SEC Form 4
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*
Mirman Abraham

(Last) (First) (Middle)
1900 GRANT STREET, SUITE 720

(Street)
DENVER CO 80203

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
LILIS ENERGY, INC. [ LLEX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President
3. Date of Earliest Transaction (Month/Day/Year)
01/31/2014
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 01/31/2014 C(1) 110,861 A $2 110,861 I By the Bralina Group, LLC(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
8% Senior Secured 2014 Convertible Debenture $2(3) 01/31/2014 C(1) $221,720.05 06/18/2013 05/16/2014 Common Stock 110,861 $0 0 I By the Bralina Group, LLC(2)
Common Stock Warrant (right to buy) $2.5 01/31/2014 J(4) 110,861 08/01/2014 01/31/2017 Common Stock 110,861 $0(4) 110,861 I By the Bralina Group, LLC(2)
Explanation of Responses:
1. Shares of common stock (the "Common Stock") of Lilis Energy, Inc. (the "Company") were issued in connection with the Reporting Person's conversion of $217,990 of 8% Senior Secured 2014 Convertible Debentures (the "Debentures") and accrued interest of $3,730.05 at $2.00 per share pursuant to the terms of the Debentures.
2. Reporting person owns a minority interest in The Bralina Group, LLC, but controls its investment decisions.
3. The conversion price of the Debentures was automatically adjusted to $2.00 per share pursuant to the private offering conducted by the Company as reported on the Company's Current Report on Form 8-K filed with the Securities and Exchange Commission on January 28, 2014.
4. The warrant was issued to the Reporting Person pursuant to the Debenture Conversion Agreement (the "Agreement") between the Company and the holders of the Debentures pursuant to which the Reporting Person received a warrant to purchase one share of Common Stock for each share of Common Stock issued upon conversion of his Debentures.
/s/ Eric Ulwelling, attorney-in-fact 02/07/2014
** 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 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.
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