0001140361-13-013278.txt : 20130319
0001140361-13-013278.hdr.sgml : 20130319
20130319200652
ACCESSION NUMBER: 0001140361-13-013278
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130319
FILED AS OF DATE: 20130319
DATE AS OF CHANGE: 20130319
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: 1800 BRIDGE PARKWAY
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
BUSINESS PHONE: (650) 610-4600
MAIL ADDRESS:
STREET 1: 1800 BRIDGE PARKWAY
CITY: REDWOOD CITY
STATE: CA
ZIP: 94065
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MERITECH CAPITAL PARTNERS II LP
CENTRAL INDEX KEY: 0001119133
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703248
BUSINESS ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 6504752200
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MCP ENTREPRENEUR PARTNERS II LP
CENTRAL INDEX KEY: 0001130610
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703245
BUSINESS ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 6504752200
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MADERA PAUL S
CENTRAL INDEX KEY: 0001255151
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703247
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GORDON MICHAEL B
CENTRAL INDEX KEY: 0001255152
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703246
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MERITECH CAPITAL AFFILIATES II LP
CENTRAL INDEX KEY: 0001255154
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703249
BUSINESS ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 6504752200
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Meritech Capital Associates II L.L.C.
CENTRAL INDEX KEY: 0001299073
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703250
BUSINESS ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650-475-2200
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Meritech Management Associates II L.L.C.
CENTRAL INDEX KEY: 0001299074
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13703251
BUSINESS ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650-475-2200
MAIL ADDRESS:
STREET 1: 245 LYTTON AVENUE
STREET 2: SUITE 350
CITY: PALO ALTO
STATE: CA
ZIP: 94301
3
1
doc1.xml
FORM 3
X0206
3
2013-03-19
0
0001118417
MODEL N, INC.
MODN
0001299074
Meritech Management Associates II L.L.C.
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001299073
Meritech Capital Associates II L.L.C.
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001255154
MERITECH CAPITAL AFFILIATES II LP
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001119133
MERITECH CAPITAL PARTNERS II LP
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001255151
MADERA PAUL S
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001255152
GORDON MICHAEL B
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
0001130610
MCP ENTREPRENEUR PARTNERS II LP
245 LYTTON AVENUE
SUITE 350
PALO ALTO
CA
94301
0
0
1
0
Series C Preferred Stock
Common Stock
2306044
I
By Meritech Capital Partners II L.P.
Series C Preferred Stock
Common Stock
59337
I
By Meritech Capital Affiliates II L.P.
Series C Preferred Stock
Common Stock
17634
I
By MCP Entrepreneur Partners II L.P.
Each share of Series C Preferred Stock will automatically convert into one-third shares of the Issuer's Common Stock upon the closing of the Issuer's initial public offering of Common Stock for no additional consideration, and has no expiration date. This conversion ratio reflects an adjustment following the 1-for-3 reverse stock split effected by the Issuer on February 26, 2013.
Shares held directly by Meritech Capital Partners II L.P. ("MCP II"). Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of MCP II, and Paul S. Madera and Michael B. Gordon, the managing members of Meritech Management Associates II L.L.C., may be deemed to share voting and dispositive power over the shares held by MCP II. Such persons and entities disclaim beneficial ownership of shares held by MCP II except to the extent of any pecuniary interest therein.
Shares held directly by Meritech Capital Affiliates II L.P. "(MCA II"). Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of MCA II, and Paul S. Madera and Michael B. Gordon, the managing members of Meritech Management Associates II L.L.C., may be deemed to share voting and dispositive power over the shares held by MCA II. Such persons and entities disclaim beneficial ownership of shares held by MCA II except to the extent of any pecuniary interest therein.
Shares held directly by MCP Entrepreneur Partners II L.P. ("Entrepreneur"). Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of Entrepreneur, and Paul S. Madera and Michael B. Gordon, the managing members of Meritech Management Associates II L.L.C., may be deemed to share voting and dispositive power over the shares held by Entrepreneur. Such persons and entities disclaim beneficial ownership of shares held by Entrepreneur except to the extent of any pecuniary interest therein.
/s/ Paul S. Madera, as a managing member of Meritech Management Associates II L.L.C
2013-03-19
/s/ Paul S. Madera, as a managing member of Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C.
2013-03-19
/s/ Paul S. Madera, as a managing member of Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of Meritech Capital Partners II L.P.
2013-03-19
/s/ Paul S. Madera, as a managing member of Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of Meritech Capital Affiliates II L.P
2013-03-19
/s/ Paul S. Madera, as a managing member of Meritech Management Associates II L.L.C., a managing member of Meritech Capital Associates II L.L.C., the general partner of MCP Entrepreneur Partners II L.P.
2013-03-19
/s/ Paul S. Madera
2013-03-19
/s/ Michael B. Gordon
2013-03-19