9999999995-21-000323.txt : 20210129 9999999995-21-000323.hdr.sgml : 20210129 20210129001518 ACCESSION NUMBER: 9999999995-21-000323 CONFORMED SUBMISSION TYPE: EFFECT PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20210128 DATE AS OF CHANGE: 20210129 EFFECTIVENESS DATE: 20210128 FILER: 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 FILING VALUES: FORM TYPE: EFFECT SEC ACT: 1933 Act SEC FILE NUMBER: 333-251770 FILM NUMBER: 21567863 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 EFFECT 1 primary_doc.xml X0101 EFFECT 33 LIVE 2021-01-28 09:15:00

S-4

0001747748 Qualtrics International Inc. 333-251770