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