0001493152-21-008588.txt : 20210412 0001493152-21-008588.hdr.sgml : 20210412 20210412211206 ACCESSION NUMBER: 0001493152-21-008588 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210408 FILED AS OF DATE: 20210412 DATE AS OF CHANGE: 20210412 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lustgarten Shai Shalom CENTRAL INDEX KEY: 0001590995 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-09047 FILM NUMBER: 21821822 MAIL ADDRESS: STREET 1: 27, HAMETZUDA STREET CITY: AZOR STATE: L3 ZIP: 5800171 FORMER NAME: FORMER CONFORMED NAME: Lustgarten Shai DATE OF NAME CHANGE: 20131104 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OMNIQ Corp. CENTRAL INDEX KEY: 0000278165 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 020314487 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1865 WEST 2100 SOUTH CITY: SALT LAKE CITY STATE: UT ZIP: 84119 BUSINESS PHONE: 800-242-7272 MAIL ADDRESS: STREET 1: 1865 WEST 2100 SOUTH CITY: SALT LAKE CITY STATE: UT ZIP: 84119 FORMER COMPANY: FORMER CONFORMED NAME: Quest Solution, Inc. DATE OF NAME CHANGE: 20140813 FORMER COMPANY: FORMER CONFORMED NAME: AMERIGO ENERGY, INC. DATE OF NAME CHANGE: 20081112 FORMER COMPANY: FORMER CONFORMED NAME: STRATEGIC GAMING INVESTMENTS, INC. DATE OF NAME CHANGE: 20060501 4 1 ownership.xml X0306 4 2021-04-08 0 0000278165 OMNIQ Corp. OMQS 0001590995 Lustgarten Shai Shalom C/O OMNIQ CORP. 1865 WEST 2100 SOUTH SALT LAKE CITY, UT 84119 1 1 1 0 Chief Executive Officer Common Stock 2021-04-08 2021-04-08 4 M 0 57026 2.20 A 803834 I See footnote Warrant 2.20 2021-04-08 2021-04-08 4 M 0 75000 D 2021-08-02 Common Stock 75000 0 D The stock options exercised herein reflect the cashless exercise of certain options issued in August 2017 scheduled to expire on August 2, 2021. In connection with the Company's 2014 Option Plan, 1,500,000 stock options were granted to Mr. Lustgarten on August 2, 2017. Following the Company's 1-for-20 reverse stock split of its common stock, effective, November 20, 2019, the number of options to be exercised is 75,000. Following the net exercise, Mr. Lustgarten has no more options from the August 2017 grant. Upon exercise, the underlying net options convert into shares of the issuer's common stock on a one-for-one basis, after giving effect to the 20:1 reverse stock split. Prior to the transaction reported herein, Walefar Investments Ltd. held 746,808 shares of the issuer's common stock, which is beneficially owned by Mr. Lustgarten. /s/ Shai Lustgarten 2021-04-12