0001569608-16-000080.txt : 20161230 0001569608-16-000080.hdr.sgml : 20161230 20161230214643 ACCESSION NUMBER: 0001569608-16-000080 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161228 FILED AS OF DATE: 20161230 DATE AS OF CHANGE: 20161230 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: Columbia Pacific Advisors, LLC CENTRAL INDEX KEY: 0001569608 STATE OF INCORPORATION: WA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 333-06208 FILM NUMBER: 162078353 BUSINESS ADDRESS: STREET 1: 1910 FAIRVIEW AVE E STREET 2: SUITE 200 CITY: SEATTLE STATE: WA ZIP: 98102 BUSINESS PHONE: 206-728-9063 MAIL ADDRESS: STREET 1: 1910 FAIRVIEW AVE E STREET 2: SUITE 200 CITY: SEATTLE STATE: WA ZIP: 98102 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2016-12-28 0 0001029581 Modsys International Ltd MDSY 0001569608 Columbia Pacific Advisors, LLC 1910 FAIRVIEW AVE E SUITE 200 SEATTLE WA 98102 0 0 1 0 Ordinary Shares 2016-12-28 4 P 0 169822 0.6524 A 5784632 I General Partner Ordinary Shares 2016-12-29 4 P 0 1010842 0.6877 A 6795474 I General Partner Ordinary Shares 2016-12-30 4 P 0 171104 0.9111 A 6966578 I General Partner Acquired by Columbia Pacific Opportunity Fund, L.P. Columbia Pacific Opportunity Fund, L.P. owns 6,930,045 Ordinary Shares Columbia Pacific Partners Fund (Delaware), L.P. owns 36,533 Ordinary Shares Alexander Washburn 2016-12-30