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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Rinat Zack C/O MODEL N, INC. 777 MARINERS ISLAND BLVD., SUITE 300 SAN MATEO, CA 94404 |
X | X | CEO and Chairman |
Zack Rinat by Errol Hunter, Attorney-in-Fact | 03/16/2018 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The Reporting Person's original Form 4 filed on March 13, 2018 misstated Mr. Rinat as indirect owner of shares held by each of the Danielle Rinat Family Heritage Trust Dated December 12, 2005 and the Gahl Rinat Family Heritage Trust Dated December 12, 2005. Mr. Rinat and his spouse, Orli Rinat, resigned as trustees as of January 25, 2018. Because of the foregoing, as of January 25, 2018 Mr. Rinat and Orli Rinat are no longer deemed to beneficially own the shares held by the Danielle Rinat Family Heritage Trust Dated December 12, 2005 and the Gahl Rinat Family Heritage Trust Dated December 12, 2005 for purposes of Rule 13d-3 of the Securities Exchange Act of 1934, as amended, because they do not have or share voting or investment power over such shares. |