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