-----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, UjbeSdJVDKILCCdcHiQ5IFY2H/dyRSFdc9mHtNJVUAWRKf+N6shPpqVVV1x8XVsP NQXua8rPhD3BjKwwXZSFqw== 0000950129-98-003906.txt : 19980914 0000950129-98-003906.hdr.sgml : 19980914 ACCESSION NUMBER: 0000950129-98-003906 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19980901 FILED AS OF DATE: 19980911 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: OPTIMA PETROLEUM CORP CENTRAL INDEX KEY: 0000872248 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 980115468 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-19020 FILM NUMBER: 98708355 BUSINESS ADDRESS: STREET 1: 600 595 HOWE STREET STREET 2: VANCOUVER BRITISH COLUMBIA CITY: CANADA V6C 2T5 STATE: A1 BUSINESS PHONE: 6046846886 MAIL ADDRESS: STREET 1: 600 595 HOWE ST STREET 2: VANCOUVER BRITISH COLUMBIA CITY: CANADA V6C 2T5 STATE: A1 COMPANY DATA: COMPANY CONFORMED NAME: BROOKSHER ROBERT R CENTRAL INDEX KEY: 0001070220 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: P O BOX 51205 CITY: LAFAYETTE STATE: LA ZIP: 70505 BUSINESS PHONE: 3182327028 3 1 ROBERT R. BROOKSHER FOR PETROQUEST ENERGY, INC. 1 --------------------------- OMB APPROVAL --------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: September 30, 1998 - -------- Estimated average burden hours per response .... 0.5 --------------------------- U.S. 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, 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* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Statement Trading Symbol of Original Brooksher Robert R. (Month/Day/Year) PetroQuest Energy, Inc. - PQUE (Month/Day/Year) - ---------------------------------------- ------------------------------------ (Last) (First) (Middle) 9/1/98 5. Relationship of Reporting ----------------------- 625 E. Kaliste Saloom Rd., Suite 400 ---------------------------- Person(s) to Issuer 7. Individual or Joint/ - ---------------------------------------- 3. IRS or Social Security (Check all applicable) Group Filing (Check (Street) Number of Reporting X Director 10% Owner Applicable Line) Person (Voluntary) ----- ----- X Form filed by Lafayette Louisiana 70508 X Officer Other (specify --- One Reporting - -------------------------------------- ----- ----- below) Person (City) (State) (Zip) ---------------------------- (give title below) Form filed by Chief Financial Officer and Secretary --- More than One ------------------------------------- Reporting Person - ----------------------------------------------------------------------------------------------------------------------------------- TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock 11,600 D - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) *If the form is filed by more than one reporting person, see Instruction 5(b)(v). SEC 1473 (7-96)
2
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security Direct ------------------------------------------------- (D) or Brooksher, Robert R. Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Nonstatutory Stock Options pursuant to 1998 Incentive Plan (1) 9/1/08 Common Stock 38,000 $ .8479 D - ------------------------------------------------------------------------------------------------------------------------------------ Option to Acquire Common Stock(2) 9/1/98 9/1/01 Common Stock 366,750 (2) D - ------------------------------------------------------------------------------------------------------------------------------------ Option to Acquire Contigent Interest Rights in Common Stock (2)(3) 9/1/98 9/1/01 Common Stock 83,350 (2) D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) Options will vest in 1/3 installments on each of 12/31/98, 12/31/99 and 12/31/00. (2) Mr. Brookshear has an oral agreement with Charles T. Goodson, Alfred J. Thomas, II, Janell B. Thomas, Alfred J. Thomas, III, Blaine A. Thomas, Natalie A. Thomas and Ralph J. Daigle whereby he has an option to purchase Common Stock and Contingent Interest Rights in Common Stock held by them for $600,000. (3) If on or before 9/1/01 the PetroQuest Energy, Inc. Common Stock has a Fair Market Value at or above U.S. $5.00 per share (as adjusted for stock splits, combinations and other similar corporate events) for a period of 20 consecutive trading days, the holder of the Contingent Interest Right shall be considered the record holder of the designated number of shares of Common Stock. /s/ Robert R. Brooksher September 9, 1998 **Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ----------------- Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Robert R. Brooksher Note. File three copies of this Form, one of which must be manually signed. If space provided is insufficient, See instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2 SEC 1473 (7-96)
-----END PRIVACY-ENHANCED MESSAGE-----