0001562180-23-001953.txt : 20230228
0001562180-23-001953.hdr.sgml : 20230228
20230228160714
ACCESSION NUMBER: 0001562180-23-001953
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: Johnson Omar
CENTRAL INDEX KEY: 0001846291
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 23685185
MAIL ADDRESS:
STREET 1: 1950 UNIVERSITY AVENUE, SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94303
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
0001846291
Johnson Omar
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
true
false
false
false
Class A Common Stock
2023-02-24
4
A
false
9287.00
A
27843.00
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.
/s/ Blake Tierney, Attorney-in-Fact
2023-02-28