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| Plan Name | FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FULL HOUSE RESORTS, INC. |
| Employer identification number (EIN): | 133391527 |
| NAIC Classification: | 713200 |
| NAIC Description: | Gambling Industries |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2015-07-01 | ||||
| 503 | 2012-04-01 | MARK MILLER | |||
| 503 | 2011-04-01 | MARK MILLER |
| Measure | Date | Value |
|---|---|---|
| 2015: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-07-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 1,879 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
| Total of all active and inactive participants | 2015-07-01 | 1,879 |
| 2012: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-04-01 | 579 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 0 |
| Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
| Total of all active and inactive participants | 2012-04-01 | 0 |
| 2011: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-04-01 | 553 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 579 |
| Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
| Total of all active and inactive participants | 2011-04-01 | 579 |
| 2015: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | First time form 5500 has been submitted | Yes |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Submission has been amended | No |
| 2012-04-01 | This submission is the final filing | Yes |
| 2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-04-01 | Plan is a collectively bargained plan | No |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: FULL HOUSE RESORTS, INC. HEALTH AND WELFARE BENEFIT PLAN 2011 form 5500 responses | ||
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | First time form 5500 has been submitted | Yes |
| 2011-04-01 | Submission has been amended | No |
| 2011-04-01 | This submission is the final filing | No |
| 2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-04-01 | Plan is a collectively bargained plan | No |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 905128 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1053385 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | KMO5982924 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | KMO5982924 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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