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) 06/13/2018 | ||||||||||||||||||||||||||
| 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 | 06/13/2018 | X | 68,182 | A | $2.5 | 1,171,544 | I | See Footnote(1) | ||
| Common Stock | 06/13/2018 | F(2) | 33,098 | D | $5.15 | 1,138,446 | I | See Footnote(1) | ||
| Common Stock | 179,347 | I | See Footnote(3) | |||||||
| Common Stock | 23,954 | 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 | ||||||||
| Warrants (Right to Buy) | $2.5 | 06/13/2018 | X | 68,182 | 06/22/2016 | 06/22/2018 | Common Stock | 68,182 | (2) | 0 | I | See Footnote(3) | |||
| Explanation of Responses: |
| 1. These securities referenced are held indirectly by Trace Capital Inc. The Reporting Person's wife is the natural person with sole voting and dispositive power for the purchase of the 68,182 shares by Trace Capital Inc. In addition, the amount of securities shown as being held by Trace Capital Inc. in Footnote 5 of the preceding Form 4 dated April 20, 2018 was inadvertently reported in the aggregate amount as being 1,103,263 shares of common stock, instead of 1,103,362. The error has been corrected in this Form 4. |
| 2. On June 13, 2018, the Reporting Person provided notice of exercise of warrants to purchase 68,182 shares of LLEX common stock for $2.50 a share on a cashless basis. Issuer executed the transaction on June 14, 2018, based on June 13, 2018 stock prices, resulting in LLEX withholding 33,098 shares to pay the exercise price. |
| 3. These securities referenced are held indirectly through Christensen GM&P Holding Corp., for which Reporting Person is the natural person with ultimate voting and dispositive power. |
| Remarks: |
| Exhibits: Exhibit 24.1 - Power of Attorney |
| /s/ Mark Jones, Attorney-In-Fact for Mark Christensen | 06/29/2018 | |
| ** 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. | ||