| 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)
| 2. Date of Event Requiring Statement (Month/Day/Year) 11/16/2021 | 3. Issuer Name and Ticker or Trading Symbol UserTesting, Inc. [ USER ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
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) |
| 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 | ||||
| Stock Option (Right to Buy) | (1) | 07/10/2028 | Common Stock | 5,099,523 | 0.89 | D | |
| Stock Option (Right to Buy) | (2) | 06/03/2030 | Common Stock | 2,500,000 | 0.95 | D | |
| Restricted Stock Unit (RSU) | (3) | 09/21/2031 | Common Stock | 351,000 | (4) | D | |
| Explanation of Responses: |
| 1. The option vests as to 1/4th of the total shares on May 9, 2019, and then 1/48th of the total shares vest monthly thereafter, subject to theReporting Holder's continued service to the Issuer on each vesting date. |
| 2. The option vests as to 1/48th of the total shares monthly, beginning May 1, 2020, subject to the Reporting Holder's continued service to theIssuer on each vesting date. |
| 3. The Restricted Stock Units ("RSUs") were granted with both (a) a liquidity event-based vesting condition and (b) a service-based vestingcondition, both of which must be satisfied in order for the RSUs to vest. The liquidity event-based vesting condition was satisfied on November 16, 2021, the effective date of the issuer's initial public offering. The service-based vesting event will be satisfied as to 25% of the total shares on November 15, 2022, with an additional 6.25% of the total shares vesting on each subsequent February 15, May 15, August 15, and November 15 thereafter until such time as the RSUs are 100% vested, subject to the Reporting Person's continued service to the Issuer on each vesting date. |
| 4. Each RSU represents a contingent right to receive one (1) share of the Issuer's Common Stock upon settlement for no consideration. |
| Remarks: |
| /s/ Ambyr O'Donnell as attorney-in-fact for Andrew MacMillan | 11/16/2021 | |
| ** 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. | ||
