401k Plan data: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES plan

MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 401k Plan overview

Plan Name	MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES
Plan identification number	552

MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

THE GOODYEAR TIRE & RUBBER COMPANY has sponsored the creation of one or more 401k plans.

Company Name: THE GOODYEAR TIRE & RUBBER COMPANY

Employer identification number (EIN): 340253240

NAIC Classification: 326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
552 2017-01-01 EVAN SCOCOS
552 2016-01-01 EVAN SCOCOS
552 2015-01-01 EVAN SCOCOS
552 2014-01-01 RICHARD J NOECHEL, VP CONTROLLER
552 2013-01-01 DAMON AUDIA, VP FINANCE DAMON AUDIA, VP FINANCE 2014-07-29
552 2012-01-01 LAURA THOMPSON, VP FINANCE LAURA THOMPSON, VP FINANCE 2013-07-29
552 2011-01-01 LAURA THOMPSON, VP FINANCE LAURA THOMPSON, VP FINANCE 2012-10-12
552 2009-01-01 LAURA THOMPSON, VP FINANCE LAURA THOMPSON, VP FINANCE 2011-10-17

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
552	2017-01-01	EVAN SCOCOS
552	2016-01-01	EVAN SCOCOS
552	2015-01-01	EVAN SCOCOS
552	2014-01-01	RICHARD J NOECHEL, VP CONTROLLER
552	2013-01-01	DAMON AUDIA, VP FINANCE	DAMON AUDIA, VP FINANCE	2014-07-29
552	2012-01-01	LAURA THOMPSON, VP FINANCE	LAURA THOMPSON, VP FINANCE	2013-07-29
552	2011-01-01	LAURA THOMPSON, VP FINANCE	LAURA THOMPSON, VP FINANCE	2012-10-12
552	2009-01-01	LAURA THOMPSON, VP FINANCE	LAURA THOMPSON, VP FINANCE	2011-10-17

Plan Statistics for MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES

401k plan membership statisitcs for MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES

Measure Date Value
2017: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2017 401k membership
Total participants, beginning-of-year 2017-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 50
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 50
2016: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2016 401k membership
Total participants, beginning-of-year 2016-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 49
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 49
2015: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2015 401k membership
Total participants, beginning-of-year 2015-01-01 141
Number of retired or separated participants receiving benefits 2015-01-01 129
Total of all active and inactive participants 2015-01-01 129
2014: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2014 401k membership
Total participants, beginning-of-year 2014-01-01 142
Number of retired or separated participants receiving benefits 2014-01-01 141
Total of all active and inactive participants 2014-01-01 141
2013: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2013 401k membership
Total participants, beginning-of-year 2013-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 142
Total of all active and inactive participants 2013-01-01 142
2012: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2012 401k membership
Total participants, beginning-of-year 2012-01-01 170
Number of retired or separated participants receiving benefits 2012-01-01 131
Total of all active and inactive participants 2012-01-01 131
2011: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2011 401k membership
Total participants, beginning-of-year 2011-01-01 168
Number of retired or separated participants receiving benefits 2011-01-01 170
Total of all active and inactive participants 2011-01-01 170
2009: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2009 401k membership
Total participants, beginning-of-year 2009-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
Number of retired or separated participants receiving benefits 2009-01-01 171
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 171

Measure	Date	Value
2017: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2017 401k membership
Total participants, beginning-of-year	2017-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	50
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	50
2016: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2016 401k membership
Total participants, beginning-of-year	2016-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	49
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	49
2015: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2015 401k membership
Total participants, beginning-of-year	2015-01-01	141
Number of retired or separated participants receiving benefits	2015-01-01	129
Total of all active and inactive participants	2015-01-01	129
2014: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2014 401k membership
Total participants, beginning-of-year	2014-01-01	142
Number of retired or separated participants receiving benefits	2014-01-01	141
Total of all active and inactive participants	2014-01-01	141
2013: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2013 401k membership
Total participants, beginning-of-year	2013-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	142
Total of all active and inactive participants	2013-01-01	142
2012: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2012 401k membership
Total participants, beginning-of-year	2012-01-01	170
Number of retired or separated participants receiving benefits	2012-01-01	131
Total of all active and inactive participants	2012-01-01	131
2011: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2011 401k membership
Total participants, beginning-of-year	2011-01-01	168
Number of retired or separated participants receiving benefits	2011-01-01	170
Total of all active and inactive participants	2011-01-01	170
2009: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2009 401k membership
Total participants, beginning-of-year	2009-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
Number of retired or separated participants receiving benefits	2009-01-01	171
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	171

Form 5500 Responses for MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES

2017: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MEDICAL BENEFITS FOR NIAGARA FALLS PLANT HOURLY RETIREES 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

301194

Policy instance

Insurance contract or identification number	301194
Number of Individuals Covered	163
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $21,365
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
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

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Company Name:	THE GOODYEAR TIRE & RUBBER COMPANY
Employer identification number (EIN):	340253240
NAIC Classification:	326200