SEC Form 4 · accession 0001144204-17-024944

LILIS ENERGY, INC. · LLEX

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Chief Executive Officer · Director

Period of report

May 3, 2017

Accepted (ET)

May 5, 2017 · 8:20 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 Stock^F1,F2	May 3, 2017	J	447,000	—	D	1,954,906	I	See Footnote
Common Stock^F3	May 5, 2017	A	280,000	—	A	2,234,906	D
Common Stock^F4	May 5, 2017	F	76,580	—	D	2,158,326	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrant (right to buy)^F1,F2	$2.50	May 3, 2017	J	204,546	D	Jun 22, 2016	Jun 22, 2018	Common Stock	204,546	545,454	I

F1Securities 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.
F2These 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.
F3Represents restricted stock granted by the Issuer pursuant to the 2016 Omnibus Incentive Plan. This restricted stock award vests immediately upon the grant date.
F4This 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