Sec Form 3 Filing - Coulombe Justin @ MOMENTIVE GLOBAL INC. - 2021-06-28

Insider filing report for Changes in Beneficial Ownership
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FORM 3
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
Coulombe Justin
2. Issuer Name and Ticker or Trading Symbol
MOMENTIVE GLOBAL INC. [ MNTV]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Financial Officer
(Last) (First) (Middle)
C/O MOMENTIVE GLOBAL INC., ONE CURIOSITY WAY
3. Date of Earliest Transaction (MM/DD/YY)
06/28/2021
(Street)
SAN MATEO, CA94403
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
Common Stock 46,824 ( 1 ) 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
Employee Stock Option (Right to buy) $ 16.7 ( 2 ) 11/14/2029 Common Stock 44,000 D
Employee Stock Option (Right to buy) $ 21.99 ( 3 ) 02/16/2031 Common Stock 36,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Coulombe Justin
C/O MOMENTIVE GLOBAL INC.
ONE CURIOSITY WAY
SAN MATEO, CA94403
Chief Financial Officer
Signatures
Lanson Wan, by power of attorney 07/02/2021
Signature of Reporting Person Date
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.

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 4(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).

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