FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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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). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
LILIS ENERGY, INC. [ LLEX ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 05/03/2017 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 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 | ||||||
Common Stock | 05/03/2017 | J | 447,000 | D | (1) | 1,954,906 | I | See Footnote(2) | ||
Common Stock | 05/05/2017 | A | 280,000 | A | (3) | 2,234,906 | D | |||
Common Stock | 05/05/2017 | F | 76,580 | D | (4) | 2,158,326 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) | 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: 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 | ||||||||
Warrant (right to buy) | $2.5 | 05/03/2017 | J | 204,546 | 06/22/2016 | 06/22/2018 | Common Stock | 204,546 | $2.5(1) | 545,454 | I | See Footnote(2) |
Explanation of Responses: |
1. Securities were originally acquired by the Reporting Person using borrowed funds. The securities are being transferred to the lender of the borrowed funds in lieu of repayment pursuant to the terms of such borrowing arrangement. |
2. These securities are held by The Bralina Group, LLC. Reporting Person has shared voting and dispositive power over the securities held by The Bralina Group, LLC with Susan Mirman. |
3. Represents restricted stock granted by the Issuer pursuant to the 2016 Omnibus Incentive Plan. This restricted stock award vests immediately upon the grant date. |
4. This forfeiture was undertaken solely to satisfy tax withholding liabilities relating to the vesting of restricted share awards held by the Reporting Person. The Reporting Person made the withholding election on May 5, 2017 with respect to restricted shares that vested on May 5, 2017. The aggregate value of the common shares so withheld was based on the closing price of the common shares on the NASDAQ Capital Market on the vesting date, which was $4.26 |
/s/ Ariella Fuchs, Attorney-In-Fact for Abraham Mirman | 05/05/2017 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |