Sec Form 4 Filing - Columbia Pacific Advisors, LLC @ Modsys International Ltd - 2017-03-29

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Columbia Pacific Advisors, LLC
2. Issuer Name and Ticker or Trading Symbol
Modsys International Ltd [ MDSY]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
1910 FAIRVIEW AVE E, SUITE 200
3. Date of Earliest Transaction (MM/DD/YY)
03/29/2017
(Street)
SEATTLE, WA98102
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Ordinary Shares 03/31/2017 P 10,000 ( 1 ) A $ 0.85 7,144,072 ( 2 ) I General Partner
Ordinary Shares 04/03/2017 P 757,575 ( 8 ) A $ 0.66 7,901,647 I General Partner
Ordinary Shares 04/04/2017 P 1,091,442 ( 7 ) A $ 0.01 8,993,089 ( 2 ) I General Partner
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants (Right to Buy) $ 0.01 03/29/2017 J 735,294 ( 3 ) 03/29/2017 03/28/2020 Ordinary Shares 735,294 $ 0 ( 4 ) 735,294 I General Partner
Warrants (Right to Buy) $ 0.01 04/04/2017 X 735,294 ( 5 ) 03/29/2017 03/28/2020 Ordinary Shares, NIS 0.04 par value 735,294 ( 5 ) $ 0.01 0 I General Partner
Warrants (Right to Buy) $ 0.01 04/04/2017 X 356,148 ( 5 ) 12/29/2015 12/29/2018( 6 ) Ordinary Shares, NIS 0.04 par value 356,148 ( 5 ) $ 0.01 0 I General Partner
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Columbia Pacific Advisors, LLC
1910 FAIRVIEW AVE E
SUITE 200
SEATTLE, WA98102
X
Signatures
Alexander Washburn 04/04/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Acquired by Columbia Pacific Opportunity Fund, L.P.
( 2 )Columbia Pacific Opportunity Fund, L.P. owns 8,956,556 Ordinary SharesColumbia Pacific Partners Fund (Delaware), L.P. owns 36,533 Ordinary Shares
( 3 )These warrants were received by a Proxy Vote of the shareholders on March 29, 2017. Under Proxy Proposal No. 8, in exchange for extending an existing guaranty to the Credit Agreement between Modern Systems Corporation, a wholly owned subsidiary of the Issuer, and Comerica Bank during 2016, Columbia Pacific Opportunity Fund, L.P. received 367,647 warrants.Under Proxy Proposal No. 9, in exchange for extending the existing guaranty to the Credit Agreement mentioned above during calendar year 2017, Columbia Pacific Opportunity Fund, L.P. received 367,647 warrants.
( 4 )These warrants were issued in exchange for Columbia Pacific Opportunity Fund, L.P. and certain other shareholders providing a guaranty with respect to the Credit Agreement.
( 5 )Exercised by Columbia Pacific Opportunity Fund, L.P.
( 6 )100,000 of these warrants expiration date was 12/31/2018
( 7 )Acquired by Columbia Pacific Opportunity Fund, L.P. on the exercise of warrants listed under Derivative Securities
( 8 )Acquired by Columbia Pacific Opportunity Fund, L.P. under Proxy Proposal No. 8 approved by the vote of the shareholders on March 29, 2017.

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