Initial Statement of Beneficial Ownership (3)
January 27 2021 - 5:05PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0104
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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
*
McGlynn Jason William |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/19/2021
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3. Issuer Name and Ticker or Trading Symbol
Amplify Energy Corp. [AMPY]
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(Last)
(First)
(Middle)
C/O AMPLIFY ENERGY CORP., 500 DALLAS STREET SUITE 1700 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
See Remarks / |
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(Street)
HOUSTON, TX 77002
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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 | 50000 (1) | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
| Explanation of Responses: |
| (1) | The common stock number referred to in Table I is an aggregate number and represents 25,000 unvested restricted stock units with service-based vesting conditions ("TSUs") and 25,000 unvested restricted stock units with performance and service-based vesting conditions ("PSUs"). These TSUs and PSUs were originally granted under the Legacy Amplify Management Incentive Plan and vest periodically so long as the reporting person remains employed by Amplify Energy Corp. or one of its affiliates on each applicable vesting date. The TSUs and PSUs convert into common stock on a one-for-one basis. |
Remarks:
SENIOR VICE PRESIDENT, CHIEF FINANCIAL OFFICER
The reporting person is the Senior Vice President & Chief Financial Officer of Amplify Energy Corp.
Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
McGlynn Jason William
C/O AMPLIFY ENERGY CORP.
500 DALLAS STREET SUITE 1700
HOUSTON, TX 77002 |
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| See Remarks |
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Signatures
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| /s/ Eric M. Willis, Attorney-in-Fact | | 1/27/2021 |
| **Signature of Reporting Person | Date |
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