401k Plan data: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN plan

SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN
Plan identification number	501

SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

SAFARI CIRCUITS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SAFARI CIRCUITS, LLC

Employer identification number (EIN): 873955696

NAIC Classification: 335900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-04-01 TERRI JOHNSON 2024-10-14
501 2022-04-01 TERRI L. JOHNSON 2023-11-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-04-01	TERRI JOHNSON	2024-10-14
501	2022-04-01	TERRI L. JOHNSON	2023-11-03

Plan Statistics for SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN

Measure Date Value
2023: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-04-01 159
Total number of active participants reported on line 7a of the Form 5500 2023-04-01 167
Total of all active and inactive participants 2023-04-01 167
2022: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 203
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 175
Total of all active and inactive participants 2022-04-01 175

Measure	Date	Value
2023: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-04-01	159
Total number of active participants reported on line 7a of the Form 5500	2023-04-01	167
Total of all active and inactive participants	2023-04-01	167
2022: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	203
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	175
Total of all active and inactive participants	2022-04-01	175

Form 5500 Responses for SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN

2023: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-04-01	Type of plan entity	Single employer plan
2023-04-01	Submission has been amended	No
2023-04-01	This submission is the final filing	No
2023-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-04-01	Plan is a collectively bargained plan	No
2023-04-01	Plan funding arrangement – Insurance	Yes
2023-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-04-01	Plan benefit arrangement – Insurance	Yes
2023-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: SAFARI CIRCUITS LLC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

304601

Policy instance

Insurance contract or identification number	304601
Number of Individuals Covered	173
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $16,570
Total amount of fees paid to insurance company	USD $0
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 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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $77,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

178264

Policy instance

Insurance contract or identification number	178264
Number of Individuals Covered	194
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $27,217
Total amount of fees paid to insurance company	USD $5,130
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 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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

178264

Policy instance

Insurance contract or identification number	178264
Number of Individuals Covered	175
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $25,735
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,037,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	25735
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

304601

Policy instance

Insurance contract or identification number	304601
Number of Individuals Covered	156
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $7,612
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $69,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,612
Insurance broker organization code?	3

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Company Name:	SAFARI CIRCUITS, LLC
Employer identification number (EIN):	873955696
NAIC Classification:	335900