401k Plan data: MICHELIN VOLUNTARY BENEFIT PLAN plan

MICHELIN VOLUNTARY BENEFIT PLAN 401k Plan overview

Plan Name	MICHELIN VOLUNTARY BENEFIT PLAN
Plan identification number	540

MICHELIN VOLUNTARY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Severance pay Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: MICHELIN NORTH AMERICA, INC.

Employer identification number (EIN): 111724631

NAIC Classification: 326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MICHELIN VOLUNTARY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
540 2017-01-01 KAREN TALLEY KAREN SUMMERS 2018-09-12
540 2016-01-01 KAREN TALLEY BARRY CROSS 2017-05-16
540 2015-01-01 KAREN TALLEY BARRY CROSS 2016-07-29
540 2014-01-01 KAREN TALLEY BARRY CROSS 2015-10-11
540 2013-01-01 KAREN TALLEY BARRY CROSS 2014-10-15
540 2012-01-01 AUDIE PENN
540 2011-01-01 AUDIE M. PENN
540 2010-01-01 TERRY WADDELL
540 2009-01-01 MARTIN STOREY MARTIN STOREY 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
540	2017-01-01	KAREN TALLEY	KAREN SUMMERS	2018-09-12
540	2016-01-01	KAREN TALLEY	BARRY CROSS	2017-05-16
540	2015-01-01	KAREN TALLEY	BARRY CROSS	2016-07-29
540	2014-01-01	KAREN TALLEY	BARRY CROSS	2015-10-11
540	2013-01-01	KAREN TALLEY	BARRY CROSS	2014-10-15
540	2012-01-01	AUDIE PENN
540	2011-01-01	AUDIE M. PENN
540	2010-01-01	TERRY WADDELL
540	2009-01-01	MARTIN STOREY	MARTIN STOREY	2010-10-14

Plan Statistics for MICHELIN VOLUNTARY BENEFIT PLAN

401k plan membership statisitcs for MICHELIN VOLUNTARY BENEFIT PLAN

Measure Date Value
2017: MICHELIN VOLUNTARY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 14,467
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 15,169
Number of retired or separated participants receiving benefits 2017-01-01 613
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 15,782
2016: MICHELIN VOLUNTARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 13,960
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 14,123
Number of retired or separated participants receiving benefits 2016-01-01 344
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 14,467
2015: MICHELIN VOLUNTARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 8,932
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 13,595
Number of retired or separated participants receiving benefits 2015-01-01 365
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 13,960
2014: MICHELIN VOLUNTARY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 13,074
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 8,527
Number of retired or separated participants receiving benefits 2014-01-01 405
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 8,932
2013: MICHELIN VOLUNTARY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 16,206
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 12,806
Number of retired or separated participants receiving benefits 2013-01-01 268
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 13,074
2012: MICHELIN VOLUNTARY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 16,217
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 16,150
Number of retired or separated participants receiving benefits 2012-01-01 56
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 16,206
2011: MICHELIN VOLUNTARY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15,011
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 15,214
Number of retired or separated participants receiving benefits 2011-01-01 24
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 15,238
2010: MICHELIN VOLUNTARY BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,355
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 15,020
Number of retired or separated participants receiving benefits 2010-01-01 39
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 15,059
2009: MICHELIN VOLUNTARY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,477
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,339
Number of retired or separated participants receiving benefits 2009-01-01 16
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 1,355

Measure	Date	Value
2017: MICHELIN VOLUNTARY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	14,467
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	15,169
Number of retired or separated participants receiving benefits	2017-01-01	613
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	15,782
2016: MICHELIN VOLUNTARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	13,960
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	14,123
Number of retired or separated participants receiving benefits	2016-01-01	344
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	14,467
2015: MICHELIN VOLUNTARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	8,932
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	13,595
Number of retired or separated participants receiving benefits	2015-01-01	365
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	13,960
2014: MICHELIN VOLUNTARY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	13,074
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	8,527
Number of retired or separated participants receiving benefits	2014-01-01	405
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	8,932
2013: MICHELIN VOLUNTARY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	16,206
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	12,806
Number of retired or separated participants receiving benefits	2013-01-01	268
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	13,074
2012: MICHELIN VOLUNTARY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	16,217
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	16,150
Number of retired or separated participants receiving benefits	2012-01-01	56
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	16,206
2011: MICHELIN VOLUNTARY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15,011
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	15,214
Number of retired or separated participants receiving benefits	2011-01-01	24
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	15,238
2010: MICHELIN VOLUNTARY BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,355
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	15,020
Number of retired or separated participants receiving benefits	2010-01-01	39
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	15,059
2009: MICHELIN VOLUNTARY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,477
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,339
Number of retired or separated participants receiving benefits	2009-01-01	16
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	1,355

Form 5500 Responses for MICHELIN VOLUNTARY BENEFIT PLAN

2017: MICHELIN VOLUNTARY BENEFIT PLAN 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	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MICHELIN VOLUNTARY BENEFIT PLAN 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	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MICHELIN VOLUNTARY BENEFIT PLAN 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	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MICHELIN VOLUNTARY BENEFIT PLAN 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	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MICHELIN VOLUNTARY BENEFIT PLAN 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 – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MICHELIN VOLUNTARY BENEFIT PLAN 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 – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MICHELIN VOLUNTARY BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: MICHELIN VOLUNTARY BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: MICHELIN VOLUNTARY BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0143169
Policy instance	6
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF385029176901
Policy instance	7
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	1000036
Policy instance	2
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	4
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	0000003433
Policy instance	5
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	1
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	1000036
Policy instance	2
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	51319-1;51319-2
Policy instance	5
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	0000003433
Policy instance	6
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	51319-1,2
Policy instance	5
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	3438
Policy instance	6
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	4
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	602578
Policy instance	2
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	51319-1,2
Policy instance	5
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	602578
Policy instance	2
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	1
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	3438
Policy instance	6
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	602578
Policy instance	2
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	1
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	3433
Policy instance	6
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	51319-1,2
Policy instance	5
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	4
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number	49823
Policy instance	7
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	6
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF3850287544-01
Policy instance	5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4794
Policy instance	2
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	3433
Policy instance	1
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	602578
Policy instance	4
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number	28245
Policy instance	5
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF3 850 287544
Policy instance	4
LEGALPLANS, USA (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number	602578
Policy instance	3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	4794
Policy instance	2
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	28971
Policy instance	1

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Company Name:	MICHELIN NORTH AMERICA, INC.
Employer identification number (EIN):	111724631
NAIC Classification:	326200