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| Plan Name | QK4 SHORT TERM DISABILITY |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | QK4 INC. |
| Employer identification number (EIN): | 610865261 |
| NAIC Classification: | 541330 |
| NAIC Description: | Engineering Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2023-06-01 | MICHAEL J. VICKERS | 2024-10-07 | ||
| 505 | 2022-06-01 | MICHAEL J. VICKERS | 2023-11-20 | ||
| 505 | 2021-06-01 | MICHAEL VICKERS | 2023-03-10 | ||
| 505 | 2020-06-01 | MICHAEL VICKERS | 2023-03-10 |
| 2023: QK4 SHORT TERM DISABILITY 2023 form 5500 responses | ||
|---|---|---|
| 2023-06-01 | Type of plan entity | Single employer plan |
| 2023-06-01 | Plan funding arrangement – Insurance | Yes |
| 2023-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: QK4 SHORT TERM DISABILITY 2022 form 5500 responses | ||
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: QK4 SHORT TERM DISABILITY 2021 form 5500 responses | ||
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: QK4 SHORT TERM DISABILITY 2020 form 5500 responses | ||
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | First time form 5500 has been submitted | Yes |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GUG0BX2R | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GUG0BX2R | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GUG0BX2R | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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