Statement of Changes in Beneficial Ownership (4)
05 Oktober 2021 - 10:55PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
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APPROVAL
OMB Number: 3235-0287
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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
|
|
| 1. Name
and Address of Reporting Person * Willis
Eric M. |
2. Issuer Name and Ticker or Trading
Symbol Amplify Energy Corp. [ AMPY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
SVP, GENERAL COUNSEL & LAND |
|
(Last)
(First)
(Middle)
500 DALLAS ST., SUITE 1700 |
3. Date of Earliest Transaction (MM/DD/YYYY)
10/1/2021
|
|
(Street)
HOUSTON, TX 77002
(City)
(State)
(Zip)
|
4. 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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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, par value $0.01 per
share |
10/1/2021 |
|
M |
|
2352 (1) |
A |
(1) |
73579 (2) |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. 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 |
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 of Derivative Security: 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 |
|
Restricted Stock Units |
(3) |
4/1/2021 |
|
A |
|
37287 |
|
(3) |
(3) |
Common Stock |
37287 |
$0 |
37287 |
D |
|
|
Restricted Stock Units |
(4) |
4/1/2021 |
|
A |
|
37287 |
|
(4) |
(4) |
Common Stock |
37287 |
$0 |
74574 (2) |
D |
|
| Explanation of
Responses: |
| (1) |
Reflects shares of common
stock, par value $0.01 per share ("Common Stock") of Amplify Energy
Corp. (the "Company") granted upon settlement of previously awarded
restricted stock units with service-based vesting conditions
("TSUs"). |
| (2) |
The total shares reported as
directly held in Table I, Column 5 of this Form 4 reflect a
decrease of 37,287 shares representing previously awarded, but
unvested, TSUs and 37,287 shares representing previously awarded,
but unvested, restricted stock units with performance and
service-based vesting conditions ("PSUs") that were previously
reported in Table I. These PSUs and TSUs are now reported in Table
II of this Form 4. |
| (3) |
These PSUs were granted
under the Amplify Energy Corp. Equity Incentive Plan and vest
pursuant to the Company's achievement of certain performance goals
and so long as the reporting person remains an officer of the
Company through the vesting date. Each PSU represents a contingent
right to receive, upon vesting, up to 200% of one share of the
Company's Common Stock. |
| (4) |
These TSUs were granted
under the Amplify Energy Corp. Equity Incentive Plan. One-third of
the TSUs vest on the first anniversary of the date of grant,
one-third of the TSUs vest on the second anniversary of the date of
grant and one-third of the TSUs vest on the third anniversary of
the date of grant, so long as the reporting person remains an
officer of the Company through the applicable vesting date. Each
TSU represents a contingent right to receive one share of Common
Stock of the Company upon vesting. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Willis Eric M.
500 DALLAS ST.
SUITE 1700
HOUSTON, TX 77002 |
|
|
SVP, GENERAL COUNSEL & LAND |
|
Signatures
|
|
/s/ Eric M. Willis |
|
10/5/2021 |
| **Signature of Reporting
Person |
Date |
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