0000899243-22-010910.txt : 20220314
0000899243-22-010910.hdr.sgml : 20220314
20220314183007
ACCESSION NUMBER: 0000899243-22-010910
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220310
FILED AS OF DATE: 20220314
DATE AS OF CHANGE: 20220314
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: 22738114
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: 22738110
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: 22738113
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: 22738111
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: 22738115
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: 22738112
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
2022-03-10
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
2022-03-10
4
P
0
93060
28.5187
A
2219883
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-03-10
4
P
0
7437
28.5187
A
177397
I
Held through Silver Lake Technology Investors VI, L.P.
Class A Common Stock
2022-03-11
4
P
0
55991
27.7527
A
2275874
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-03-11
4
P
0
4475
27.7527
A
181872
I
Held through Silver Lake Technology Investors VI, L.P.
Class A Common Stock
2022-03-11
4
P
0
10750
28.6522
A
2286624
I
Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock
2022-03-11
4
P
0
859
28.6522
A
182731
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 $28.19 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 $27.38 to $28.33. The price reported is a weighted average price.
Represents shares of Class A common stock purchased in multiple transactions at prices ranging from $28.39 to $29.00. 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.
2022-03-14
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C.
2022-03-14
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.
2022-03-14
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.
2022-03-14
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.
2022-03-14
/s/ Egon Durban
2022-03-14