0000899243-19-019923.txt : 20190718 0000899243-19-019923.hdr.sgml : 20190718 20190718172931 ACCESSION NUMBER: 0000899243-19-019923 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20190718 FILED AS OF DATE: 20190718 DATE AS OF CHANGE: 20190718 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BERNSHTEYN ROBERT CENTRAL INDEX KEY: 0001436655 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38982 FILM NUMBER: 19961977 MAIL ADDRESS: STREET 1: C/O SUCCESSFACTORS, INC., 1500 FASHION STREET 2: ISLAND BLVD., SUITE 300 CITY: SAN MATEO STATE: CA ZIP: 94404 FORMER NAME: FORMER CONFORMED NAME: BERNSHTYEN ROBERT DATE OF NAME CHANGE: 20080603 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Medallia, Inc. CENTRAL INDEX KEY: 0001540184 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. [7370] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 575 MARKET STREET STREET 2: SUITE 1850 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: (650) 321-3000 MAIL ADDRESS: STREET 1: 575 MARKET STREET STREET 2: SUITE 1850 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 FORMER COMPANY: FORMER CONFORMED NAME: Medallia Inc. DATE OF NAME CHANGE: 20120123 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2019-07-18 0 0001540184 Medallia, Inc. MDLA 0001436655 BERNSHTEYN ROBERT C/O MEDALLIA, INC. 575 MARKET STREET, SUITE 1850 SAN FRANCISCO CA 94105 1 0 0 0 Class A Common Stock 17397 D Each share of Class A Common Stock shall be reclassified into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock. The reported shares are represented by restricted stock units, or RSUs, which vest in three equal annual installments beginning on June 15, 2020. Exhibit 24 - Power of Attorney /s/ Alan K. Grebene, by power of attorney 2019-07-18 EX-24 2 attachment1.htm EX-24 DOCUMENT

                                                                      Exhibit 24

                               POWER OF ATTORNEY

       The undersigned, as a Section 16 reporting person of Medallia, Inc. (the
"Company"), hereby constitutes and appoints Roxanne Oulman, Alan Grebene,
Margaret Chow and Leah Wilson, and each of them, as the undersigned's true and
lawful attorney-in-fact to:

       1.     complete and execute Forms 3, 4 and 5 and other forms and all
              amendments thereto as such attorney-in-fact shall in his
              discretion determine to be required or advisable pursuant to
              Section 16 of the Securities Exchange Act of 1934 (as amended) and
              the rules and regulations promulgated thereunder, or any successor
              laws and regulations, as a consequence of the undersigned's
              ownership, acquisition or disposition of securities of the
              Company; and

       2.     do all acts necessary in order to file such forms with the SEC,
              any securities exchange or national association, the Company and
              such other person or agency as the attorneys-in-fact shall deem
              appropriate.

       The undersigned hereby ratifies and confirms all that said
attorneys-in-fact and agents shall do or cause to be done by virtue hereof. The
undersigned acknowledges that the foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934 (as amended).

       This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
Company and the foregoing attorneys-in-fact.

       IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 19th day of June, 2019.


                                             Signature: /s/ Robert Bernshteyn
                                                        ------------------------
                                             Print Name: Robert Bernshteyn