0001692940-19-000004.txt : 20190222 0001692940-19-000004.hdr.sgml : 20190222 20190222203530 ACCESSION NUMBER: 0001692940-19-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190222 FILED AS OF DATE: 20190222 DATE AS OF CHANGE: 20190222 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mellott Russell CENTRAL INDEX KEY: 0001692940 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35840 FILM NUMBER: 19627878 MAIL ADDRESS: STREET 1: C/O MODEL N, INC., 1600 SEAPORT BLVD. STREET 2: SUITE 400,PACIFIC SHORES CENTER - BLDG.6 CITY: REDWOOD CITY STATE: CA ZIP: 94063 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MODEL N, INC. CENTRAL INDEX KEY: 0001118417 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. [7370] IRS NUMBER: 770528806 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 300 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: (650) 610-4600 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 300 CITY: SAN MATEO STATE: CA ZIP: 94404 FORMER COMPANY: FORMER CONFORMED NAME: MODEL T1 INC DATE OF NAME CHANGE: 20001031 FORMER COMPANY: FORMER CONFORMED NAME: MODEL N INC DATE OF NAME CHANGE: 20000707 4 1 wf-form4_155088571588003.xml FORM 4 X0306 4 2019-02-22 0 0001118417 MODEL N, INC. MODN 0001692940 Mellott Russell C/O MODEL N, INC. 777 MARINERS ISLAND BLVD., SUITE 300 SAN MATEO CA 94404 0 1 0 0 SVP and Chief Revenue Officer Common Stock 2019-02-22 4 S 0 24518 17.06 D 203985 D All shares reported as disposed of in this Form 4 were sold by the Reporting Person in order to pay the federal and state tax withholding obligations resulting from the vesting of the Reporting Person's Performance-Based Restricted Stock Units ("PB-RSUs"). The Reporting Person did not sell or otherwise dispose of any of the shares reported on this Form 4 for any reason other than to cover required taxes. Includes an additional 39,955 shares of common stock issued upon vesting of Performance-Based RSUs ("PB-RSUs") granted to the Reporting Person on February 22, 2017 in connection with the achievement of 228% of certain performance criteria related to the Reporting Person's PB-RSUs. Russell Mellott by Errol Hunter, Attorney-in-Fact 2019-02-22