0001562180-23-003951.txt : 20230505
0001562180-23-003951.hdr.sgml : 20230505
20230505133157
ACCESSION NUMBER: 0001562180-23-003951
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230503
FILED AS OF DATE: 20230505
DATE AS OF CHANGE: 20230505
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Smith Ryan S
CENTRAL INDEX KEY: 0001842748
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39952
FILM NUMBER: 23892726
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
1
primarydocument.xml
PRIMARY DOCUMENT
X0407
4
2023-05-03
false
0001747748
Qualtrics International Inc.
XM
0001842748
Smith Ryan S
333 WEST RIVER PARK DRIVE
PROVO
UT
84604
true
true
false
false
Founder and Executive Chair
true
Class A Common Stock
2023-05-03
4
S
false
412099.00
17.8955
D
11653339.00
D
Class A Common Stock
6000000.00
I
By Q II, LLC
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 $17.88 to $17.92, 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.
/s/ Blake Tierney, Attorney-in-Fact
2023-05-05