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
- Represents securities held by Silver Lake Partners VI DE (AIV), L.P. ("SLP VI")
- Represents securities held by Silver Lake Technology Investors VI, L.P. ("SLTI VI")
- 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.
- 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.
- 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.