SEC Form 4 · accession 0001213900-16-016423
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
Aug 24, 2016
Accepted (ET)
Aug 26, 2016 · 6:01 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 | — | Aug 24, 2016 | D | 200 | D | — | — | Common Stock | 181,818 | 1,650 | I |
| Warrant (Right to Buy)F6,F4,F5,F7 | $2.50 | Aug 24, 2016 | D | 90,909 | D | — | — | Common Stock | 90,909 | 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 $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 committed to purchase 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, subsequent to which the Reporting Person transferred his commitment to purchase 200 shares of Series B 6% Convertible Preferred Stock to Mr. Kevin Nanke, the Issuer's Executive Vice President and Chief Financial Officer which resulted in the disposal of 200 shares of Series B 6% Convertible Preferred Stock and 90,909 shares of common stock underlying the warrant.
- F5The Bralina Group LLC, for which the Reporting Person has voting and dispositive control over the securities held by it.
- F6Represents underlying shares of common stock.
- F7The 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.