0001628280-21-001047.txt : 20210128 0001628280-21-001047.hdr.sgml : 20210128 20210128172234 ACCESSION NUMBER: 0001628280-21-001047 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210128 FILED AS OF DATE: 20210128 DATE AS OF CHANGE: 20210128 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SAP SE CENTRAL INDEX KEY: 0001000184 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] STATE OF INCORPORATION: 2M FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39952 FILM NUMBER: 21566481 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 NAME: FORMER CONFORMED NAME: SAP AG DATE OF NAME CHANGE: 20091023 FORMER NAME: FORMER CONFORMED NAME: SAP AKTIENGESELLSCHAFT SYSTEMS APPLICATIONS PRODUCTS IN DATA DATE OF NAME CHANGE: 19960807 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SAP America, Inc. CENTRAL INDEX KEY: 0001319085 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39952 FILM NUMBER: 21566482 BUSINESS ADDRESS: STREET 1: 3999 WEST CHESTER PIKE CITY: NEWTOWN SQUARE STATE: PA ZIP: 19073 BUSINESS PHONE: 610-661-1000 MAIL ADDRESS: STREET 1: 3999 WEST CHESTER PIKE CITY: NEWTOWN SQUARE STATE: PA ZIP: 19073 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 3 1 wf-form3_161187254209357.xml FORM 3 X0206 3 2021-01-28 0 0001747748 Qualtrics International Inc. XM 0001000184 SAP SE DIETMAR-HOPP-ALLEE 16 WALLDORF 2M 69190 GERMANY 1 0 1 0 0001319085 SAP America, Inc. 3999 WEST CHESTER PIKE NEWTOWN SQUARE PA 19073 1 0 1 0 Class B Common Stock Class A Common Stock 423170610.0 I See Footnote Converts into Class B Common Stock upon the election of the holder on a one-for-one basis. These shares of Class B Common Stock are held by SAP America, Inc., a wholly-owned subsidiary of SAP SE. /s/ Luka Mucic, Authorized Signatory of SAP SE 2021-01-28 /s/ Michael Ploetner, Authorized Signatory of SAP SE 2021-01-28 /s/ Mary Beth Hanss, Authorized Signatory of SAP America, Inc. 2021-01-28