0001118417-20-000073.txt : 20200519 0001118417-20-000073.hdr.sgml : 20200519 20200519214118 ACCESSION NUMBER: 0001118417-20-000073 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200516 FILED AS OF DATE: 20200519 DATE AS OF CHANGE: 20200519 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Adams Timothy M CENTRAL INDEX KEY: 0001298669 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35840 FILM NUMBER: 20895562 MAIL ADDRESS: STREET 1: 311 ARSENAL STREET CITY: WATERTOWN STATE: MA ZIP: 02472 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_158993886134510.xml FORM 4 X0306 4 2020-05-16 0 0001118417 MODEL N, INC. MODN 0001298669 Adams Timothy M C/O MODEL N, INC. 777 MARINERS ISLAND BOULEVARD, SUITE 300 SAN MATEO CA 94404 1 0 0 0 Common Stock 2020-05-16 4 A 0 124 0 A 45400 D In connection with the Reporting Person's transition from serving as the Chair of the Issuer's Nominating and Corporate Governance Committee to serving as a member of the Issuer's Nominating and Corporate Governance Committee, 179 unvested restricted stock units (RSUs) previously granted to the Reporting Person for service as the Chair of the Nominating and Corporate Governance Committee were cancelled and 124 RSUs for service as a member of the Nominating and Corporate Governance Committee were granted. The amount of securities reported in this column represents shares of common stock issuable upon the vesting of the new RSU award, which vests in three equal installments on August 15, 2020, November 15, 2020, and February 15, 2021 provided the Reporting Person continues to serve on the Nominating and Corporate Governance Committee through the applicable vest date. Since the date of the Reporting Person's last ownership report, 179 unvested RSUs previously granted to the Reporting Person were cancelled for no value as described in footnote 1. /s/ Tim Adams by Errol Hunter, Attorney-in-Fact 2020-05-19