401k Plan data: QUALTRICS LABS INC 401(K) PLAN plan

QUALTRICS LABS INC 401(K) PLAN 401k Plan overview

Plan Name	QUALTRICS LABS INC 401(K) PLAN
Plan identification number	001

QUALTRICS LABS INC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

QUALTRICS LABS INC has sponsored the creation of one or more 401k plans.

Company Name: QUALTRICS LABS INC

Employer identification number (EIN): 770591992

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALTRICS LABS INC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 CHRIS BECKSTEAD
001 2012-01-01 CHRIST BECKSTEAD
001 2011-01-01 STUART ORGILL 2012-09-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2013-01-01	CHRIS BECKSTEAD
001	2012-01-01	CHRIST BECKSTEAD
001	2011-01-01	STUART ORGILL	2012-09-04

Plan Statistics for QUALTRICS LABS INC 401(K) PLAN

401k plan membership statisitcs for QUALTRICS LABS INC 401(K) PLAN

Measure Date Value
2013: QUALTRICS LABS INC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 302
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 10
Total of all active and inactive participants 2013-01-01 315
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 315
Number of participants with account balances 2013-01-01 59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: QUALTRICS LABS INC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 277
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 282
Number of participants with account balances 2012-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2013: QUALTRICS LABS INC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	302
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	10
Total of all active and inactive participants	2013-01-01	315
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	315
Number of participants with account balances	2013-01-01	59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: QUALTRICS LABS INC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	277
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	282
Number of participants with account balances	2012-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on QUALTRICS LABS INC 401(K) PLAN

Measure	Date	Value
2013 : QUALTRICS LABS INC 401(K) PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$315,941
Total of all expenses incurred	2013-12-31	$43,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$39,219
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$233,199
Value of total assets at end of year	2013-12-31	$556,341
Value of total assets at beginning of year	2013-12-31	$283,821
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$4,202
Total interest from all sources	2013-12-31	$30
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$80,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$233,199
Participant contributions at end of year	2013-12-31	$7,394
Participant contributions at beginning of year	2013-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$272,520
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$556,341
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$283,821
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$548,595
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$276,480
Interest earned on other investments	2013-12-31	$30
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$352
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$7,341
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$82,712
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$39,219
Contract administrator fees	2013-12-31	$4,202
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	KEDDINGTON & CHRISTENSEN
Accountancy firm EIN	2013-12-31	454186798
2012 : QUALTRICS LABS INC 401(K) PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$194,984
Total of all expenses incurred	2012-12-31	$5,864
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$3,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$172,885
Value of total assets at end of year	2012-12-31	$283,821
Value of total assets at beginning of year	2012-12-31	$94,701
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,489
Total interest from all sources	2012-12-31	$2
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$158,973
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$13,912
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$189,120
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$283,821
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$94,701
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$276,480
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$94,642
Interest earned on other investments	2012-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$7,341
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$59
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$22,097
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$3,375
Contract administrator fees	2012-12-31	$2,489
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	KEDDINGTON & CHRISTENSEN
Accountancy firm EIN	2012-12-31	454186798

Form 5500 Responses for QUALTRICS LABS INC 401(K) PLAN

2013: QUALTRICS LABS INC 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: QUALTRICS LABS INC 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number	802389-000
Policy instance	1
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number	802389-000
Policy instance	1

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Company Name:	QUALTRICS LABS INC
Employer identification number (EIN):	770591992
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services