0001562180-23-001948.txt : 20230228
0001562180-23-001948.hdr.sgml : 20230228
20230228160608
ACCESSION NUMBER: 0001562180-23-001948
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230224
FILED AS OF DATE: 20230228
DATE AS OF CHANGE: 20230228
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Brightful De'Porres
CENTRAL INDEX KEY: 0001892599
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 23685145
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: 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
1
primarydocument.xml
PRIMARY DOCUMENT
X0306
4
2023-02-24
false
0001747748
Qualtrics International Inc.
XM
0001892599
Brightful De'Porres
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
false
true
false
false
See Remarks
Class A Common Stock
2023-02-24
4
A
false
165118.00
A
645502.00
D
Represents restricted stock units ("RSUs") granted on February 24, 2023 under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan. These RSUs vest in 12 equal quarterly installments following February 1, 2023, subject to the Reporting Person's continued service to the Issuer on each such date.
President, Worldwide Field Operations
/s/ Blake Tierney, Attorney-in-Fact
2023-02-28