401k Plan data: EMPLOYEE LIFE & DISABILITY PLAN plan

EMPLOYEE LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	EMPLOYEE LIFE & DISABILITY PLAN
Plan identification number	534

EMPLOYEE LIFE & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: MITSUBISHI HEAVY INDUSTRIES AMERICA, INC.

Employer identification number (EIN): 363031033

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
534 2017-01-01
534 2016-01-01
534 2015-01-01 FRANCINE CHRISTIAN FRANCINE CHRISTIAN 2016-10-17
534 2014-01-01 THERESA KELLY THERESA KELLY 2015-10-13
534 2013-01-01 ALLISON CARVAINIS
534 2012-01-01 ALLISON CARVAINIS
534 2011-01-01 ALLISON CARVAINIS
534 2010-01-01 ALLISON CARVAINIS
534 2009-01-01 ALLISON CARVAINIS 2010-07-26
534 2009-01-01 ALLISON CARVAINIS 2010-07-26
534 2009-01-01 ALLISON CARVAINIS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
534	2017-01-01
534	2016-01-01
534	2015-01-01	FRANCINE CHRISTIAN	FRANCINE CHRISTIAN	2016-10-17
534	2014-01-01	THERESA KELLY	THERESA KELLY	2015-10-13
534	2013-01-01	ALLISON CARVAINIS
534	2012-01-01	ALLISON CARVAINIS
534	2011-01-01	ALLISON CARVAINIS
534	2010-01-01	ALLISON CARVAINIS
534	2009-01-01		ALLISON CARVAINIS	2010-07-26
534	2009-01-01		ALLISON CARVAINIS	2010-07-26
534	2009-01-01	ALLISON CARVAINIS

Plan Statistics for EMPLOYEE LIFE & DISABILITY PLAN

401k plan membership statisitcs for EMPLOYEE LIFE & DISABILITY PLAN

Measure Date Value
2017: EMPLOYEE LIFE & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,853
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,839
Number of retired or separated participants receiving benefits 2017-01-01 0
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 2,839
2016: EMPLOYEE LIFE & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2,712
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,765
Number of retired or separated participants receiving benefits 2016-01-01 0
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 2,765
2015: EMPLOYEE LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,519
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2,719
Total of all active and inactive participants 2015-01-01 2,719
Total participants 2015-01-01 2,719
Number of employers contributing to the scheme 2015-01-01 8
2014: EMPLOYEE LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,476
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,519
Number of retired or separated participants receiving benefits 2014-01-01 0
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 2,519
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2,519
Number of employers contributing to the scheme 2014-01-01 8
2013: EMPLOYEE LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,115
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,474
Number of retired or separated participants receiving benefits 2013-01-01 2
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 2,476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 2,476
Number of employers contributing to the scheme 2013-01-01 6
2012: EMPLOYEE LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,836
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,115
Number of retired or separated participants receiving benefits 2012-01-01 0
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 2,115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 2,115
Number of employers contributing to the scheme 2012-01-01 5
2011: EMPLOYEE LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,665
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,836
Number of retired or separated participants receiving benefits 2011-01-01 0
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 1,836
Total participants 2011-01-01 1,836
2010: EMPLOYEE LIFE & DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,388
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,665
Number of retired or separated participants receiving benefits 2010-01-01 0
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 1,665
Total participants 2010-01-01 1,665
Number of employers contributing to the scheme 2010-01-01 5
2009: EMPLOYEE LIFE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,171
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,388
Number of retired or separated participants receiving benefits 2009-01-01 0
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 1,388
Total participants 2009-01-01 1,388
Number of employers contributing to the scheme 2009-01-01 5

Measure	Date	Value
2017: EMPLOYEE LIFE & DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,853
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,839
Number of retired or separated participants receiving benefits	2017-01-01	0
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	2,839
2016: EMPLOYEE LIFE & DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,712
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,765
Number of retired or separated participants receiving benefits	2016-01-01	0
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	2,765
2015: EMPLOYEE LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,519
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,719
Total of all active and inactive participants	2015-01-01	2,719
Total participants	2015-01-01	2,719
Number of employers contributing to the scheme	2015-01-01	8
2014: EMPLOYEE LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,476
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,519
Number of retired or separated participants receiving benefits	2014-01-01	0
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	2,519
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2,519
Number of employers contributing to the scheme	2014-01-01	8
2013: EMPLOYEE LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,115
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,474
Number of retired or separated participants receiving benefits	2013-01-01	2
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	2,476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2,476
Number of employers contributing to the scheme	2013-01-01	6
2012: EMPLOYEE LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,836
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,115
Number of retired or separated participants receiving benefits	2012-01-01	0
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	2,115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	2,115
Number of employers contributing to the scheme	2012-01-01	5
2011: EMPLOYEE LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,665
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,836
Number of retired or separated participants receiving benefits	2011-01-01	0
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	1,836
Total participants	2011-01-01	1,836
2010: EMPLOYEE LIFE & DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,388
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,665
Number of retired or separated participants receiving benefits	2010-01-01	0
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	1,665
Total participants	2010-01-01	1,665
Number of employers contributing to the scheme	2010-01-01	5
2009: EMPLOYEE LIFE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,171
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,388
Number of retired or separated participants receiving benefits	2009-01-01	0
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	1,388
Total participants	2009-01-01	1,388
Number of employers contributing to the scheme	2009-01-01	5

Form 5500 Responses for EMPLOYEE LIFE & DISABILITY PLAN

2017: EMPLOYEE LIFE & DISABILITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple 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: EMPLOYEE LIFE & DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	Submission has been amended	Yes
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

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	4
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	YOK960227
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	4
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	YOK960227
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	4
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	YOK960227
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	3
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	3
CIGNA LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK960169
Policy instance	2
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	NYK600075
Policy instance	1
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract number	FLY960211
Policy instance	3

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Company Name:	MITSUBISHI HEAVY INDUSTRIES AMERICA, INC.
Employer identification number (EIN):	363031033
NAIC Classification:	333200