FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
LILIS ENERGY, INC. [ LLEX ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/01/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 06/01/2018 | X | 522,728 | A | $2.5 | 4,549,981 | I | See Footnote(1) | ||
Common Stock | 06/01/2018 | F(2) | 219,634 | D | $5.95 | 4,330,347(3) | I | See Footnote(1) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrant (right to buy) | $2.5 | 06/01/2018 | X | 522,728 | 06/22/2016 | 06/22/2018 | Common Stock | 522,728 | $0 | 0 | I | See Footnote(1) |
Explanation of Responses: |
1. These securities referenced in Column 4 of Table 1 and Column 5 of Table 2 are held by Perugia Investments L.P. Reporting Person is the manager of Perugia and has sole voting and dispositive power over the securities held by Perugia. |
2. On June 1, 2018, the reporting person provided notice of exercise of its warrant to purchase 522,728 shares of LLEX common stock for $2.50 a share on a cashless basis. Issuer executed the transaction on June 8, 2018, based on May 31, 2018 stock prices, resulting in LLEX's withholding of 219,634 of the warrant shares to pay the exercise price and issuing to the reporting person the remaining 303,094 shares. |
3. Of the securities referenced in Column 5, 2,706,792 shares of common stock are held by Perugia Investments L.P., 1,583,555 shares of common stock are held directly by Mr. Ormand, and 40,000 shares of common stock are held the Bruin Trust, an irrevocable trust managed by Jerry Ormand, Mr. Ormand's brother, as trustee and whose beneficiaries include the adult children of Mr. Ormand. |
Remarks: |
Exhibits: Exhibit 24.1 - Power of Attorney |
/s/ Mark Jones, Attorney-In-Fact for Ronald D. Ormand | 06/18/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |