0001562180-23-001348.txt : 20230213
0001562180-23-001348.hdr.sgml : 20230213
20230213194709
ACCESSION NUMBER: 0001562180-23-001348
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230203
FILED AS OF DATE: 20230213
DATE AS OF CHANGE: 20230213
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Beckstead Chris
CENTRAL INDEX KEY: 0001842543
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 23621169
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: 471754215
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
2023-02-03
2023-02-07
false
0001747748
Qualtrics International Inc.
XM
0001842543
Beckstead Chris
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
President
Class A Common Stock
2023-02-03
4
S
false
17656.00
16.563
D
5681152.00
D
Class A Common Stock
2023-02-03
4
S
false
34418.00
16.563
D
5646734.00
D
On February 7, 2023, the Reporting Person filed a Form 4 erroneously reporting a sale of 17,663, instead of 17,656, shares of Class A common stock.
Represents shares required to be sold by the Reporting Person to cover tax withholding obligations in connection with the vesting of restricted stock units. These sales were automatic and intended to qualify under Rule 10b5-1.
The price reported in column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $16.47 to $16.75, inclusive. 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.
On February 7, 2023, the Reporting Person filed a Form 4 erroneously reporting a sale of 34,430, instead of 34,418, shares of Class A common stock.
Represents shares required to be sold by the Reporting Person to cover tax withholding obligations in connection with the vesting of performance stock units. These sales were automatic and intended to qualify under Rule 10b5-1.
The Form 4 filed on February 7, 2023 is amended to correct the number of shares beneficially owned following the transaction.
/s/ Blake Tierney, Attorney-in-Fact
2023-02-13