0001562180-23-001004.txt : 20230203
0001562180-23-001004.hdr.sgml : 20230203
20230203200221
ACCESSION NUMBER: 0001562180-23-001004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230201
FILED AS OF DATE: 20230203
DATE AS OF CHANGE: 20230203
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bachman Robert W
CENTRAL INDEX KEY: 0001842759
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 23588071
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: 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
X0306
4
2023-02-01
false
0001747748
Qualtrics International Inc.
XM
0001842759
Bachman Robert W
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
Chief Financial Officer
Class A Common Stock
2023-02-01
4
A
false
59654.00
A
600301.00
D
Represents the number of performance stock units ("PSUs") granted under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan which vested on February 1, 2023. The extent to which these PSUs vest is conditional upon the achievement of objectives set and approved by the Board. To the extent these objectives are met on an annual basis, these PSUs vest 25% on the first anniversary of the grant date and ratably thereafter in 3 equal annual installments.
/s/ Blake Tierney, Attorney-in-Fact
2023-02-03