SEC Form 4 · accession 0001144204-17-022803
LILIS ENERGY, INC. · LLEX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Ronald D Ormand
Officer — Executive Chairman · Director
Period of report
Apr 25, 2017
Accepted (ET)
Apr 27, 2017 · 9:29 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001437557
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F3 | Apr 25, 2017 | C | 993,334 | — | A | 3,489,086 | I | See Footnote |
| Common StockF2,F4 | Apr 25, 2017 | X | 40,000 | — | A | 3,529,086 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B 6% Convertible Preferred StockF3,F1 | — | Apr 25, 2017 | C | 1,000 | D | — | — | Common Stock | 993,334 | 0 | I |
| Warrant (right to buy)F4 | $0.10 | Apr 25, 2017 | X | 40,000 | D | May 6, 2016 | May 6, 2019 | Common Stock | 40,000 | 0 | I |
Explanation of responses
- F1The Series B 6% Convertible Preferred Stock were converted in full into Lilis Energy, Inc. common stock at a conversion price of $1.10 and takes into account the increased stated value due to accrued and cumulative dividends. Such Preferred Stock had no expiration date.
- F2The common stock purchase warrant held by the Reporting Person was exercised at an exercise price of $0.10 per share and was set to expire on May 6, 2019.
- F3These securities are held by Perugia Investments L.P. Reporting Person is the manager of Perugia and has sole voting and dispositive power over the securities held by Perugia.
- F4These securities are held by The Bruin Trust, an irrevocable trust managed by Jerry Ormand, Reporting Person's brother, as trustee and whose beneficiaries include the adult children of Reporting Person.