Sec Form 4 Filing - Brightful De'Porres @ Qualtrics International Inc. - 2023-06-28

FORM 4 Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person Brightful De'Porres 2. Issuer Name and Ticker or Trading Symbol Qualtrics International Inc. [ XM] 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) _____ Director _____ 10% Owner X __ Officer (give title below) _____ Other (specify below) See Remarks (Last) (First) (Middle) 333 WEST RIVER PARK DRIVE 3. Date of Earliest Transaction (MM/DD/YY) 06/28/2023 (Street) PROVO, UT84604 4. If Amendment, Date Original Filed (MM/DD/YY) 6. Individual or Joint/Group Filing (Check Applicable Line) __ X __ Form filed by One Reporting Person _____ Form filed by More than One Reporting Person (City) (State) (Zip)

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 1.Title of Security (Instr. 3) 2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4) Code V Amount (A) or (D) Price Class A Common Stock 06/28/2023 D( 1 )( 2 ) 625,038 ( 3 ) ( 4 ) ( 5 ) ( 6 ) D 0 D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities) 1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) 6. Date Exercisable and Expiration Date (MM/DD/YY) 7. Title and Amount of Underlying Securities (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4) Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares

Reporting Owners Reporting Owner Name / Address Relationships Director 10% Owner Officer Other Brightful De'Porres 333 WEST RIVER PARK DRIVE PROVO, UT84604 See Remarks Signatures /s/ Blake Tierney, Attorney-in-Fact 06/28/2023 Signature of Reporting Person Date

Explanation of Responses:

( 1 )Pursuant to the Agreement and Plan of Merger, dated March 12, 2023 (the "Merger Agreement"), by and among Qualtrics International Inc., a Delaware corporation ("Issuer"), Quartz Holdco, LLC, a Delaware limited liability company ("Parent") and Quartz MergerCo, Inc., a Delaware corporation and a wholly owned subsidiary of Parent ("Merger Sub"), on June 28, 2023, Merger Sub merged with and into Issuer, with Issuer surviving the merger as a wholly owned subsidiary of Parent (the "Merger"). ( 2 )At the effective time of the Merger (the "Effective Time"), each then outstanding share of Issuer Class A common stock, par value $0.0001 per share ("Class A Common Stock") and Issuer Class B common stock, par value $0.0001 per share ("Class B Common Stock" and together with Class A Common Stock, "Common Stock"), other than the Excluded Shares (as defined in the Merger Agreement) was cancelled, ceased to exist and automatically converted into the right to receive $18.15 in cash, without interest and after giving effect to any applicable withholding taxes. ( 3 )These shares include restricted stock units of Issuer (each, an "RSU") and performance stock units of Issuer (each, a "PSU"). Each RSU and PSU that, as of immediately prior to the Effective Time, was vested in accordance with its terms after giving effect to any vesting that occurred as a result of the transactions in connection with the Merger but had not yet been settled (each, a "Vested RSU" and "Vested PSU," respectively), was cancelled as of the Effective Time and converted into the right to receive an amount in cash, without interest, equal to the product of $18.15 and the aggregate number of shares of Common Stock subject to such Vested RSU or Vested PSU, as applicable, less applicable taxes and authorized deductions. ( 4 )Each RSU that, as of immediately prior to the Effective Time, was not a Vested RSU (each, an "Unvested RSU") was converted into the contingent right to receive an amount in cash equal to the product of $18.15 and the aggregate number of shares of Common Stock subject to such Unvested RSU (the "Unvested RSU Consideration"). Subject to the Reporting Person's continued service with Issuer and its subsidiaries through the applicable vesting dates, such Unvested RSU Consideration will vest and become payable at the same time as the underlying Unvested RSU would have vested and become payable pursuant to its terms and will otherwise generally remain subject to the same terms and conditions as applied to the underlying Unvested RSU immediately prior to the Effective Time. ( 5 )Each PSU that, as of immediately prior to the Effective Time, was not a Vested PSU (each, an "Unvested PSU") was converted into the contingent right to receive an amount in cash equal to the product of $18.15 and the aggregate number of shares of Common Stock subject to such Unvested PSU based on the attainment of the applicable performance metrics at the target level of performance (the "Unvested PSU Consideration"). ( 6 )(Continued from Footnote 5) Subject to the Reporting Person's continued service with Issuer and its subsidiaries through the applicable time-based vesting dates, such Unvested PSU Consideration will vest and become payable at the same time as the underlying Unvested PSU would have vested and become payable pursuant to its terms and will otherwise generally remain subject to the same terms and conditions as applied to the underlying Unvested PSU immediately prior to the Effective Time, except that no performance-based vesting metrics or criteria will apply from and after the Effective Time.

Remarks: President, Worldwide Field Operations

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