Zig Serafin - Feb 1, 2021 Form 4/A - Amendment Insider Report for Qualtrics International Inc. (XM)

Role
Chief Executive Officer, Director
Signature
/s/ Blake Tierney, Attorney-in-Fact
Stock symbol
XM
Transactions as of
Feb 1, 2021
Transactions value $
$0
Form type
4/A - Amendment
Date filed
10/20/2021, 01:25 PM
Date Of Original Report
Feb 2, 2021
Next filing
Jul 15, 2021

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction XM Class A Common Stock Award +853K 853K Feb 1, 2021 Direct F1
transaction XM Class A Common Stock Award +12M +1406.72% 12.9M Feb 1, 2021 Direct F2, F3
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 On February 2, 2021, the Reporting Person filed a Form 4 erroneously reporting an acquisition of 853,048, instead of 853,047, restricted stock units ("RSUs") with respect to Class A common stock granted to the Reporting Person in exchange for cash-settled fixed value rights tendered in the exchange offer in connection with the initial public offering of the Registrant's Class A common stock (the "Exchange Offer"). These RSUs continue to vest in equal monthly installments, in accordance with the vesting terms of the original awards that were tendered in the Exchange Offer.
F2 Represents RSUs granted under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan. These RSUs vest 25% on the first anniversary of the grant date and ratably thereafter in 12 equal quarterly installments.
F3 The Form 4 filed on February 2, 2021 is amended to correct the number of shares beneficially owned following the transaction.