0001209191-17-051268.txt : 20170905 0001209191-17-051268.hdr.sgml : 20170904 20170905161257 ACCESSION NUMBER: 0001209191-17-051268 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170901 FILED AS OF DATE: 20170905 DATE AS OF CHANGE: 20170905 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clarke Ben CENTRAL INDEX KEY: 0001714020 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37530 FILM NUMBER: 171068880 MAIL ADDRESS: STREET 1: 500 WEST 5TH STREET CITY: AUSTIN STATE: TX ZIP: 78701 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Amplify Snack Brands, INC CENTRAL INDEX KEY: 0001640313 STANDARD INDUSTRIAL CLASSIFICATION: FOOD & KINDRED PRODUCTS [2000] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 WEST 5TH STREET CITY: AUSTIN STATE: TX ZIP: 78701 BUSINESS PHONE: 847-982-9800 MAIL ADDRESS: STREET 1: 500 WEST 5TH STREET CITY: AUSTIN STATE: TX ZIP: 78701 FORMER COMPANY: FORMER CONFORMED NAME: TA Holdings 1, Inc. DATE OF NAME CHANGE: 20150422 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-09-01 0 0001640313 Amplify Snack Brands, INC BETR 0001714020 Clarke Ben 500 WEST 5TH STREET AUSTIN TX 78701 1 0 0 0 Common Stock 2017-09-01 4 A 0 27972 0.00 A 27972 D These shares represent Restricted Stock Units (each, an "RSU") and will be settled in the Issuer's Common Stock upon vesting. Each RSU represents a contingent right to receive one share of the Issuer's Common Stock. The RSUs will vest according to the following schedule: 1/3rd of the RSUs will vest on September 1, 2018, 1/3rd of the RSUs will vest on September 1, 2019, and 1/3rd of the RSUs will vest on September 1, 2020, provided that the Reporting Person continues to have a service relationship with the Issuer through each such date. /s/ Bradley C. Weber, as Attorney-in-Fact to the Reporting Person 2017-09-01