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