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HEALTH & VISION PLAN 401k Plan overview

Plan NameHEALTH & VISION PLAN
Plan identification number 503

HEALTH & VISION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Vision

401k Sponsoring company profile

MITSUBISHI MOTORS NORTH AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name:MITSUBISHI MOTORS NORTH AMERICA, INC.
Employer identification number (EIN):953673256
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH & VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-01-01SHEILA GREGORY2024-09-24
5032022-01-01BETTY ANN LAY2023-07-24
5032021-01-01DORA SIU2022-10-07
5032020-01-01DORA SIU2021-10-04
5032019-01-01DORA SIU2020-07-31
5032018-01-01DORA SIU2019-10-07
5032017-01-01
5032016-01-01ANGIE O'LEARY
5032015-01-01ANGIE O'LEARY
5032014-01-01ANGIE O'LEARY
5032013-01-01ANGIE O'LEARY
5032012-01-01
5032011-01-01
5032010-01-01
5032009-01-01

Plan Statistics for HEALTH & VISION PLAN

401k plan membership statisitcs for HEALTH & VISION PLAN

Measure Date Value
2023: HEALTH & VISION PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01813
Total number of active participants reported on line 7a of the Form 55002023-01-010
Number of retired or separated participants receiving benefits2023-01-01800
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01800
Number of employers contributing to the scheme2023-01-010
2022: HEALTH & VISION PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01860
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01811
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01811
2021: HEALTH & VISION PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01870
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-01860
Total of all active and inactive participants2021-01-01860
2020: HEALTH & VISION PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01898
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-01870
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01870
2019: HEALTH & VISION PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01928
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01900
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01900
2018: HEALTH & VISION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01953
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01931
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01931
2017: HEALTH & VISION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,288
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-01115
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01115
2016: HEALTH & VISION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,474
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-011,288
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,288
2015: HEALTH & VISION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,413
Total number of active participants reported on line 7a of the Form 55002015-01-01211
Number of retired or separated participants receiving benefits2015-01-01909
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,120
2014: HEALTH & VISION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,442
Total number of active participants reported on line 7a of the Form 55002014-01-011,218
Number of retired or separated participants receiving benefits2014-01-01187
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,405
2013: HEALTH & VISION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,412
Total number of active participants reported on line 7a of the Form 55002013-01-011,247
Number of retired or separated participants receiving benefits2013-01-01187
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,434
2012: HEALTH & VISION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,451
Total number of active participants reported on line 7a of the Form 55002012-01-011,223
Number of retired or separated participants receiving benefits2012-01-01182
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011,405
Total participants2012-01-011,405
2011: HEALTH & VISION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,488
Total number of active participants reported on line 7a of the Form 55002011-01-011,261
Number of retired or separated participants receiving benefits2011-01-01182
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-011,443
Total participants2011-01-011,443
2010: HEALTH & VISION PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,514
Total number of active participants reported on line 7a of the Form 55002010-01-011,269
Number of retired or separated participants receiving benefits2010-01-01210
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,479
Total participants2010-01-011,479
2009: HEALTH & VISION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,621
Total number of active participants reported on line 7a of the Form 55002009-01-011,288
Number of retired or separated participants receiving benefits2009-01-01219
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,507
Total participants2009-01-011,507

Form 5500 Responses for HEALTH & VISION PLAN

2023: HEALTH & VISION PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: HEALTH & VISION PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: HEALTH & VISION PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: HEALTH & VISION PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: HEALTH & VISION PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: HEALTH & VISION PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HEALTH & VISION PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: HEALTH & VISION PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: HEALTH & VISION PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: HEALTH & VISION PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: HEALTH & VISION PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: HEALTH & VISION PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: HEALTH & VISION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: HEALTH & VISION PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: HEALTH & VISION PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract numberE00066741789
Policy instance 1
Insurance contract or identification numberE00066741789
Number of Individuals Covered801
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,231,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract numberE00066741789
Policy instance 1
Insurance contract or identification numberE00066741789
Number of Individuals Covered824
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,224,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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