FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/23/2016 |
3. Issuer Name and Ticker or Trading Symbol
LILIS ENERGY, INC. [ LLEX ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) 09/01/2016 |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 242,172(1) | D(2) | |
Common Stock | 1,863,946(1)(5) | I | See Footnote 3(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrant | 06/23/2016 | 06/23/2018 | Common Stock | 200,000(1)(5) | $25(4) | I | See Footnote (3)(3) |
Explanation of Responses: |
1. This amendment to the Initial Statement of Beneficial Ownership Securities on Form 3 filed on September 1, 2016 is being filed to correct the original Form 3 and to amend Form 4 on 9/1/16 and on Form 4/A on 9/2/16 to properly reflect securities owned herein. Pursuant to Rule 16a-2(c) the holdings resulting from the acquisition transaction that results in a person becoming a 10% owner are reportable on the initial Form 3. The Reporting Person erroneously reported the acquisition transaction that results in the person becoming a 10% owner on Form 4 on 9/1/16 and on Form 4/A on 9/2/16. |
2. This represents shares of Issuer common stock held by the reporting person Sean O'Sullivan Revocable Living Trust. The natural person with ultimate voting control or investment control over the shares of common stock held by Sean O'Sullivan Revocable Living Trust is Sean O'Sullivan. |
3. This represents shares of Issuer common stock held by SOSV Investments LLC f/k/a SOSventures LLC. The natural person with ultimate voting control or investment control over the shares of common stock held by SOSV Investments LLC is Sean O'Sullivan, who is also the natural person with ultimate voting control or investment control over the reporting person. |
4. The exercise price is subject to downward adjustment if, prior to nine months after June 23, 2016, the Issuer issues warrants in a capital raising transaction that entitle the holder to acquire common stock at a price per share that is less than $25.00. |
5. This amendment to the Initial Statement of Beneficial Ownership Securities on Form 3 filed on September 1, 2016 is also being filed to correct the original Form 3 by adding shares held indirectly through an additional reporting person that were erroneously reported on Form 4/A on September 2, 2016 instead of hereto as part of the initial acquisition transaction under Rule 16a-2(c). |
William Farah as Attorney-In-Fact for Sean O'Sullivan Trustee | 09/09/2016 | |
** 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 5 (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. |