0000919574-16-015892.txt : 20161014 0000919574-16-015892.hdr.sgml : 20161014 20161014175440 ACCESSION NUMBER: 0000919574-16-015892 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140101 FILED AS OF DATE: 20161014 DATE AS OF CHANGE: 20161014 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Modsys International Ltd CENTRAL INDEX KEY: 0001029581 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371] IRS NUMBER: 000000000 STATE OF INCORPORATION: L3 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6600 LBJ FREEWAY STREET 2: STE 210 CITY: DALLAS STATE: TX ZIP: 75240 BUSINESS PHONE: 206-395-4152 MAIL ADDRESS: STREET 1: 6600 LBJ FREEWAY STREET 2: STE 210 CITY: DALLAS STATE: TX ZIP: 75240 FORMER COMPANY: FORMER CONFORMED NAME: BLUEPHOENIX SOLUTIONS LTD DATE OF NAME CHANGE: 20030811 FORMER COMPANY: FORMER CONFORMED NAME: CRYSTAL SYSTEMS SOLUTIONS LTD DATE OF NAME CHANGE: 19961224 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SELF MICHAEL R. CENTRAL INDEX KEY: 0001513203 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 333-06208 FILM NUMBER: 161937713 MAIL ADDRESS: STREET 1: 714 3RD STREET SOUTH CITY: KIRKLAND STATE: WA ZIP: 98033 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAKE UNION CAPITAL MANAGEMENT, LLC CENTRAL INDEX KEY: 0001513202 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 333-06208 FILM NUMBER: 161937714 BUSINESS ADDRESS: STREET 1: 714 3RD STREET SOUTH CITY: KIRKLAND STATE: WA ZIP: 98033 BUSINESS PHONE: 206-838-3277 MAIL ADDRESS: STREET 1: 714 3RD STREET SOUTH CITY: KIRKLAND STATE: WA ZIP: 98033 3 1 p_form3-mdsy.xml OWNERSHIP DOCUMENT X0206 3 2014-01-01 0 0001029581 Modsys International Ltd MDSY 0001513202 LAKE UNION CAPITAL MANAGEMENT, LLC 714 3RD STREET SOUTH KIRKLAND WA 98033 0 0 1 0 0001513203 SELF MICHAEL R. 714 3RD STREET SOUTH KIRKLAND WA 98033 0 0 1 0 Ordinary Shares, NIS 0.04 per share 1978329 I Footnote These securities are held in the accounts of two investment partnerships (collectively, the "Investment Vehicles") for which Lake Union Capital Management, LLC ("Lake Union") serves as the general partner. Michael Self is the managing member of Lake Union. Lake Union and Mr. Self may be deemed to beneficially own the securities held by the Investment Vehicles by virtue of Lake Union's position as general partner of the Investment Vehicles and Mr. Self's status as the managing member of Lake Union. Each of the Investment Vehicles and Lake Union disclaim beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein, and affirmatively disclaim being a "group" for purposes of Section 16 of the Securities Exchange Act of 1934, as amended. Lake Union Capital Management, LLC, By: /s/ Michael Self, Managing Member 2016-10-14 /s/ Michael Self 2016-10-14