-----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, QrPrAvJZca2x5kG2S36BplI9EYjDi/WxumKG5+r7PI3S5x9jtZtp6DdUfSEVpSYm uBpcgjVdNu5GJ5zfg3TRhw== 0000950129-00-001685.txt : 20000407 0000950129-00-001685.hdr.sgml : 20000407 ACCESSION NUMBER: 0000950129-00-001685 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990914 FILED AS OF DATE: 20000406 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: PETROQUEST ENERGY INC CENTRAL INDEX KEY: 0000872248 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 980115468 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-19020 FILM NUMBER: 594448 BUSINESS ADDRESS: STREET 1: 400 E KALISTE SALOOM RD SUITE 3000 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3372327028 MAIL ADDRESS: STREET 1: 600 595 HOWE ST STREET 2: VANCOUVER BRITISH COLUMBIA CITY: CANADA V6C 2T5 STATE: A1 FORMER COMPANY: FORMER CONFORMED NAME: OPTIMA PETROLEUM CORP DATE OF NAME CHANGE: 19950726 COMPANY DATA: COMPANY CONFORMED NAME: GARCIA FRANCISCO A CENTRAL INDEX KEY: 0001011849 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] DIRECTOR IRS NUMBER: 261967600 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O CRAMER ROSENTHAL MACGLYNN LLC STREET 2: 520 MADISON AVE 32ND FL CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 3053613189 MAIL ADDRESS: STREET 1: C/O CRAMER ROSENTHAL STREET 2: 520 MADISON AVE 32ND FL CITY: NEW YORK STATE: NY ZIP: 10022 3 1 FRANCISCO A. GARCIA FOR PETROQUEST ENERGY, INC. 1 -------------------------- OMB APPROVAL -------------------------- - -------- OMB Number: 3235-0104 FORM 3 Expires: December 31, 2001 - -------- Estimated average burden hours per response.... 0.5 -------------------------- 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, 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 Garcia Francisco A. (Month/Day/Year) PetroQuest Energy, Inc. (PQUE) (Month/Day/Year) - ---------------------------------------- ------------------------------------ 9/20/99 (Last) (First) (Middle) 9/14/99 5. Relationship of Reporting ----------------------- 881 Ocean Drive, #20-F ---------------------------- Person(s) to Issuer 7. Individual or Joint/ - ---------------------------------------- 3. I.R.S. Identification (Check all applicable) Group Filing (Check (Street) Number of Reporting X Director 10% Owner Applicable Line) Person, if an entity ----- ----- X Form filed by Key Biscayne Florida 33149 (voluntary) Officer Other (specify --- One Reporting - -------------------------------------- ----- ----- below) Person (City) (State) (Zip) ---------------------------- (give title below) 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: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 5) (Instr. 5) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.001 per share 40,000 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 (3-99) POTENTIAL PERSONS WHO ARE TO RESPOND TO THE COLLECTIONS OF INFORMATION CONTAINED IN THIS FORM ARE NOT REQUIRED TO RESPOND UNLESS THE FORM DISPLAYS A CURRENTLY VALID OMB CONTROL NUMBER.
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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 Date Expira- Amount or Indirect (I) Exercis- tion Title Number (Instr. 5) able Date of Shares - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock Warrants 8/3/99 8/2/03 Common Stock, par 20,000 $1.25 D value $.001 per share - ------------------------------------------------------------------------------------------------------------------------------------ Nonstatutory Stock Options 9/14/99 9/14/09 Common Stock 50,000 $1.50 D pursuant to 1998 Incentive Plan - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ FRANCISCO A. GARCIA 4/4/00 **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 Note. File three copies of this Form, one of which must be manually signed. Page 2 If space is insufficient, See Instruction 6 for procedure. SEC 1473 (3-99)
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. -----END PRIVACY-ENHANCED MESSAGE-----