0001562180-21-005766.txt : 20210902 0001562180-21-005766.hdr.sgml : 20210902 20210902171827 ACCESSION NUMBER: 0001562180-21-005766 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210901 FILED AS OF DATE: 20210902 DATE AS OF CHANGE: 20210902 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: 211234170 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 2021-09-01 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 2021-09-01 4 S false 1814.00 45.7965 D 1172481.00 D This transaction was effected pursuant to a Rule 10b5-1 trading plan previously adopted by the Reporting Person. The price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $45.35 to $46.10. The Reporting Person undertakes 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 sold at each separate price within the range set forth in this footnote. /s/ Blake Tierney, Attorney-in-Fact 2021-09-02