SEC Form 4 · accession 0001213900-16-014289
LILIS ENERGY, INC. · LLEX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Abraham Mirman
Officer — Chief Executive Officer · Director
Period of report
Jun 14, 2016
Accepted (ET)
Jun 16, 2016 · 8:03 pm EDT
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B 6% Convertible Preferred StockF4,F5,F1,F2,F3 | — | Jun 14, 2016 | P | 1,850 | A | — | — | Common Stock | 16,818,182 | 1,850 | I |
| Warrant (Right to Buy)F4,F5,F6 | $0.25 | Jun 14, 2016 | P | 1 | A | — | — | Common Stock | 8,409,091 | 1 | I |
Explanation of responses
- F1The Series B 6% Convertible Preferred Stock is convertible into the issuer's common stock at a rate determined by dividing the stated value ($1,000) by $0.11.
- F2The Series B 6% Convertible Preferred Stock is exercisable immediately upon issuance, subject to certain conditions including the receipt of requisite stockholder approval pursuant to the Certificate of Designation.
- F3The Series B 6% Convertible Preferred Stock has no expiration date.
- F4The reporting person purchased 1,850 shares of Series B 6% Convertible Preferred Stock and a warrant to purchase 8,409,091 shares of the issuer's common stock for an aggregate purchase price of $1,850,000.
- F5The Bralina Group LLC, for which the Reporting Person has voting and dispositive control over the securities held by it.
- F6The Warrant has a term of two years and exercisable immediately upon issuance, subject to certain conditions including the receipt of requisite stockholder approval pursuant to the Warrant.