Slta Vi (Gp), L.L.C. - 06 Dec 2021 Form 4 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.
Issuer symbol
XM
Transactions as of
06 Dec 2021
Transactions value $
$5,294,191
Form type
4
Filing time
08 Dec 2021, 19:00:13 UTC
Previous filing
03 Dec 2021
Next filing
02 Feb 2022
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction XM Class A Common Stock Purchase $4.9M +150K +15.27% $32.76 1.13M 06 Dec 2021 Held through Silver Lake Partners VI DE (AIV), L.P. F1, F4, F5
transaction XM Class A Common Stock Purchase $392K +12K +15.27% $32.76 90.3K 06 Dec 2021 Held through Silver Lake Technology Investors VI, L.P. F2, F4, F5
holding XM Class A Common Stock 22.5M 06 Dec 2021 Held through SLP Quartz Aggregator, L.P. 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 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.
F4 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.
F5 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.

Remarks:

The Reporting Persons are jointly filing this Form 4 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, or are subject to Section 16 of the Exchange Act, and each Reporting Person disclaims beneficial ownership of these securities, except to the extent of such Reporting Person's pecuniary interest therein, if any.