2023 Form 5500 filing — Qualtrics Health & Welfare Plan
Plain-English filing summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, this is the 2023 Form 5500 filing (EFAST2 acknowledgement 20240816161329NAL0014807825001) for Qualtrics Health & Welfare Plan, reported by Qualtrics, LLC under EIN 45-4964116 and plan number 501. It reports 4,009 participants. Attached schedules in the loaded dataset include Schedule C (service provider compensation).
Filing snapshot
- EFAST2 acknowledgement
- 20240816161329NAL0014807825001
- Plan sponsor
- Qualtrics, LLC
- EIN
- 45-4964116
- Plan number
- 501
- Location
- Provo, UT
- Received date
- not reported in the loaded dataset
Reported financial snapshot
Reported figures as filed, in whole dollars. Only fields the filing reports are shown.
This 2023 filing is loaded, but detailed Schedule H/I financial figures are not present for it in the current loaded dataset. Participant counts and filing identity above are reported; asset and contribution detail comes from the financial schedules where filed.
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Aetna Life Insurance Company | CONTRACT ADMINISTRATOR | $1,503,992 | not reported in the loaded dataset |
| Umr, Inc | CLAIMS PROCESSING | $412,283 | $17,036 |
| Optumrx, Inc. | PHARMACY BENEFIT MANAGEME | $55,683 | $1,296 |