0000899243-19-020157.txt : 20190723 0000899243-19-020157.hdr.sgml : 20190723 20190723203219 ACCESSION NUMBER: 0000899243-19-020157 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190723 FILED AS OF DATE: 20190723 DATE AS OF CHANGE: 20190723 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Oulman Roxanne CENTRAL INDEX KEY: 0001523073 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38982 FILM NUMBER: 19969034 MAIL ADDRESS: STREET 1: 4140 DUBLIN BOULEVARD STREET 2: SUITE 400 CITY: DUBLIN STATE: CA ZIP: 94568 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-07-23 0 0001540184 Medallia, Inc. MDLA 0001523073 Oulman Roxanne C/O MEDALLIA, INC 575 MARKET STREET, SUITE 1850 SAN FRANCISCO CA 94105 0 1 0 0 CFO and EVP Class A Common Stock 2019-07-23 4 J 0 525000 D 0 D Common Stock 2019-07-23 4 J 0 525000 A 525000 D Employee Stock Option (right to buy) 6.73 2019-07-23 4 J 0 1000000 D 2028-11-14 Class A Common Stock 1000000 0 D Employee Stock Option (right to buy) 6.73 2019-07-23 4 J 0 1000000 A 2028-11-14 Common Stock 1000000 1000000 D Each share of Class A Common Stock was reclassified in an exempt transaction pursuant to Rule 16b-7 into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock. One-fourth of the shares subject to the option vest on November 5, 2019 and 1/48th vest monthly thereafter. /s/ Alan K. Grebene, by power of attorney 2019-07-23