SEC Form 4 · accession 0001213900-16-016363
LILIS ENERGY, INC. · LLEX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
R Glenn Dawson
Director
Period of report
Aug 22, 2016
Accepted (ET)
Aug 23, 2016 · 6:00 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,F1,F2,F3 | — | Aug 22, 2016 | P | 125 | A | — | — | Common Stock | 113,636 | 125 | D |
| Warrant (Right to Buy)F4,F5 | $2.50 | Aug 22, 2016 | P | 1 | A | — | — | Common Stock | 56,819 | 1 | D |
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 $1.10.
- 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 125 shares of Series B 6% Convertible Preferred Stock and a warrant to purchase 56,819 shares of the issuer's common stock for an aggregate purchase price of $125,000.
- F5The 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 terms of the Warrant.