SEC Form 4 · accession 0001213900-16-014506

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

Jun 23, 2016

Accepted (ET)

Jun 27, 2016 · 8:03 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^F2,F1	Jun 23, 2016	C	50,000	—	A	81,231	D
Common Stock^F2,F3	Jun 23, 2016	C	681,819	—	A	763,050	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A 8% Convertible Preferred Stock^F1,F2	—	Jun 23, 2016	C	250	D	—	—	Common Stock	50,000	0	D
Subordinated Convertible Note^F3,F2	—	Jun 23, 2016	C	—	D	—	—	Common Stock	681,819	0	D
Stock Option (Right to Buy)^F4	$1.34	Jun 24, 2016	A	1,250,000	A	—	Jun 24, 2026	Common Stock	1,250,000	1,250,000	D

F1The Series A 8% Convertible Preferred Stock converted into Lilis Energy, Inc. common stock at $5.00 and had no expiration date.
F2All share amounts that appear in this report have been adjusted to reflect a 1-for-10 reverse stock split of Lilis Energy, Inc.'s outstanding common stock effected on June 23, 2016.
F3The Subordinated Convertible Notes held by the Reporting Person were converted in full into Lilis Energy, Inc. common stock at $1.10 on June 23, 2016 and was set to mature on June 30, 2016.
F4This option vests over two years, with 34% vesting on the date of the grant, 33% vesting on the first anniversary of the date of the grant and 33% vesting on the second anniversary of the date of the grant, subject to continued service through each vesting date.