Statement of Changes in Beneficial Ownership (4)
24 July 2021 - 6:01AM
Edgar (US Regulatory)
FORM 4
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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 OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
MacMillan Andrew J |
2. Issuer Name and Ticker or Trading Symbol
OMNIQ Corp.
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OMQS
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O OMNIQ CORP. 1865 WEST 2100 SOUTH |
3. Date of Earliest Transaction
(MM/DD/YYYY)
7/21/2021 |
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(Street)
SALT LAKE CITY, UT 84119
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 7/21/2021 | 7/21/2021 | M(1) | | 18996 | A | $2.20 | 18996 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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 |
| Stock Option (right to buy) | $2.20 | 7/21/2021 | 7/21/2021 | M (1) | | | 25000 (1) | (1) | 8/2/2021 (1) | Common stock | 18996 (1) | (2) | $0 (1) | D | |
| Explanation of Responses: |
| (1) | The stock options exercised herein reflect the cashless exercise of certain options scheduled to expire on August 2, 2021. In connection with the Company's 2014 Option Plan, 500,000 stock options were granted to Mr. MacMillan 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 in the stock option grant is 25,000. For this transaction, the number of options to be exercised by Mr. MacMillan is 25,000. Following the net exercise, Mr. MacMillan will have 0 remaining options from this class of options within the August 2, 2017 stock option grant. |
| (2) | Upon exercise, the underlying net options convert into shares of the issuer's common stock on a one-for-one basis. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
MacMillan Andrew J
C/O OMNIQ CORP. 1865 WEST 2100 SOUTH
SALT LAKE CITY, UT 84119 | X |
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Signatures
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| /s/ Andrew J. MacMillan | | 7/23/2021 |
| **Signature of Reporting Person | Date |
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