Silver Lake Partners VI DE (AIV), L.P. 3
3 · Qualtrics International Inc. · Filed May 17, 2021
Insider Transaction Report
Form 3
Silver Lake Partners VI DE (AIV), L.P.
Director10% Owner
Holdings
- 111,120(indirect: Held through Silver Lake Partners VI DE (AIV), L.P.)
Class A Common Stock
- 8,880(indirect: Held through Silver Lake Technology Investors VI, L.P.)
Class A Common Stock
Footnotes (4)
- [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.