SEC Form 4 · accession 0001569608-17-000009
Modsys International Ltd · MDSYF
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Columbia Pacific Advisors, LLC
10% Owner
Period of report
Mar 29, 2017
Accepted (ET)
Apr 4, 2017 · 10:00 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001029581
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Ordinary SharesF1,F2 | Mar 31, 2017 | P | 10,000 | $0.85 | A | 7,144,072 | I | General Partner |
| Ordinary SharesF8 | Apr 3, 2017 | P | 757,575 | $0.66 | A | 7,901,647 | I | General Partner |
| Ordinary SharesF7,F2 | Apr 4, 2017 | P | 1,091,442 | $0.01 | A | 8,993,089 | I | General Partner |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrants (Right to Buy)F3,F4 | $0.01 | Mar 29, 2017 | J | 735,294 | A | Mar 29, 2017 | Mar 28, 2020 | Ordinary Shares | 735,294 | 735,294 | I |
| Warrants (Right to Buy)F5 | $0.01 | Apr 4, 2017 | X | 735,294 | D | Mar 29, 2017 | Mar 28, 2020 | Ordinary Shares, NIS 0.04 par value | 735,294 | 0 | I |
| Warrants (Right to Buy)F5,F6 | $0.01 | Apr 4, 2017 | X | 356,148 | D | Dec 29, 2015 | Dec 29, 2018 | Ordinary Shares, NIS 0.04 par value | 356,148 | 0 | I |
Explanation of responses
- F1Acquired by Columbia Pacific Opportunity Fund, L.P.
- F2Columbia Pacific Opportunity Fund, L.P. owns 8,956,556 Ordinary Shares Columbia Pacific Partners Fund (Delaware), L.P. owns 36,533 Ordinary Shares
- F3These 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.
- F4These 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.
- F5Exercised by Columbia Pacific Opportunity Fund, L.P.
- F6100,000 of these warrants expiration date was 12/31/2018
- F7Acquired by Columbia Pacific Opportunity Fund, L.P. on the exercise of warrants listed under Derivative Securities
- F8Acquired by Columbia Pacific Opportunity Fund, L.P. under Proxy Proposal No. 8 approved by the vote of the shareholders on March 29, 2017.