-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, MiYLXaByir6XdzQ7qUszW1YviaUUlIZXz19AzcNIUCH9XUjCfPGBzABsfBy4LJTi SHehzyX8ZOjQJydDsKsqyw== 0001016286-02-000017.txt : 20020913 0001016286-02-000017.hdr.sgml : 20020913 20020912181950 ACCESSION NUMBER: 0001016286-02-000017 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020808 FILED AS OF DATE: 20020913 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: SALAS PETER E CENTRAL INDEX KEY: 0001016286 RELATIONSHIP: OWNER FILING VALUES: FORM TYPE: 3/A BUSINESS ADDRESS: STREET 1: 129 EAST 17TH STREET CITY: NEW YORK STATE: NY ZIP: 10003 BUSINESS PHONE: 2129825071 MAIL ADDRESS: STREET 1: 129 EAST 17TH STREET CITY: NEW YORK STATE: NY ZIP: 10003 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: TENGASCO INC CENTRAL INDEX KEY: 0001001614 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 870267438 STATE OF INCORPORATION: TN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-15555 FILM NUMBER: 02762938 BUSINESS ADDRESS: STREET 1: 603 MAIN AVE STREET 2: SUITE 500 CITY: KNOXVILLE STATE: TN ZIP: 37902 BUSINESS PHONE: 4235231124 MAIL ADDRESS: STREET 1: 630 MAIN AVENUE STREET 2: SUITE 500 CITY: KNOXVILLE STATE: TN ZIP: 37902 3/A 1 tgcform3a.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3/A INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ________________________________________________________________________________ 1. Name and Address of Reporting Person* Salas Peter E. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 129 East 17th Street - -------------------------------------------------------------------------------- (Street) New York NY 10003 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) 8/8/2002 ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol TENGASCO INC. (TGC) ________________________________________________________________________________ 5. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [x] 10% Owner [ ] Officer (give title below) [_] Other (specify below) CEO ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) 9/6/2002 ________________________________________________________________________________ 7. 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 2. Amount of Securities 3. Ownership Form: Beneficially Owned Direct (D) or Indirect (I) - -------------------------------------------------------------------------------- Common Stock 1,739,720 I - -------------------------------------------------------------------------------- ================================================================================ * If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Form 3-07/98) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================ 4. Ownership Form of 1. Title of 2. Title and Amount of 3. Conversion Derivative Derivative Securities Underlying Price of Security Security Derivative Security Derivative Direct (D) Security or Common Shares Indirect(I) - -------------------------------------------------------------------------------- Common Stock Purchase Warrants 10,500 7.98 I - -------------------------------------------------------------------------------- Convertible Preferred 105,000 7.98 I - -------------------------------------------------------------------------------- Option* 357,910 2.315 I - -------------------------------------------------------------------------------- *Option exercisable from 2/14/03 to 3/16/03 granted to Industrial Resources Corporation ("IRC"), sole shareholder and President of which is Malcolm E. Ratliff, a Director and CEO of the Company. If the option is not exercised, IRC may be required by Dolphin to purchase the same number of shares as had been subject to the option at a price of $2.421 per share. - -------------------------------------------------------------------------------- ================================================================================ Explanation of Responses: This amended form 3 is being filed by Peter E. Salas as General Partner of Dolphin Offshore Partners, L.P. which purchased the above securities with its working capital in a series of transactions as outlined in earlier 13D and 13D/A filings. /s/ Peter E. Salas 9/12/2002 - --------------------------------------------- ----------------------- *Signature of Reporting Person Date * Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -----END PRIVACY-ENHANCED MESSAGE-----