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 X0306 4 2021-08-02 false 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