0001562180-22-003729.txt : 20220503
0001562180-22-003729.hdr.sgml : 20220503
20220503200742
ACCESSION NUMBER: 0001562180-22-003729
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220501
FILED AS OF DATE: 20220503
DATE AS OF CHANGE: 20220503
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Thimsen John
CENTRAL INDEX KEY: 0001842163
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22889376
MAIL ADDRESS:
STREET 1: 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: 000000000
STATE OF INCORPORATION: DE
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
X0306
4
2022-05-01
false
0001747748
Qualtrics International Inc.
XM
0001842163
Thimsen John
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
Chief Technology Officer
Class A Common Stock
2022-05-01
4
F
false
25018.00
18.54
D
1210833.00
D
Represents shares of Class A common stock withheld by the Issuer in satisfaction of tax withholding obligations in connection with the vesting of restricted stock units previously granted to the Reporting Person. Such withholding is mandated by an election of the Issuer made in advance and does not represent a discretionary trade by the Reporting Person.
/s/ Blake Tierney, Attorney-in-Fact
2022-05-03