Zig Serafin - 01 Feb 2022 Form 4 Insider Report for Qualtrics International Inc.

Source evidence Original filing metadata and source links for verification. 5 source fields
SEC form
4
Accepted by SEC
03 Feb 2022, 20:19:11 UTC
Prior SEC filing
20 Jan 2022
Next SEC filing
18 Feb 2022
Source filing
View source filing
Reporting owner 1 detail
Reporting owner signature
/s/ Blake Tierney, Attorney-in-Fact

Key filing fact

Zig Serafin filed Form 4 for Qualtrics International Inc. on 03 Feb 2022.

Key facts

  • This page summarizes Zig Serafin's Form 4 filing for Qualtrics International Inc..
  • 3 reported transactions and 0 derivative rows are listed below.
  • Accepted by SEC: 03 Feb 2022, 20:19.

Change

  • Previous filing in this sequence was filed on 20 Jan 2022.
  • Current net transaction value: -$59,759,804.

Research use

  • This tells you what this filing adds before you inspect full transaction and derivative tables.
  • You can trace every row back to the original SEC filing document.

Evidence

Filed on Form 4

Ownership activity is grounded in SEC Form 4 disclosures.

View source filing

Reported non-derivative transactions

Shares, units, or other non-derivative securities reported in this filing.

XM transaction

Class A Common Stock

Award

Transaction value
Shares
+1,500,000
Change %
+12%
Price
Shares after
14,169,546
Date
01 Feb 2022
Ownership
Direct
Footnotes
F1
XM transaction

Class A Common Stock

Tax liability

Transaction value
$39,791,579
Shares
-1,324,179
Change %
-9.3%
Price
$30.05
Shares after
12,845,367
Date
01 Feb 2022
Ownership
Direct
Footnotes
F2
XM transaction

Class A Common Stock

Tax liability

Transaction value
$19,968,225
Shares
-664,500
Change %
-5.2%
Price
$30.05
Shares after
12,180,867
Date
01 Feb 2022
Ownership
Direct
Footnotes
F3
* marks a reported price that did not pass the local price check.

Additional SEC filing notes

Filing notes and footnotes

Explanation of responses 3 footnotes

Footnote F1

Represents the number of performance stock units ("PSUs") granted under the 2021 Qualtrics International Inc. Employee Omnibus Equity Plan which vested on February 1, 2022. The extent to which these PSUs vest is conditional upon the achievement of objectives set and approved by the Board. To the extent these objectives are met on an annual basis, these PSUs vest 25% on the first anniversary of the grant date and ratably thereafter in 3 equal annual installments.

Footnote F2

Represents shares of Class A common stock withheld by the Issuer in satisfaction of tax withholding obligations in connection with the vesting of restricted stock units previously granted to the Reporting Person. Such withholding is mandated by an election of the Issuer made in advance and does not represent a discretionary trade by the Reporting Person.

Footnote F3

Represents shares of Class A common stock withheld by the Issuer in satisfaction of tax withholding obligations in connection with the vesting of performance stock units previously granted to the Reporting Person. Such withholding is mandated by an election of the Issuer made in advance and does not represent a discretionary trade by the Reporting Person.

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