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