401k Plan data: FOUNDCARE, INC. RETIREMENT PLAN plan

FOUNDCARE, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	FOUNDCARE, INC. RETIREMENT PLAN
Plan identification number	001

FOUNDCARE, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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.
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

FOUNDCARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOUNDCARE, INC.

Employer identification number (EIN): 542083748

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about FOUNDCARE, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2002-06-20

Company Identification Number: N02000004723

Legal Registered Office Address: 423 FERN STREET

WEST PALM BEACH

33401

More information about FOUNDCARE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUNDCARE, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 ROBERT AGUERO ROBERT AGUERO 2018-10-10
001 2017-01-01 2018-10-09
001 2016-01-01 ROBERT AGUERO 2017-05-01 ROBERT AGUERO 2017-05-01
001 2015-01-01 ROBERT AGUERO 2016-06-28 ROBERT AGUERO 2016-06-28
001 2014-01-01 ROBERT AGUERO 2015-07-17 ROBERT AGUERO 2015-07-17
001 2013-01-01 ROBERT AGUERO 2014-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	ROBERT AGUERO		ROBERT AGUERO	2018-10-10
001	2017-01-01		2018-10-09
001	2016-01-01	ROBERT AGUERO	2017-05-01	ROBERT AGUERO	2017-05-01
001	2015-01-01	ROBERT AGUERO	2016-06-28	ROBERT AGUERO	2016-06-28
001	2014-01-01	ROBERT AGUERO	2015-07-17	ROBERT AGUERO	2015-07-17
001	2013-01-01	ROBERT AGUERO	2014-07-29

Plan Statistics for FOUNDCARE, INC. RETIREMENT PLAN

401k plan membership statisitcs for FOUNDCARE, INC. RETIREMENT PLAN

Measure Date Value
2022: FOUNDCARE, INC. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 150
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 31
Total of all active and inactive participants 2022-01-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 191
Number of participants with account balances 2022-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 7
2021: FOUNDCARE, INC. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 175
Number of retired or separated participants receiving benefits 2021-01-01 7
Number of other retired or separated participants entitled to future benefits 2021-01-01 29
Total of all active and inactive participants 2021-01-01 211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 211
Number of participants with account balances 2021-01-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 6
2020: FOUNDCARE, INC. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 149
Number of retired or separated participants receiving benefits 2020-01-01 9
Number of other retired or separated participants entitled to future benefits 2020-01-01 25
Total of all active and inactive participants 2020-01-01 183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 183
Number of participants with account balances 2020-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: FOUNDCARE, INC. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 140
Number of retired or separated participants receiving benefits 2019-01-01 8
Number of other retired or separated participants entitled to future benefits 2019-01-01 25
Total of all active and inactive participants 2019-01-01 173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 173
Number of participants with account balances 2019-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 6
2018: FOUNDCARE, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 120
Number of retired or separated participants receiving benefits 2018-01-01 8
Number of other retired or separated participants entitled to future benefits 2018-01-01 20
Total of all active and inactive participants 2018-01-01 148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 148
Number of participants with account balances 2018-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 11
2017: FOUNDCARE, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 99
Number of retired or separated participants receiving benefits 2017-01-01 9
Number of other retired or separated participants entitled to future benefits 2017-01-01 23
Total of all active and inactive participants 2017-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 131
Number of participants with account balances 2017-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 13

Measure	Date	Value
2022: FOUNDCARE, INC. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	150
Number of retired or separated participants receiving benefits	2022-01-01	10
Number of other retired or separated participants entitled to future benefits	2022-01-01	31
Total of all active and inactive participants	2022-01-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	191
Number of participants with account balances	2022-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	7
2021: FOUNDCARE, INC. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	175
Number of retired or separated participants receiving benefits	2021-01-01	7
Number of other retired or separated participants entitled to future benefits	2021-01-01	29
Total of all active and inactive participants	2021-01-01	211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	211
Number of participants with account balances	2021-01-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	6
2020: FOUNDCARE, INC. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	149
Number of retired or separated participants receiving benefits	2020-01-01	9
Number of other retired or separated participants entitled to future benefits	2020-01-01	25
Total of all active and inactive participants	2020-01-01	183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	183
Number of participants with account balances	2020-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: FOUNDCARE, INC. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	140
Number of retired or separated participants receiving benefits	2019-01-01	8
Number of other retired or separated participants entitled to future benefits	2019-01-01	25
Total of all active and inactive participants	2019-01-01	173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	173
Number of participants with account balances	2019-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	6
2018: FOUNDCARE, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	120
Number of retired or separated participants receiving benefits	2018-01-01	8
Number of other retired or separated participants entitled to future benefits	2018-01-01	20
Total of all active and inactive participants	2018-01-01	148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	148
Number of participants with account balances	2018-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	11
2017: FOUNDCARE, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	99
Number of retired or separated participants receiving benefits	2017-01-01	9
Number of other retired or separated participants entitled to future benefits	2017-01-01	23
Total of all active and inactive participants	2017-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	131
Number of participants with account balances	2017-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	13

Financial Data on FOUNDCARE, INC. RETIREMENT PLAN

Measure	Date	Value
2022 : FOUNDCARE, INC. RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-93,527
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$476,165
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$472,230
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$796,447
Value of total assets at end of year	2022-12-31	$5,174,099
Value of total assets at beginning of year	2022-12-31	$5,743,791
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$3,935
Total interest from all sources	2022-12-31	$6,001
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$300,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$483,556
Participant contributions at end of year	2022-12-31	$92,442
Participant contributions at beginning of year	2022-12-31	$70,316
Participant contributions at end of year	2022-12-31	$28,969
Participant contributions at beginning of year	2022-12-31	$12,040
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$70,565
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$527
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$1,427
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-569,692
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,174,099
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,743,791
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$4,382,389
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,744,111
Interest on participant loans	2022-12-31	$5,207
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$124,290
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$17,505
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$17,505
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$794
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$519,144
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$877,777
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-895,975
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$242,326
Employer contributions (assets) at end of year	2022-12-31	$26,338
Employer contributions (assets) at beginning of year	2022-12-31	$20,615
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$472,230
Contract administrator fees	2022-12-31	$3,935
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	TEMPLETON & COMPANY, LLC
Accountancy firm EIN	2022-12-31	141918990
2021 : FOUNDCARE, INC. RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,288,200
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$178,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$177,279
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$734,552
Value of total assets at end of year	2021-12-31	$5,743,791
Value of total assets at beginning of year	2021-12-31	$4,634,304
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,434
Total interest from all sources	2021-12-31	$5,425
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$300,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$446,550
Participant contributions at end of year	2021-12-31	$70,316
Participant contributions at beginning of year	2021-12-31	$81,027
Participant contributions at end of year	2021-12-31	$12,040
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$370
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$1,427
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,109,487
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,743,791
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,634,304
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,744,111
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$4,541,950
Interest on participant loans	2021-12-31	$5,477
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$17,505
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$11,327
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$11,327
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$-52
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$877,777
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$548,223
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$287,632
Employer contributions (assets) at end of year	2021-12-31	$20,615
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$177,279
Contract administrator fees	2021-12-31	$1,434
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	TEMPLETON COMPANY
Accountancy firm EIN	2021-12-31	141918990
2020 : FOUNDCARE, INC. RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,128,873
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$242,304
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$240,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$607,747
Value of total assets at end of year	2020-12-31	$4,634,304
Value of total assets at beginning of year	2020-12-31	$3,747,735
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,363
Total interest from all sources	2020-12-31	$6,038
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$1,363
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$300,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$380,367
Participant contributions at end of year	2020-12-31	$81,027
Participant contributions at beginning of year	2020-12-31	$126,325
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$416
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$886,569
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,634,304
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,747,735
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$4,541,950
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,610,009
Interest on participant loans	2020-12-31	$6,060
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$11,327
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$11,401
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$11,401
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$-22
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$515,088
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$226,964
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$240,941
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	TEMPLETON & COMPANY, LLC
Accountancy firm EIN	2020-12-31	141918990
2019 : FOUNDCARE, INC. RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$1,084,372
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$175,311
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$173,183
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$510,128
Value of total assets at end of year	2019-12-31	$3,747,735
Value of total assets at beginning of year	2019-12-31	$2,838,674
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,128
Total interest from all sources	2019-12-31	$5,670
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$2,128
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$300,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$334,172
Participant contributions at end of year	2019-12-31	$126,325
Participant contributions at beginning of year	2019-12-31	$30,423
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$909,061
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,747,735
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,838,674
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$3,610,009
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,797,705
Interest on participant loans	2019-12-31	$5,534
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$11,401
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$10,546
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$10,546
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$136
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$568,574
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$175,956
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$173,183
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	TEMPLETON & COMPANY, LLC
Accountancy firm EIN	2019-12-31	141918990
2018 : FOUNDCARE, INC. RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$346,216
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$226,251
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$223,123
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$553,642
Value of total assets at end of year	2018-12-31	$2,838,674
Value of total assets at beginning of year	2018-12-31	$2,718,709
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,128
Total interest from all sources	2018-12-31	$962
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$3,128
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$300,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$334,333
Participant contributions at end of year	2018-12-31	$30,423
Participant contributions at beginning of year	2018-12-31	$37,746
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$35,609
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$119,965
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,838,674
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,718,709
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,797,705
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,672,361
Interest on participant loans	2018-12-31	$1,901
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$10,546
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$8,602
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$8,602
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$-939
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-208,388
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$183,700
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$223,123
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	TEMPLETON AND COMPANY, LLC
Accountancy firm EIN	2018-12-31	141918990
2017 : FOUNDCARE, INC. RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
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	$807,691
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$53,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$51,139
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$506,046
Value of total assets at end of year	2017-12-31	$2,718,709
Value of total assets at beginning of year	2017-12-31	$1,964,326
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,169
Total interest from all sources	2017-12-31	$820
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$2,169
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$200,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$292,076
Participant contributions at end of year	2017-12-31	$37,746
Participant contributions at beginning of year	2017-12-31	$21,283
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$46,566
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	$754,383
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,718,709
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,964,326
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
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,672,361
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,924,880
Interest on participant loans	2017-12-31	$1,703
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$8,602
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$18,163
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$18,163
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$-883
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$300,825
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	$167,404
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$51,139
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
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	TEMPLETON AND COMPANY
Accountancy firm EIN	2017-12-31	141918990

Form 5500 Responses for FOUNDCARE, INC. RETIREMENT PLAN

2022: FOUNDCARE, INC. RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: FOUNDCARE, INC. RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: FOUNDCARE, INC. RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: FOUNDCARE, INC. RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: FOUNDCARE, INC. RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: FOUNDCARE, INC. RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
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	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Number of Individuals Covered	122
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,256
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $3,256
Insurance broker organization code?	7

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Number of Individuals Covered	106
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,560
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $3,560
Insurance broker organization code?	7

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,202
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $1,202
Amount paid for insurance broker fees	0
Insurance broker organization code?	7

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,090
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $2,090
Amount paid for insurance broker fees	0
Insurance broker organization code?	7

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Number of Individuals Covered	98
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,047
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $2,047
Amount paid for insurance broker fees	0
Insurance broker organization code?	7

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

031-81286

Policy instance

Insurance contract or identification number	031-81286
Number of Individuals Covered	104
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,704
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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
Commission paid to Insurance Broker	USD $1,704
Amount paid for insurance broker fees	0
Insurance broker organization code?	7
Insurance broker name	NATIONWIDE LIFE INSURANCE COMPANY

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Company Name:	FOUNDCARE, INC.
Employer identification number (EIN):	542083748
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2002-06-20
Company Identification Number:	N02000004723
Legal Registered Office Address:	423 FERN STREET WEST PALM BEACH 33401