SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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

(Last) (First) (Middle)
C/O AMPLIFY ENERGY CORP.
500 DALLAS STREET SUITE 1700

(Street)
HOUSTON TX 77002

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/19/2021
3. Issuer Name and Ticker or Trading Symbol
Amplify Energy Corp. [ AMPY ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
5. 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 Beneficially Owned
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 50,000(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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
/s/ Eric M. Willis, Attorney-in-Fact 01/27/2021
** 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 5 (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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