0001562180-22-001359.txt : 20220211
0001562180-22-001359.hdr.sgml : 20220211
20220211124956
ACCESSION NUMBER: 0001562180-22-001359
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220201
FILED AS OF DATE: 20220211
DATE AS OF CHANGE: 20220211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Anderson Brad R.
CENTRAL INDEX KEY: 0001892442
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22618757
MAIL ADDRESS:
STREET 1: C/O 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/A
1
primarydocument.xml
PRIMARY DOCUMENT
X0306
4/A
2022-02-01
2022-02-03
false
0001747748
Qualtrics International Inc.
XM
0001892442
Anderson Brad R.
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
President, Products & Services
Class A Common Stock
2022-02-01
4
A
false
41666.00
A
373241.00
D
Class A Common Stock
2022-02-01
4
F
false
28030.00
30.05
D
345211.00
D
Class A Common Stock
2022-02-01
4
F
false
16396.00
30.05
D
328815.00
D
Represents the number of performance stock units ("PSUs") granted under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan which vested on February 1, 2022. The extent to which these PSUs vest is conditional upon the achievement of objectives set and approved by the Board. To the extent these objectives are met on an annual basis, these PSUs vest 25% on the first anniversary of the grant date and ratably thereafter in 3 equal annual installments.
Represents shares of Class A common stock withheld by the Issuer in satisfaction of tax withholding obligations in connection with the vesting of restricted stock units previously granted to the Reporting Person. Such withholding is mandated by an election of the Issuer made in advance and does not represent a discretionary trade by the Reporting Person.
Represents shares of Class A common stock withheld by the Issuer in satisfaction of tax withholding obligations in connection with the vesting of performance stock units previously granted to the Reporting Person. Such withholding is mandated by an election of the Issuer made in advance and does not represent a discretionary trade by the Reporting Person.
/s/ Blake Tierney, Attorney-in-Fact
2022-02-11