0000947871-22-000223.txt : 20220214 0000947871-22-000223.hdr.sgml : 20220214 20220214101929 ACCESSION NUMBER: 0000947871-22-000223 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 2 FILED AS OF DATE: 20220214 DATE AS OF CHANGE: 20220214 GROUP MEMBERS: SAP AMERICA, INC. SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: Qualtrics International Inc. CENTRAL INDEX KEY: 0001747748 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-92162 FILM NUMBER: 22626699 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SAP SE CENTRAL INDEX KEY: 0001000184 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 STATE OF INCORPORATION: 2M FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: DIETMAR-HOPP-ALLEE 16 CITY: WALLDORF STATE: 2M ZIP: 69190 BUSINESS PHONE: 0114962277 MAIL ADDRESS: STREET 1: DIETMAR-HOPP-ALLEE 16 CITY: WALLDORF STATE: 2M ZIP: 69190 FORMER COMPANY: FORMER CONFORMED NAME: SAP AG DATE OF NAME CHANGE: 20091023 FORMER COMPANY: FORMER CONFORMED NAME: SAP AKTIENGESELLSCHAFT SYSTEMS APPLICATIONS PRODUCTS IN DATA DATE OF NAME CHANGE: 19960807 SC 13G 1 ss790198_sc13g.htm SCHEDULE 13G

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

 

SCHEDULE 13G

 (Amendment No. )*

 

Under the Securities Exchange Act of 1934

 




 

Qualtrics International Inc.
(Name of Issuer)

 

 

Class A Common Stock, par value $0.0001 per share
(Title of Class of Securities)

 

 

747601201
(CUSIP Number)

 

 

December 31, 2021
(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

 

☐  Rule 13d-1(b)

☐  Rule 13d-1(c)

☒  Rule 13d-1(d)

 

 

*The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

 

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). 

 

 

   

 

CUSIP No. 747601201  SCHEDULE 13G Page 2 of 8 Pages

 

         
1

NAME OF REPORTING PERSONS

I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) 

 

SAP SE

2

CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)

(a) o

(b) o

 
3

SEC USE ONLY

 

 

4

CITIZENSHIP OR PLACE OF ORGANIZATION

 

Federal Republic of Germany

NUMBER OF

SHARES

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

5

SOLE VOTING POWER

 

0

6

SHARED VOTING POWER

 

423,170,610 (1)

7

SOLE DISPOSITIVE POWER

 

0

8

SHARED DISPOSITIVE POWER

 

423,170,610 (1)

9

AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

 

423,170,610 (1)

10

CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions)

 

 

o
11

PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)

 

77.9%

12

TYPE OF REPORTING PERSON (See Instructions)

 

OO

 

(1)Represents shares of Class B Common Stock convertible into an equal number of shares of Class A Common Stock at any time.

 

 

   

 

CUSIP No. 747601201  SCHEDULE 13G Page 3 of 8 Pages

 

         
1

NAME OF REPORTING PERSONS

I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) 

 

SAP America, Inc.

2

CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)

(a) o

(b) o

 
3

SEC USE ONLY

 

 

4

CITIZENSHIP OR PLACE OF ORGANIZATION

 

Delaware

NUMBER OF

SHARES

BENEFICIALLY

OWNED BY

EACH

REPORTING

PERSON

WITH

5

SOLE VOTING POWER

 

0

6

SHARED VOTING POWER

 

423,170,610 (1)

7

SOLE DISPOSITIVE POWER

 

0

8

SHARED DISPOSITIVE POWER

 

423,170,610 (1)

9

AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

 

423,170,610 (1)

10

CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (See Instructions)

 

 

o
11

PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)

 

77.9%

12

TYPE OF REPORTING PERSON (See Instructions)

 

OO

 

(1)Represents shares of Class B Common Stock convertible into an equal number of shares of Class A Common Stock at any time.
   

 

CUSIP No.  747601201  SCHEDULE 13G Page 4 of 8 Pages

 

Item 1.   (a) Name of Issuer:

Qualtrics International Inc.

    (b) Address of Issuer’s Principal Executive Offices:

333 West River Park Drive

Provo, Utah 84604

 

Item 2.   (a) Name of Person Filing:

SAP SE

SAP America, Inc.

    (b) Address of Principal Business Office:

SAP SE

Deitmar-Hopp-Allee 16

69190 Walldorf, Federal Republic of Germany

 

SAP America, Inc.

999 West Chester Pike

Newtown Square, PA, 19073

    (c) Citizenship:

Please refer to Item 4 on each cover sheet for each filing person.

    (d) Title of Class of Securities:

Class A Common Stock, par value $0.0001 per share

    (e) CUSIP No.:

         747601201

 

 

 

   

 

 CUSIP No. 747601201  SCHEDULE 13G Page 5 of 8 Pages

 

 

Item 3. If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

 

     
(a)   ¨   Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o)
     
(b)   ¨   Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
     
(c)   ¨   Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).
     
(d)   ¨   Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).
     
(e)   ¨   An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
     
(f)   ¨   An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
     
(g)   ¨   A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
     
(h)   ¨   A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
     
(i)   ¨   A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
     
(j)   ¨   A non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J);
     
(k)   ¨   Group, in accordance with §240.13d-1(b)(1)(ii)(K). If filing as a non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J), please specify the type of institution:                                         
         

.

   

 

CUSIP No. 747601201  SCHEDULE 13G Page 6 of 8 Pages

 

 

 Item 4. Ownership:

Information with respect the Reporting Person’s ownership as of December 31, 2021 is incorporated by reference to items (5) – (9) and (11) of the cover page for the Reporting Person.

 

Item 5. Ownership of Five Percent or Less of a Class.

If this statement is being filed to report the fact that as of the date hereof the Reporting Person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following [ ].

 

Item 6. Ownership of More Than Five Percent on Behalf of Another Person.

 

Not applicable.

Item 7. Identification and Classification of the Subsidiary which Acquired the Security Being Reported on by the Parent Holding Company or Control Person.

 

Not Applicable.

Item 8. Identification and Classification of Members of the Group.

 

Not Applicable.

Item 9. Notice of Dissolution of Group.

 

Not Applicable.

 

Item 10. Certification.

 

Not applicable.

 

 

 

 

 

 

   

 

CUSIP No. 747601201  SCHEDULE 13G Page 7 of 8 Pages

 

 

SIGNATURES

 

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

 

Dated: February 14, 2022

 

 

  SAP SE
       
  By: /s/ Luka Mucic
    Name:  Luka Mucic
    Title:  Authorized Signatory of SAP SE
       
       
  By: /s/ Georg Kniese
    Name:  Georg Kniese
    Title:  Authorized Signatory of SAP SE

 

  SAP America, Inc.
       
  By: /s/ Mary Beth Hanss
    Name:  Mary Beth Hanss
    Title:  Authorized Signatory of SAP America, Inc.

 

 

 

 

   

 

EX-99.A 2 ss790198_ex99a.htm JOINT FILING AGREEMENT

 

CUSIP No. 747601201  SCHEDULE 13G Page 8 of 8 Pages

 

 

EXHIBIT A

JOINT FILING AGREEMENT

 

The undersigned hereby agree that this amendment to Schedule 13G dated February 14, 2022 (the “Schedule 13G”), with respect to the Class A Common Stock, par value $0.0001 per share, of Qualtrics International Inc. is filed on behalf of each of us pursuant to and in accordance with the provisions of Rule 13d-1(k) under the Securities Exchange Act of 1934, as amended, and that this Agreement shall be included as an Exhibit to the Schedule 13G. Each of the undersigned agrees to be responsible for the timely filing of the Schedule 13G, and for the completeness and accuracy of the information concerning itself contained therein. This Agreement may be executed in any number of counterparts, all of which taken together shall constitute one and the same instrument.

 

IN WITNESS WHEREOF, the undersigned have executed this Agreement as of February 14, 2022.

 

 

  SAP SE
       
  By: /s/ Luka Mucic
    Name:  Luka Mucic
    Title:  Authorized Signatory of SAP SE
       
       
  By: /s/ Georg Kniese
    Name:  Georg Kniese
    Title:  Authorized Signatory of SAP SE

 

  SAP America, Inc.
       
  By: /s/ Mary Beth Hanss
    Name:  Mary Beth Hanss
    Title:  Authorized Signatory of SAP America, Inc.