0001104659-22-065272.txt : 20220526 0001104659-22-065272.hdr.sgml : 20220526 20220526161757 ACCESSION NUMBER: 0001104659-22-065272 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220523 FILED AS OF DATE: 20220526 DATE AS OF CHANGE: 20220526 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAFOND DANIEL CENTRAL INDEX KEY: 0001916192 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40147 FILM NUMBER: 22970300 MAIL ADDRESS: STREET 1: C/O QUALTEK SERVICES INC. STREET 2: 475 SENTRY PARKWAY E, SUITE 200 CITY: BLUE BELL STATE: PA ZIP: 19422 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: QualTek Services Inc. CENTRAL INDEX KEY: 0001839412 STANDARD INDUSTRIAL CLASSIFICATION: WATER, SEWER, PIPELINE, COMM AND POWER LINE CONSTRUCTION [1623] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 888 SAN CLEMENTE DRIVE, SUITE 400 CITY: NEWPORT BEACH STATE: CA ZIP: 92660 BUSINESS PHONE: 949-887-0331 MAIL ADDRESS: STREET 1: 888 SAN CLEMENTE DRIVE, SUITE 400 CITY: NEWPORT BEACH STATE: CA ZIP: 92660 FORMER COMPANY: FORMER CONFORMED NAME: Roth CH Acquisition III Co DATE OF NAME CHANGE: 20210107 4 1 tm2217068-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-05-23 0 0001839412 QualTek Services Inc. QTEK 0001916192 LAFOND DANIEL C/O QUALTEK SERVICES, INC. 475 SENTRY PARKWAY E, SUITE 200 BLUE BELL PA 19422 1 0 0 0 Class A Common Stock 2022-05-23 4 D 0 10000 1.45 A 10000 D /s/ Daniel Lafond 2022-05-26