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