0001562180-23-005525.txt : 20230628 0001562180-23-005525.hdr.sgml : 20230628 20230628163547 ACCESSION NUMBER: 0001562180-23-005525 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230626 FILED AS OF DATE: 20230628 DATE AS OF CHANGE: 20230628 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stucki Brian CENTRAL INDEX KEY: 0001954798 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39952 FILM NUMBER: 231052743 MAIL ADDRESS: STREET 1: C/O QUALTRICS INTERNATIONAL INC. STREET 2: 333 WEST RIVER PARK DRIVE CITY: PROVO STATE: UT ZIP: 84604 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Qualtrics International Inc. CENTRAL INDEX KEY: 0001747748 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 471754215 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 333 WEST RIVER PARK DRIVE CITY: PROVO STATE: UT ZIP: 84604 BUSINESS PHONE: 385-203-4999 MAIL ADDRESS: STREET 1: 333 WEST RIVER PARK DRIVE CITY: PROVO STATE: UT ZIP: 84604 4 1 primarydocument.xml PRIMARY DOCUMENT X0407 4 2023-06-26 false 0001747748 Qualtrics International Inc. XM 0001954798 Stucki Brian 333 WEST RIVER PARK DRIVE PROVO UT 84604 false true false false See Remarks true Class A Common Stock 2023-06-26 4 S false 12000.00 18.14 D 596788.00 D The sale reported in this Form 4 was effectuated pursuant to a Rule 10b5-1 trading plan adopted by the Reporting Person on December 14, 2021. President and Chief Operating Officer /s/ Blake Tierney, Attorney-in-Fact 2023-06-28