401k Plan data: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN plan

QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 401k Plan overview

Plan Name	QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN
Plan identification number	008

QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

QHCCS, LLC has sponsored the creation of one or more 401k plans.

Company Name: QHCCS, LLC

Employer identification number (EIN): 383980467

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about QHCCS, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2016-05-05

Company Identification Number: 0802452113

Legal Registered Office Address: 1573 MALLORY LN STE 100

BRENTWOOD
United States of America (USA)
37027

More information about QHCCS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
008 2018-01-01
008 2017-01-01 WILLIAM SCHWEINHART WILLIAM SCHWEINHART 2018-10-15
008 2016-01-01 WILLIAM SCHWEINHART WILLIAM SCHWEINHART 2017-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
008	2018-01-01
008	2017-01-01	WILLIAM SCHWEINHART	WILLIAM SCHWEINHART	2018-10-15
008	2016-01-01	WILLIAM SCHWEINHART	WILLIAM SCHWEINHART	2017-10-13

Plan Statistics for QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN

401k plan membership statisitcs for QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN

Measure Date Value
2018: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 0
Number of participants with account balances 2018-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 275
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 28
Total of all active and inactive participants 2017-01-01 303
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 303
Number of participants with account balances 2017-01-01 230
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 13
2016: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 280
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 273
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 27
Total of all active and inactive participants 2016-01-01 300
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 300
Number of participants with account balances 2016-01-01 225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 10

Measure	Date	Value
2018: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	0
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	275
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	28
Total of all active and inactive participants	2017-01-01	303
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	303
Number of participants with account balances	2017-01-01	230
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	13
2016: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	273
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	27
Total of all active and inactive participants	2016-01-01	300
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	300
Number of participants with account balances	2016-01-01	225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	10

Financial Data on QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN

Measure	Date	Value
2018 : QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-10	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-10	$0
Total unrealized appreciation/depreciation of assets	2018-12-10	$0
Total transfer of assets to this plan	2018-12-10	$9,126
Total transfer of assets from this plan	2018-12-10	$4,222,654
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-10	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-10	$0
Total income from all sources (including contributions)	2018-12-10	$60,935
Total loss/gain on sale of assets	2018-12-10	$0
Total of all expenses incurred	2018-12-10	$7,272,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-10	$7,242,323
Expenses. Certain deemed distributions of participant loans	2018-12-10	$0
Value of total corrective distributions	2018-12-10	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-10	$260,528
Value of total assets at end of year	2018-12-10	$0
Value of total assets at beginning of year	2018-12-10	$11,424,871
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-10	$29,955
Total income from rents	2018-12-10	$0
Total interest from all sources	2018-12-10	$2,528
Total dividends received (eg from common stock, registered investment company shares)	2018-12-10	$4,818
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-10	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-10	$4,818
Administrative expenses professional fees incurred	2018-12-10	$6,499
Was this plan covered by a fidelity bond	2018-12-10	Yes
Value of fidelity bond cover	2018-12-10	$10,000,000
If this is an individual account plan, was there a blackout period	2018-12-10	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-10	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-10	No
Amount of non-exempt transactions with any party-in-interest	2018-12-10	$0
Contributions received from participants	2018-12-10	$179,694
Participant contributions at end of year	2018-12-10	$0
Participant contributions at beginning of year	2018-12-10	$150,348
Participant contributions at end of year	2018-12-10	$0
Participant contributions at beginning of year	2018-12-10	$25,844
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-10	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-10	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-10	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-10	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-10	$0
Other income not declared elsewhere	2018-12-10	$241
Administrative expenses (other) incurred	2018-12-10	$0
Liabilities. Value of operating payables at beginning of year	2018-12-10	$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	2018-12-10	No
Value of net income/loss	2018-12-10	$-7,211,343
Value of net assets at end of year (total assets less liabilities)	2018-12-10	$0
Value of net assets at beginning of year (total assets less liabilities)	2018-12-10	$11,424,871
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-10	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-10	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2018-12-10	$0
Were any leases to which the plan was party in default or uncollectible	2018-12-10	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2018-12-10	$0
Investment advisory and management fees	2018-12-10	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-10	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-10	$742,149
Value of interest in pooled separate accounts at end of year	2018-12-10	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-10	$433,401
Interest on participant loans	2018-12-10	$2,528
Income. Interest from loans (other than to participants)	2018-12-10	$0
Interest earned on other investments	2018-12-10	$0
Income. Interest from US Government securities	2018-12-10	$0
Income. Interest from corporate debt instruments	2018-12-10	$0
Value of interest in common/collective trusts at end of year	2018-12-10	$0
Value of interest in common/collective trusts at beginning of year	2018-12-10	$9,770,794
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-10	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-10	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-10	$-15,867
Net investment gain/loss from pooled separate accounts	2018-12-10	$-9,345
Net investment gain or loss from common/collective trusts	2018-12-10	$-181,968
Net gain/loss from 103.12 investment entities	2018-12-10	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-10	No
Was there a failure to transmit to the plan any participant contributions	2018-12-10	No
Has the plan failed to provide any benefit when due under the plan	2018-12-10	No
Contributions received in cash from employer	2018-12-10	$80,834
Employer contributions (assets) at end of year	2018-12-10	$0
Employer contributions (assets) at beginning of year	2018-12-10	$302,335
Income. Dividends from preferred stock	2018-12-10	$0
Income. Dividends from common stock	2018-12-10	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-10	$7,242,323
Contract administrator fees	2018-12-10	$23,456
Liabilities. Value of benefit claims payable at beginning of year	2018-12-10	$0
Did the plan have assets held for investment	2018-12-10	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	2018-12-10	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-10	Yes
Aggregate proceeds on sale of assets	2018-12-10	$0
Aggregate carrying amount (costs) on sale of assets	2018-12-10	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2018-12-10	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-10	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-10	Disclaimer
Accountancy firm name	2018-12-10	LBMC, PC
Accountancy firm EIN	2018-12-10	621199757
2017 : QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$0
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$262,285
Total transfer of assets from this plan	2017-12-31	$147,528
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$2,513,767
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,039,014
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,015,909
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,110,700
Value of total assets at end of year	2017-12-31	$11,424,871
Value of total assets at beginning of year	2017-12-31	$9,835,361
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$23,105
Total income from rents	2017-12-31	$0
Total interest from all sources	2017-12-31	$6,421
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$9,884
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$9,884
Administrative expenses professional fees incurred	2017-12-31	$0
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Amount of non-exempt transactions with any party-in-interest	2017-12-31	$0
Contributions received from participants	2017-12-31	$706,264
Participant contributions at end of year	2017-12-31	$150,348
Participant contributions at beginning of year	2017-12-31	$138,807
Participant contributions at end of year	2017-12-31	$25,844
Participant contributions at beginning of year	2017-12-31	$25,475
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$102,101
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$271
Administrative expenses (other) incurred	2017-12-31	$0
Liabilities. Value of operating payables at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$1,474,753
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$11,424,871
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$9,835,361
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2017-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2017-12-31	$0
Investment advisory and management fees	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$742,149
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$570,051
Value of interest in pooled separate accounts at end of year	2017-12-31	$433,401
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$367,320
Interest on participant loans	2017-12-31	$6,421
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$0
Income. Interest from US Government securities	2017-12-31	$0
Income. Interest from corporate debt instruments	2017-12-31	$0
Value of interest in common/collective trusts at end of year	2017-12-31	$9,770,794
Value of interest in common/collective trusts at beginning of year	2017-12-31	$8,450,305
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$101,887
Net investment gain/loss from pooled separate accounts	2017-12-31	$74,848
Net investment gain or loss from common/collective trusts	2017-12-31	$1,209,756
Net gain/loss from 103.12 investment entities	2017-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$302,335
Employer contributions (assets) at end of year	2017-12-31	$302,335
Employer contributions (assets) at beginning of year	2017-12-31	$283,403
Income. Dividends from preferred stock	2017-12-31	$0
Income. Dividends from common stock	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,015,909
Contract administrator fees	2017-12-31	$23,105
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$0
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Aggregate proceeds on sale of assets	2017-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2017-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	LBMC, PC
Accountancy firm EIN	2017-12-31	621199757
2016 : QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$0
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$9,092,438
Total transfer of assets from this plan	2016-12-31	$445,715
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$2,122,890
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$934,252
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$893,405
Expenses. Certain deemed distributions of participant loans	2016-12-31	$20,532
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,000,779
Value of total assets at end of year	2016-12-31	$9,835,361
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$20,315
Total income from rents	2016-12-31	$0
Total interest from all sources	2016-12-31	$6,055
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$9,973
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$9,973
Administrative expenses professional fees incurred	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Amount of non-exempt transactions with any party-in-interest	2016-12-31	$0
Contributions received from participants	2016-12-31	$661,162
Participant contributions at end of year	2016-12-31	$138,807
Participant contributions at end of year	2016-12-31	$25,475
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$56,214
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$39
Administrative expenses (other) incurred	2016-12-31	$0
Liabilities. Value of operating payables at beginning of year	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$1,188,638
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$9,835,361
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2016-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2016-12-31	$0
Investment advisory and management fees	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$570,051
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Value of interest in pooled separate accounts at end of year	2016-12-31	$367,320
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$6,055
Income. Interest from loans (other than to participants)	2016-12-31	$0
Interest earned on other investments	2016-12-31	$0
Income. Interest from US Government securities	2016-12-31	$0
Income. Interest from corporate debt instruments	2016-12-31	$0
Value of interest in common/collective trusts at end of year	2016-12-31	$8,450,305
Value of interest in common/collective trusts at beginning of year	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$86,891
Net investment gain/loss from pooled separate accounts	2016-12-31	$103,108
Net investment gain or loss from common/collective trusts	2016-12-31	$916,045
Net gain/loss from 103.12 investment entities	2016-12-31	$0
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	$283,403
Employer contributions (assets) at end of year	2016-12-31	$283,403
Employer contributions (assets) at beginning of year	2016-12-31	$0
Income. Dividends from preferred stock	2016-12-31	$0
Income. Dividends from common stock	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$893,405
Contract administrator fees	2016-12-31	$20,315
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	Yes
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$0
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
Aggregate proceeds on sale of assets	2016-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-12-31	$0
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	LBMC, PC
Accountancy firm EIN	2016-12-31	621199757

Form 5500 Responses for QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN

2018: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	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: QUORUM HEALTH AFFINITY MEDICAL CENTER STANDARD 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
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

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

716969

Policy instance

Insurance contract or identification number	716969
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-10
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

716969

Policy instance

Insurance contract or identification number	716969
Number of Individuals Covered	303
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	QHCCS, LLC
Employer identification number (EIN):	383980467
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2016-05-05
Company Identification Number:	0802452113
Legal Registered Office Address:	1573 MALLORY LN STE 100 BRENTWOOD United States of America (USA) 37027