Filing Details

Accession Number:
0000899243-21-047402
Form Type:
4
Zero Holdings:
No
Publication Time:
2021-12-08 20:00:13
Reporting Period:
2021-12-06
Accepted Time:
2021-12-08 20:00:13
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1747748 Qualtrics International Inc. XM () DE
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1418226 Silver Lake Group, L.l.c. C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No No No
1651403 Egon Durban C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No No No
1830249 Silver Lake Technology Associates Vi, L.p. C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No Yes No
1830356 Slta Vi (Gp), L.l.c. C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No Yes No
1850029 Silver Lake Partners Vi De (Aiv), L.p. C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No Yes No
1850130 L.p. Vi Investors Technology Lake Silver C/O Silver Lake
2775 Sand Hill Road, Suite 100
Menlo Park CA 94025
Yes No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Class A Common Stock Acquisiton 2021-12-06 149,635 $32.76 1,129,733 No 4 P Indirect Held through Silver Lake Partners VI DE (AIV), L.P.
Class A Common Stock Acquisiton 2021-12-06 11,958 $32.76 90,280 No 4 P Indirect Held through Silver Lake Technology Investors VI, L.P.
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect Held through Silver Lake Partners VI DE (AIV), L.P.
No 4 P Indirect Held through Silver Lake Technology Investors VI, L.P.
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Class A Common Stock 22,518,484 Indirect Held through SLP Quartz Aggregator, L.P.
Footnotes
  1. Represents securities held by Silver Lake Partners VI DE (AIV), L.P. ("SLP VI")
  2. Represents securities held by Silver Lake Technology Investors VI, L.P. ("SLTI VI")
  3. Represents securities held by SLP Quartz Aggregator, L.P. ("SLP Quartz"). SLP VI Aggregator GP, L.L.C. ("SLP VI GP") is the general partner of SLP Quartz.
  4. Silver Lake Technology Associates VI, L.P. ("SLTA VI") is the general partner of each of SLP VI and SLTI VI and the managing member of SLP VI GP. SLTA VI (GP), L.L.C. ("SLTA VI GP") is the general partner of SLTA VI. Silver Lake Group, L.L.C. ("SLG") is the managing member of SLTA VI GP. Mr. Egon Durban serves as a member of the board of directors of Qualtrics International Inc. (the "Issuer") and is Co-CEO and Managing Member of SLG. Each of SLP VI, SLTI VI, SLP Quartz, SLP VI GP, SLTA VI, SLTA VI GP and SLG may be deemed to be a director by deputization of the Issuer.
  5. Represents shares of Class A common stock purchased in multiple transactions at prices ranging from $32.17 to $33.00. The price reported is a weighted average price. The Reporting Persons undertake 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 of Class A common stock purchased at each separate price within the range set forth in this footnote.