FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Modsys International Ltd [ MDSY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/29/2017 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Ordinary Shares | 03/31/2017 | P | 10,000(1) | A | $0.85 | 7,144,072(2) | I | General Partner | ||
Ordinary Shares | 04/03/2017 | P | 757,575(8) | A | $0.66 | 7,901,647 | I | General Partner | ||
Ordinary Shares | 04/04/2017 | P | 1,091,442(7) | A | $0.01 | 8,993,089(2) | I | General Partner |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrants (Right to Buy) | $0.01 | 03/29/2017 | J | 735,294(3) | 03/29/2017 | 03/28/2020 | Ordinary Shares | 735,294 | $0(4) | 735,294 | I | General Partner | |||
Warrants (Right to Buy) | $0.01 | 04/04/2017 | X | 735,294(5) | 03/29/2017 | 03/28/2020 | Ordinary Shares, NIS 0.04 par value | 735,294(5) | $0.01 | 0 | I | General Partner | |||
Warrants (Right to Buy) | $0.01 | 04/04/2017 | X | 356,148(5) | 12/29/2015 | 12/29/2018(6) | Ordinary Shares, NIS 0.04 par value | 356,148(5) | $0.01 | 0 | I | General Partner |
Explanation of Responses: |
1. Acquired by Columbia Pacific Opportunity Fund, L.P. |
2. Columbia Pacific Opportunity Fund, L.P. owns 8,956,556 Ordinary Shares Columbia Pacific Partners Fund (Delaware), L.P. owns 36,533 Ordinary Shares |
3. These warrants were received by a Proxy Vote of the shareholders on March 29, 2017. Under Proxy Proposal No. 8, in exchange for extending an existing guaranty to the Credit Agreement between Modern Systems Corporation, a wholly owned subsidiary of the Issuer, and Comerica Bank during 2016, Columbia Pacific Opportunity Fund, L.P. received 367,647 warrants. Under Proxy Proposal No. 9, in exchange for extending the existing guaranty to the Credit Agreement mentioned above during calendar year 2017, Columbia Pacific Opportunity Fund, L.P. received 367,647 warrants. |
4. These warrants were issued in exchange for Columbia Pacific Opportunity Fund, L.P. and certain other shareholders providing a guaranty with respect to the Credit Agreement. |
5. Exercised by Columbia Pacific Opportunity Fund, L.P. |
6. 100,000 of these warrants expiration date was 12/31/2018 |
7. Acquired by Columbia Pacific Opportunity Fund, L.P. on the exercise of warrants listed under Derivative Securities |
8. Acquired by Columbia Pacific Opportunity Fund, L.P. under Proxy Proposal No. 8 approved by the vote of the shareholders on March 29, 2017. |
Alexander Washburn | 04/04/2017 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |