contributions at beginning of year	2015-12-31	$545,437
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$189,141
Other income not declared elsewhere	2015-12-31	$387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-211,900
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$18,956,833
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$21,609,781
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$17,041,984
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$19,015,619
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$20,661
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,391,980
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,048,725
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-901,365
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$933,499
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,994,178
Contract administrator fees	2015-12-31	$37,151
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	ROBISON GARY JOHNSON & ASSOCIATES
Accountancy firm EIN	2015-12-31	461765638
2014 : FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$4,549,895
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,706,104
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,663,605
Expenses. Certain deemed distributions of participant loans	2014-12-31	$27,207
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$3,343,158
Value of total assets at end of year	2014-12-31	$21,609,781
Value of total assets at beginning of year	2014-12-31	$18,765,990
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$15,292
Total interest from all sources	2014-12-31	$57,233
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$1,922,209
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$1,922,209
Administrative expenses professional fees incurred	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	No
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$2,005,190
Participant contributions at end of year	2014-12-31	$545,437
Participant contributions at beginning of year	2014-12-31	$559,251
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$380,995
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$15
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$2,843,791
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$21,609,781
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$18,765,990
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$19,015,619
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$16,471,467
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$17,149
Interest earned on other investments	2014-12-31	$40,084
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,048,725
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,735,272
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-772,705
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$956,973
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,663,605
Contract administrator fees	2014-12-31	$15,277
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	ROBISON GARY JOHNSON & ASSOCIATES
Accountancy firm EIN	2014-12-31	731486733

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

2017: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

Policy instance

Insurance policy start date	2017-01-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $1,291
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $439
Insurance broker organization code?	3
Insurance broker name	BOBBY PARKS

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 60590

Policy instance

Insurance contract or identification number	MR 60590
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,611
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,611
Insurance broker organization code?	4
Insurance broker name	TBS AGENCY INC

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

Policy instance

Total amount of commissions paid to insurance broker	USD $2,003
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $681
Insurance broker organization code?	3
Insurance broker name	JAMES FORTUNE

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 60590

Policy instance

Insurance contract or identification number	MR 60590
Number of Individuals Covered	1209
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $20,000
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,000
Insurance broker organization code?	4
Insurance broker name	TBS AGENCY INC

Potentially related plans

FOUNDATION AFFILIATES MULTIPLE EMPLOYER 401(K) AND [EIN = 731487633]

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Company Name:	FOUNDATION SURGICAL HOSPITAL
Employer identification number (EIN):	352330205
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)