| Plan Name | FULLY WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | FULLY LLC |
| Employer identification number (EIN): | 473785296 |
| NAIC Classification: | 442299 |
| NAIC Description: | All Other Home Furnishings Stores |
Additional information about FULLY LLC
| Jurisdiction of Incorporation: | Florida Department of State Division of Corporations |
| Incorporation Date: | 1978-02-27 |
| Company Identification Number: | 566533 |
| Legal Registered Office Address: |
400 NE 67TH ST MIAMI 33138 |
More information about FULLY LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-05-01 |
| 2019: FULLY WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | First time form 5500 has been submitted | Yes |
| 2019-05-01 | Submission has been amended | No |
| 2019-05-01 | This submission is the final filing | Yes |
| 2019-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-05-01 | Plan is a collectively bargained plan | No |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) | |
| Policy contract number | 10016217 |
| Policy instance | 1 |
| PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 ) | |
| Policy contract number | G0040180 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5951810 |
| Policy instance | 3 |
| CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) | |
| Policy contract number | CASCADE |
| Policy instance | 4 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E4823381 |
| Policy instance | 5 |