0001140361-13-013859.txt : 20130325
0001140361-13-013859.hdr.sgml : 20130325
20130325161300
ACCESSION NUMBER: 0001140361-13-013859
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130325
FILED AS OF DATE: 20130325
DATE AS OF CHANGE: 20130325
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Barnds Thomas
CENTRAL INDEX KEY: 0001474980
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13714253
MAIL ADDRESS:
STREET 1: C/O ACCEL-KKR CAPITAL PARTNERS III, LP
STREET 2: 2500 SAND HILL ROAD, SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Palumbo Robert
CENTRAL INDEX KEY: 0001475179
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13714252
MAIL ADDRESS:
STREET 1: C/O ACCEL-KKR CAPITAL PARTNERS III, LP
STREET 2: 2500 SAND HILLS ROAD, STE. 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
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: AKKR MANAGEMENT COMPANY, LLC
CENTRAL INDEX KEY: 0001474979
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13714254
BUSINESS ADDRESS:
STREET 1: 2500 SAND HILL ROAD
STREET 2: SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-289-2460
MAIL ADDRESS:
STREET 1: 2500 SAND HILL ROAD
STREET 2: SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ACCEL-KKR INTERNET CO LLC
CENTRAL INDEX KEY: 0001572373
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35840
FILM NUMBER: 13714255
BUSINESS ADDRESS:
STREET 1: 2500 SAND HILL ROAD, SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 289-2460
MAIL ADDRESS:
STREET 1: 2500 SAND HILL ROAD, SUITE 300
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
doc1.xml
FORM 4
X0306
4
2013-03-25
1
0001118417
MODEL N, INC.
MODN
0001572373
ACCEL-KKR INTERNET CO LLC
C/O ACCEL-KKR
2500 SAND HILL ROAD, SUITE 300
MENLO PARK
CA
94025
0
0
1
0
0001474979
AKKR MANAGEMENT COMPANY, LLC
C/O ACCEL-KKR
2500 SAND HILL ROAD, SUITE 300
MENLO PARK
CA
94025
0
0
1
0
0001474980
Barnds Thomas
C/O ACCEL-KKR
2500 SAND HILL ROAD, SUITE 300
MENLO PARK
CA
94025
0
0
1
0
0001475179
Palumbo Robert
C/O ACCEL-KKR
2500 SAND HILL ROAD, SUITE 300
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2013-03-25
4
C
0
1475926
A
1475926
I
See Footnotes
Common Stock
2013-03-25
4
C
0
391811
A
1867737
I
See Footnotes
Common Stock
2013-03-25
4
S
0
740000
14.415
D
1127737
I
See Footnotes
Series B Preferred Stock
2013-03-25
4
C
0
3714284
0
D
Common Stock
1475926
0
I
See Footnotes
Series C Preferred Stock
2013-03-25
4
C
0
1175433
0
D
Common Stock
391811
0
I
See Footnotes
Accel-KKR Company LLC is the record owner of the common stock of Model N, Inc. (the "Issuer"). In connection with the Issuer's initial public offering of common stock on March 25, 2013, each share of Series B Preferred Stock automatically converted into 0.397365 shares of the Issuer's common stock for no additional consideration reflecting an adjustment following the one-for-three reverse stock split effectuated by the Issuer on February 26, 2013. All shares of common stock, including fractions thereof, issued upon conversion were aggregated. No fractional share was issued upon conversion of any shares of any series of preferred stock.
Accel-KKR Company LLC is the record owner of the common stock of the Issuer. In connection with the Issuer's initial public offering of common stock on March 25, 2013, each share of Series C Preferred Stock automatically converted into one-third shares of the Issuer's common stock for no additional consideration reflecting an adjustment following the one-for-three reverse stock split effectuated by the Issuer on February 26, 2013. All shares of common stock, including fractions thereof, issued upon conversion were aggregated. No fractional share was issued upon conversion of any shares of any series of preferred stock.
Accel-KKR Internet Company LLC is the managing member of Accel-KKR Company LLC and AKKR Management Company, LLC is the manager of Accel-KKR Internet Company LLC. The managing members of AKKR Management Company, LLC are Thomas C. Barnds and Robert A. Palumbo. Each of Accel-KKR Internet Company LLC, AKKR Management Company, LLC, Mr. Barnds and Mr. Palumbo may be deemed to share voting and dispositive power with respect to the shares held of record by Accel-KKR Company LLC. Each reporting person disclaims beneficial ownership of such securities except to the extent of such person's pecuniary interest therein.
The record owner of the reported securities has separately filed a Form 4.
None.
Accel-KKR Internet Company LLC, by AKKR Management Company, LLC, its Managing Member, by /s/ Thomas C. Barnds, its Managing Member
2013-03-25
AKKR Management Company, LLC, by /s/ Thomas C. Barnds, its Manager Member
2013-03-25
/s/ Thomas C. Barnds
2013-03-25
/s/ Robert A. Palumbo
2013-03-25