SEC Form 3: Coulombe Justin claimed ownership of 46,824 units of Common Stock
$SVMK
Computer Software: Programming, Data Processing
Technology
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/28/2021 |
3. Issuer Name and Ticker or Trading Symbol
MOMENTIVE GLOBAL INC. [ MNTV ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Common Stock | 46,824(1) | D | |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Employee Stock Option (Right to buy) | (2) | 11/14/2029 | Common Stock | 44,000 | 16.7 | D | |
| Employee Stock Option (Right to buy) | (3) | 02/16/2031 | Common Stock | 36,000 | 21.99 | D | |
| Explanation of Responses: |
| 1. Includes 40,906 restricted stock units ("RSU's"). Each RSU represents a contingent right to receive one share of Issuer's common stock, subject to the applicable vesting schedule and conditions. |
| 2. Grant of Stock Option exercisable for a total of 64,000 shares ("NSOs"). 1/4th of the total number of NSOs vested on 08/15/2020 and 1/16th of the total number of NSOs vest quarterly thereafter, subject to the Reporting Person's continued service to the Company until fully vested. 20,0000 shares subject to the option have been exercised to date and 44,000 shares are unexercised. |
| 3. Grant of Stock Option exercisable for a total of 36,000 shares ("NSOs"). 1/12th of the total number of NSOs vested on 05/15/2021 and 1/12th of the total number of NSOs vest quarterly thereafter, subject to the Reporting Person's continued service to the Company until fully vested. |
| Remarks: |
| Lanson Wan, by power of attorney | 07/02/2021 | |
| ** Signature of Reporting Person | Date | |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
| * If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. | ||