0001562180-21-005111.txt : 20210803
0001562180-21-005111.hdr.sgml : 20210803
20210803114500
ACCESSION NUMBER: 0001562180-21-005111
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210802
FILED AS OF DATE: 20210803
DATE AS OF CHANGE: 20210803
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Thimsen John
CENTRAL INDEX KEY: 0001842163
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 211138579
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: 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
primarydocument.xml
PRIMARY DOCUMENT
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2021-08-02
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0001747748
Qualtrics International Inc.
XM
0001842163
Thimsen John
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
Chief Technology Officer
Class A Common Stock
2021-08-02
4
S
false
1814.00
40.85
D
1175116.00
D
This transaction was effected pursuant to a Rule 10b5-1 trading plan previously adopted by the Reporting Person.
/s/ Blake Tierney, Attorney-in-Fact
2021-08-03