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AMERICAN DAWN MEDICAL AND LIFE INSURANCE 401k Plan overview

Plan NameAMERICAN DAWN MEDICAL AND LIFE INSURANCE
Plan identification number 502

AMERICAN DAWN MEDICAL AND LIFE INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AMERICAN DAWN, INC. has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN DAWN, INC.
Employer identification number (EIN):953512325
NAIC Classification:448150
NAIC Description:Clothing Accessories Stores

Additional information about AMERICAN DAWN, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1991-12-01
Company Identification Number: 0012267206
Legal Registered Office Address: 401 W ARTESIA BLVD

COMPTON
United States of America (USA)
90220

More information about AMERICAN DAWN, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN DAWN MEDICAL AND LIFE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-11-01VI NGUYEN2023-02-28
5022018-11-01LILLIAN HUANG2020-02-26
5022018-11-01VI NGUYEN2021-10-14
5022017-11-01
5022016-11-01
5022015-11-01VI NGUYEN
5022014-11-01VI NGUYEN
5022013-11-01VI NGUYEN
5022012-11-01VI NGUYEN

Plan Statistics for AMERICAN DAWN MEDICAL AND LIFE INSURANCE

401k plan membership statisitcs for AMERICAN DAWN MEDICAL AND LIFE INSURANCE

Measure Date Value
2021: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-11-01112
Total number of active participants reported on line 7a of the Form 55002021-11-01112
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-01112
Number of employers contributing to the scheme2021-11-010
2018: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-11-01107
Total number of active participants reported on line 7a of the Form 55002018-11-01102
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-011
Total of all active and inactive participants2018-11-01103
Number of employers contributing to the scheme2018-11-010
2017: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-11-01119
Total number of active participants reported on line 7a of the Form 55002017-11-01119
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01119
Number of employers contributing to the scheme2017-11-010
2016: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-11-01100
Total number of active participants reported on line 7a of the Form 55002016-11-01119
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01119
2015: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-11-01115
Total number of active participants reported on line 7a of the Form 55002015-11-0197
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-0197
2014: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-11-01107
Total number of active participants reported on line 7a of the Form 55002014-11-01115
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01115
2013: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-11-01106
Total number of active participants reported on line 7a of the Form 55002013-11-01107
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-01107
2012: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-11-01106
Total number of active participants reported on line 7a of the Form 55002012-11-01106
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-010
Total of all active and inactive participants2012-11-01106

Form 5500 Responses for AMERICAN DAWN MEDICAL AND LIFE INSURANCE

2021: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – General assets of the sponsorYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedYes
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: AMERICAN DAWN MEDICAL AND LIFE INSURANCE 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC22421
Policy instance 1
Insurance contract or identification numberC22421
Number of Individuals Covered124
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $81,428
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,418,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,428
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100012307
Policy instance 2
Insurance contract or identification number40000100012307
Number of Individuals Covered21
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,273
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $12,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,273
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100012307
Policy instance 2
Insurance contract or identification number40000100012307
Number of Individuals Covered26
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $1,454
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,454
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC22421
Policy instance 1
Insurance contract or identification numberC22421
Number of Individuals Covered157
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $86,910
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,427,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,910
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC22421
Policy instance 1
Insurance contract or identification numberC22421
Number of Individuals Covered152
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $138,717
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,365,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100012307
Policy instance 2
Insurance contract or identification number40000100012307
Number of Individuals Covered25
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $1,441
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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