FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/21/2014 |
3. Issuer Name and Ticker or Trading Symbol
LILIS ENERGY, INC. [ LLEX ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 866,414 | I | By Runnels Family Trust DTD 1-11-2000(1) |
Common Stock | 906,610 | I | By T.R. Winston & Company, LLC(2) |
Common Stock | 122,991 | I | By High Tide, LLC(3) |
Common Stock | 4,025 | I | By Pangaea Partners, LLC(4) |
Common Stock | 5,250 | I | By TRW Capital Management, LLC(5) |
Common Stock | 575,795 | I | By Golden Tiger, LLC(6) |
Common Stock By SEP IRA Pershing LLC Custodian(7) | 25 | D | |
Common Stock By G. Tyler Runnels 401k(8) | 15,000 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock Warrant (right to buy) | 05/28/2010 | 05/28/2015 | Common Stock | 16,667 | $6 | I | By High Tide, LLC(3) |
Common Stock Warrant (right to buy) | 05/28/2010 | 05/28/2015 | Common Stock | 83,334 | $6 | I | By Runnels Family Trust DTD 1-11-2000(1) |
Common Stock Warrant (right to buy) | 05/28/2010 | 05/28/2015 | Common Stock | 800,000 | $6 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 05/28/2010 | 05/28/2015 | Common Stock | 83,400 | $6 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 05/10/2013 | 05/10/2016 | Common Stock | 150,000 | $4.25 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 06/27/2013 | 06/27/2016 | Common Stock | 650,000 | $4.25 | I | By T.R. Winston & Company, LLC(2) |
8% Senior Secured 2014 Convertible Debenture | 01/31/2014 | 01/15/2015 | Common Stock | 427,164 | $2 | I | By Runnels Family Trust DTD 1-11-2000(1) |
Common Stock Warrant (right to buy) | 07/23/2014 | 07/23/2017 | Common Stock | 86,125 | $2.5 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 07/23/2014 | 07/23/2017 | Common Stock | 243,000 | $2.5 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 08/01/2014 | 08/01/2017 | Common Stock | 85,480 | $2.5 | I | By Runnels Family Trust DTD 1-11-2000(1) |
Common Stock Warrant (right to buy) | 08/01/2014 | 08/01/2017 | Common Stock | 203,423 | $2.5 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 08/01/2014 | 08/01/2017 | Common Stock | 225,000 | $2.5 | I | By T.R. Winston & Company, LLC(2) |
Series A 8% Convertible Preferred Stock | 09/16/2014 | (9) | Common Stock | 529 | (10) | I | By T.R. Winston & Company, LLC(2) |
Series A 8% Convertible Preferred Stock | 09/16/2014 | (9) | Common Stock | 250 | (10) | I | By Runnels Family Trust DTD 1-11-2000(1) |
Common Stock Warrant (right to buy) | 11/30/2014 | 11/30/2017 | Common Stock | 109,751 | $2.89 | I | By T.R. Winston & Company, LLC(2) |
Common Stock Warrant (right to buy) | 11/30/2014 | 11/30/2017 | Common Stock | 51,868 | $2.89 | I | By Runnels Family Trust DTD 1-11-2000(1) |
Explanation of Responses: |
1. Mr. Runnels, with Jasmine N. Runnels, is trustee of the Runnels Family Trust DTD 1-11-2000. |
2. Mr. Runnels is the majority owner of T.R. Winston & Company, LLC. |
3. Mr. Runnels is the manager of High Tide, LLC. |
4. Mr. Runnels is the manager of Pangaea Partners, LLC. |
5. Mr. Runnels is the chairman of TRW Capital Management, LLC. |
6. Mr. Runnels is the manager of Golden Tiger, LLC. |
7. The shares held by SEP IRA Pershing LLC Custodian are held for the account of Mr. Runnels. |
8. The shares held by G. Tyler Runnels 401k are held for the account of Mr. Runnels. |
9. The Series A 8% Convertible Preferred Stock has no expiration date. |
10. The Series A 8% Convertible Preferred Stock is convertible into the issuer's common stock at a rate determined by dividing the stated value ($1,000) by $2.41. |
Remarks: |
Exhibit List: Exhibit 24.1 Power of Attorney |
/s/ Eric Ulwelling, as attorney | 12/05/2014 | |
** 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 5 (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. |