SEC Form 4 · accession 0001213900-17-000896
LILIS ENERGY, INC. · LLEX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
R Glenn Dawson
Director
Period of report
Jan 30, 2017
Accepted (ET)
Feb 2, 2017 · 5:02 pm EST
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 StockF1 | Jan 30, 2017 | C | 117,822 | — | A | 333,777 | D | |
| Common StockF2,F3 | Jan 31, 2017 | A | 107,084 | — | A | 440,861 | D |
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 StockF1,F4 | — | Jan 30, 2017 | C | 125 | D | — | — | Common Stock | 117,822 | 0 | D |
Explanation of responses
- F1The Series B 6% Convertible Preferred Stock held by the Reporting Person were converted in full into Lilis Energy, Inc. common stock at $1.10 on January 30, 2017 and had no expiration date.
- F2Represents restricted stock granted by the Issuer to the Reporting Person on January 31, 2017 for Reporting Person's service on the Board of Directors.
- F3Includes 3,334 Restricted Stock Units (RSU's) that vested on January 13, 2017.
- F4The amount of underlying derivative securities takes into account the increased stated value of the Series B 6% Convertible Preferred Stock due to accrued and cumulative dividends.