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*
(Street)
| 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) 07/13/2017 | ||||||||||||||||||||||||||
| 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 | 07/13/2017(1) | A | 175,000 | A | (2) | 175,525 | D | |||
| Common Stock | 07/13/2017 | F | 16,273 | D | (3) | 159,252 | D | |||
| 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 | ||||||||
| Stock Option (Right to Buy) | $4.84 | 07/13/2017(1) | A | 325,000 | (4) | (5) | Common Stock | 325,000 | $0 | 325,000 | D | ||||
| Explanation of Responses: |
| 1. These equity awards were approved by Lilis Energy, Inc.'s Board of Directors (the "Board") and Compensation Committee (the "Committee") on June 26, 2017, subject to stockholder approval of the second amendment to the 2016 Omnibus Incentive Plan (the "Plan"), under which the equity awards were granted. The second amendment to the Plan was approved by the stockholders on July 13, 2017. |
| 2. Represents restricted stock granted by the Issuer pursuant to the 2016 Omnibus Incentive Plan. This restricted stock award vests over two years, with 34% vesting on July 13, 2017 (the date of stockholder approval of the second amendment to the Plan), 33% vesting on June 26, 2018 (the first anniversary of Board and Committee approval of the award) and 33% vesting on June 26, 2019 (the second anniversary of Board and Committee approval of the award), subject to continued service through each vesting date. |
| 3. This forfeiture was undertaken solely to satisfy tax withholding liabilities relating to the vesting of restricted share awards held by the Reporting Person. The Reporting Person made the withholding election on July 13, 2017 with respect to restricted shares that vested on July 13, 2017. The aggregate value of the common shares so withheld was based on the closing price of the common shares on the NYSE MKT on July 13, 2017, which was $4.97. |
| 4. Represents options to purchase common stock granted by the Issuer pursuant to the 2016 Omnibus Incentive Plan. This option vests over two years, with 34% vesting on July 13, 2017 (the date of stockholder approval of the second amendment to the Plan), 33% vesting on June 26, 2018 (the first anniversary of Board and Committee approval of the option) and 33% vesting on June 26, 2019 (the second anniversary of Board and Committee approval of the option), subject to continued service through each vesting date. |
| 5. This option to purchase common stock expires 10 years from July 26, 2017 (the date of Board and Committee approval of the option). |
| /s/ Ariella Fuchs, Attorney-In-Fact for James Linville | 07/14/2017 | |
| ** 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. | ||