SEC Form 4 · accession 0001213900-16-009989
LILIS ENERGY, INC. · LLEX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Abraham Mirman
Officer — Chief Executive Officer · Director · 10% Owner
Period of report
Jan 5, 2016
Accepted (ET)
Jan 7, 2016 · 9:33 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001437557
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Subordinated Convertible NoteF1 | $0.50 | Jan 5, 2016 | P | — | A | Jan 5, 2016 | — | Common Stock | 1,500,000 | 1,500,000 | D |
| Warrant (Right to Buy)F2 | $0.25 | Jan 5, 2016 | P | 3,000,000 | A | Jan 5, 2016 | Jan 5, 2019 | Common Stock | 3,000,000 | 3,000,000 | D |
Explanation of responses
- F1Includes the principal amount but does not account for interest. The Subordinated Convertible Note (the "Note") accrues interest at a rate of 12% per annum and matures on June 30, 2016. The outstanding principal and accrued interest on the Note can be converted at any time prior to repayment of the Note.
- F2A warrant to purchase 3,000,000 shares of common stock was issued by the Company as additional consideration for the purchase price of the Note.