0001562180-22-001852.txt : 20220223
0001562180-22-001852.hdr.sgml : 20220223
20220223203119
ACCESSION NUMBER: 0001562180-22-001852
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220218
FILED AS OF DATE: 20220223
DATE AS OF CHANGE: 20220223
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Anderson Brad R.
CENTRAL INDEX KEY: 0001892442
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 22665988
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
1
primarydocument.xml
PRIMARY DOCUMENT
X0306
4
2022-02-18
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
2022-02-18
4
A
false
150515.00
A
482090.00
D
Represents restricted stock units ("RSUs") granted on February 18, 2022 under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan. These RSUs vest in 16 equal quarterly installments following February 1, 2022, subject to the Reporting Person's continued service to the Issuer on each such date.
Reflects the correction of immaterial errors in Column 5 reported in the Reporting Person's Form 4/A filed on February 11, 2022.
/s/ Blake Tierney, Attorney-in-Fact
2022-02-23