Silver Lake Partners VI DE (AIV), L.P. - May 13, 2021 Form 3 Insider Report for Qualtrics International Inc. (XM)

Role
Director, 10%+ Owner
Signature
By: /s/ Egon Durban, Co-CEO of Silver Lake Group, L.L.C., managing member of SLTA VI (GP), L.L.C., general partner of Silver Lake Technology Associates VI, L.P., general partner of Silver Lake Partners VI DE (AIV), L.P.
Stock symbol
XM
Transactions as of
May 13, 2021
Transactions value $
$0
Form type
3
Date filed
5/17/2021, 09:14 PM
Next filing
Jul 26, 2021

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding XM Class A Common Stock 111K May 13, 2021 Held through Silver Lake Partners VI DE (AIV), L.P. F1, F3, F4
holding XM Class A Common Stock 8.88K May 13, 2021 Held through Silver Lake Technology Investors VI, L.P. F2, F3, F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Represents securities held by Silver Lake Partners VI DE (AIV), L.P. ("SLP VI")
F2 Represents securities held by Silver Lake Technology Investors VI, L.P. ("SLTI VI")
F3 Silver Lake Technology Associates VI, L.P. ("SLTA VI") is the general partner of each of SLP VI and STLI VI. 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 a Managing Member of SLG. Each of SLP VI, SLTI VI, SLTA VI, SLTA VI GP and SLG may be deemed to be a director by deputization of the Issuer.
F4 Not included on this Form 3 are an additional 22,518,484 shares of Class A Common Stock held by SLP Quartz Aggregator, L.P., an affiliate of the Reporting Persons. SLTA, STLA GP, SLG and Mr. Egon Durban have separately filed a Form 4 in connection with the acquisition of the shares of Class A Common Stock described in this Form.

Remarks:

The Reporting Persons are jointly filing this Form 3 pursuant to Rule 16a-3(j) under the Exchange Act. This filing shall not be deemed an admission that the Reporting Persons are beneficial owners of all securities covered by this filing for purposes of Section 16 of the Exchange Act or otherwise, and each Reporting Person disclaims beneficial ownership of these securities, except to the extent of such Reporting Person's pecuniary interest therein, if any.