0000899243-22-007287.txt : 20220223
0000899243-22-007287.hdr.sgml : 20220223
20220223060541
ACCESSION NUMBER: 0000899243-22-007287
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220218
FILED AS OF DATE: 20220223
DATE AS OF CHANGE: 20220223
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Silver Lake Group, L.L.C.
CENTRAL INDEX KEY: 0001418226
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660505
BUSINESS ADDRESS:
STREET 1: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 6502338120
MAIL ADDRESS:
STREET 1: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Durban Egon
CENTRAL INDEX KEY: 0001651403
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660501
MAIL ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Silver Lake Technology Associates VI, L.P.
CENTRAL INDEX KEY: 0001830249
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660504
BUSINESS ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8120
MAIL ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2775 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Silver Lake Technology Investors VI L.P.
CENTRAL INDEX KEY: 0001850130
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660502
BUSINESS ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8120
MAIL ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SLTA VI (GP), L.L.C.
CENTRAL INDEX KEY: 0001830356
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660506
BUSINESS ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8120
MAIL ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Silver Lake Partners VI DE (AIV), L.P.
CENTRAL INDEX KEY: 0001850029
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22660503
BUSINESS ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8120
MAIL ADDRESS:
STREET 1: C/O SILVER LAKE
STREET 2: 2776 SAND HILL ROAD, SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
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
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-02-18
0
0001747748
Qualtrics International Inc.
XM
0001830356
SLTA VI (GP), L.L.C.
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
1
0
0001418226
Silver Lake Group, L.L.C.
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
1
0
0001830249
Silver Lake Technology Associates VI, L.P.
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
1
0
0001850029
Silver Lake Partners VI DE (AIV), L.P.
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
1
0
0001850130
Silver Lake Technology Investors VI L.P.
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
1
0
0001651403
Durban Egon
C/O SILVER LAKE
2775 SAND HILL ROAD, SUITE 100
MENLO PARK
CA
94025
1
0
0
0
Class A Common Stock
2022-02-18
4
P
0
38848
28.8224
A
1569299
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-02-18
4
P
0
3104
28.8224
A
125407
I
Held through Silver Lake Technology Investors VI, L.P.
Class A Common Stock
2022-02-22
4
P
0
80805
27.9756
A
1650104
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-02-22
4
P
0
6458
27.9756
A
131865
I
Held through Silver Lake Technology Investors VI, L.P.
Class A Common Stock
2022-02-22
4
P
0
9675
28.6472
A
1659779
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-02-22
4
P
0
773
28.6472
A
132638
I
Held through Silver Lake Technology Investors VI, L.P.
Class A Common Stock
22518484
I
Held through SLP Quartz Aggregator, L.P.
Represents securities held by Silver Lake Partners VI DE (AIV), L.P. ("SLP VI").
Represents securities held by Silver Lake Technology Investors VI, L.P. ("SLTI VI").
Represents securities held by SLP Quartz Aggregator, L.P. ("SLP Quartz"). SLP VI Aggregator GP, L.L.C. ("SLP VI GP") is the general partner of SLP Quartz.
Silver Lake Technology Associates VI, L.P. ("SLTA VI") is the general partner of each of SLP VI and SLTI VI and the managing member of SLP VI GP. SLTA VI (GP), L.L.C. ("SLTA VI GP") is the general partner of SLTA VI. Silver Lake Group, L.L.C. ("SLG") is the managing member of SLTA VI GP. Mr. Egon Durban serves as a member of the board of directors of Qualtrics International Inc. (the "Issuer") and is Co-CEO and Managing Member of SLG. Each of SLP VI, SLTI VI, SLP Quartz, SLP VI GP, SLTA VI, SLTA VI GP and SLG may be deemed to be a director by deputization of the Issuer.
Represents shares of Class A common stock purchased in multiple transactions at prices ranging from $28.695 to $29.00. The price reported is a weighted average price. The Reporting Persons undertake to provide to the Issuer, any security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares of Class A common stock purchased at each separate price within the range set forth in the footnotes to this Form 4.
Represents shares of Class A common stock purchased in multiple transactions at prices ranging from $27.56 to $28.55. The price reported is a weighted average price.
Represents shares of Class A common stock purchased in multiple transactions at prices ranging from $28.56 to $28.74. The price reported is a weighted average price.
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C., managing member of SLTA VI (GP), L.L.C.
2022-02-23
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C.
2022-02-23
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C., managing member of SLTA VI (GP), L.L.C., general partner of Silver Lake Technology Associates VI, L.P.
2022-02-23
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C., managing member of SLTA VI (GP), L.L.C., general partner of Silver Lake Technology Associates VI, L.P., general partner of Silver Lake Partners VI DE (AIV), L.P.
2022-02-23
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C., managing member of SLTA VI (GP), L.L.C., GP of Silver Lake Technology Associates VI, L.P., general partner of Silver Lake Technology Investors VI, L.P.
2022-02-23
/s/ Egon Durban
2022-02-23