SEC Form 4 · accession 0001213900-16-014865

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)

Jul 11, 2016 · 7:25 am 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	45,455	—	A	45,455	D
Common Stock^F3	Jul 7, 2016	A	170,500	$0.00	A	215,955	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Subordinated Convertible Note^F1,F2	—	Jun 23, 2016	C	—	D	—	—	Common Stock	45,455	0	D

F1The 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.
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.
F3Granted by the Issuer pursuant to the 2016 Omnibus Incentive Plan. The shares vest 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.