-----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, UiWcmCaHJkyUYBVlLYkNgtd8gs8JtZSh9+H4AkbuIlEAEuAlM1TeJNdoDTHG22p1 SBaH9HB4trgdnKGU5A29ug== 0000950129-01-501287.txt : 20010612 0000950129-01-501287.hdr.sgml : 20010612 ACCESSION NUMBER: 0000950129-01-501287 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010508 FILED AS OF DATE: 20010611 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: 4 SEC ACT: SEC FILE NUMBER: 000-19020 FILM NUMBER: 1658174 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: DAIGLE RALPH J CENTRAL INDEX KEY: 0001070221 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: P O BOX 51205 CITY: LAFAYETTE STATE: LA ZIP: 70505 BUSINESS PHONE: 3182327028 4 1 h88165fe4.txt RALPH J. DAIGLE FOR PQUE 1 - ------ -------------------------- FORM 4 OMB APPROVAL - ------ -------------------------- [ ] CHECK THIS BOX IF NO OMB Number: 3235-0287 LONGER SUBJECT TO Expires: December 31, 2001 SECTION 16. FORM 4 Estimated average burden OR FORM 5 OBLIGATIONS hours per response.... 0.5 MAY CONTINUE. SEE -------------------------- INSTRUCTION 1(b). UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) DAIGLE RALPH J. PETROQUEST ENERGY, INC. -- PQUE to Issuer (Check all applicable) - --------------------------------------------- ---------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS Identification 4. Statement for ---- --- Number of Reporting Month/Year X Officer (give Other (Specify 400 E. KALISTE SALOOM RD., SUITE 3000 Person, if an entity MAY 2001 ---- title --- below) - --------------------------------------------- (voluntary) ------------------- below) (Street) 5. If Amendment, SENIOR VICE PRESIDENT -- LAFAYETTE LOUISIANA 70508 Date of Original EXPLORATION - --------------------------------------------- -------------------- (Month/Year) -------------------------------- (City) (State) (Zip) 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 ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature (Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In- Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct (Instr. 8) End of Month Direct Benefi- (Month/ (Instr. 3 and 4) (D) or cial Day/ ------------------------------------ Indirect Owner- Year) Code V Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 5/8/00 S 8,335 D $1.5625 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 5/8/00 S 8,335 D $1.5625 - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 5/3/01 M 500,100 A $0 2,649,595 D - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 16,000 I By daughter - ------------------------------------------------------------------------------------------------------------------------------------ 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 4(b)(v). SEC 1474 (7-96)
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FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price Security sion or action action Derivative cisable and of Underlying of (Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv- Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative Deriv- Day/ Disposed of (D) (Month/Day/ Secur- ative Year) (Instr. 3, 4, Year) ity Security and 5) (Instr. 5) ----------------------------------- Date Expira- Amount or -------------------------- Exer- tion Title Number of Code V (A) (D) cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ CALL OPTION (obligation to $1.75 5/08/00 E (1) 9/1/98 5/08/00 (1) (1) sell) - ------------------------------------------------------------------------------------------------------------------------------------ CALL OPTION (obligation to $1.75 5/08/00 S 1 (2) 5/08/05 Common 36,675 $0 sell) Stock - ------------------------------------------------------------------------------------------------------------------------------------ CALL OPTION (obligation to $1.75 5/08/00 S 1 (2) 5/08/05 Common 36,675 $0 sell) Stock - ------------------------------------------------------------------------------------------------------------------------------------ CONTINGENT INTEREST RIGHT $0 5/03/01 M 500,100 5/3/01 9/1/01 Common 500,100 IN COMMON STOCK Stock - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative Form of Indirect Securities Derivative Beneficial Beneficially Security: Ownership Owned at End Direct (D) (Instr. 4) of Month or Indirect (I) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------- -0- D - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- -0- - ------------------------------------------------------------------------------------------------------- -0- D - ------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------- Explanation of Responses: 1. On September 1, 1998, Mr. Daigle granted a call option to an officer of the Company for 110,025 shares of Common Stock and 25,005 Contingent Stock Issue Rights (the "CSIRs"). 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 CSIRs shall be considered the record holder of the designated number of shares of Common Stock (i.e., 25,005 shares). The call option was cancelled on May 8, 2000. 2. The option vests as to 1/3 of the 42,787 shares of Common Stock on each of the first, second and third anniversaries of the grant date. /s/ RALPH J. DAIGLE 6/8/01 **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. 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.
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