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