SEC Form 4 · accession 0001213900-16-014510

LILIS ENERGY, INC. · LLEX

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

Reporting owner

Director

Period of report

Jun 23, 2016

Accepted (ET)

Jun 27, 2016 · 8:06 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,F3	Jun 23, 2016	C	100,000	—	A	109,388	I	Perugia Investments, L.P.
Common Stock^F2,F4,F5	Jun 23, 2016	C	1,136,364	—	A	1,245,752	I	The Bruin Trust

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A 8% Convertible Preferred Stock^F3,F1,F2	—	Jun 23, 2016	C	500	D	—	—	Common Stock	100,000	0	I
Subordinated Convertible Note^F5,F4,F2	—	Jun 23, 2016	C	—	D	—	—	Common Stock	1,136,364	0	I

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.
F3Reporting Person is the manager of Perugia Investments L.P. and has voting and dispositive control over the securities held by it.
F4Each of the 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 were set to mature June 30, 2016 and April 1, 2017, as applicable.
F5The Reporting Person disclaims beneficial ownership of the securities reported herein except to the extent of his pecuniary interest therein. The filing of this statement shall not be deemed to be an admission that, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the reporting person is the beneficial owners of any securities reported herein.