-----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, HzkYTrQwr9J8xrMNkQskER8LuajafphHhfUVbJVa91CCzWQEgkLcseu3cYsuiH9s c7sxqPrjo44H2MekeT0/Sg== 0000950129-01-502973.txt : 20010913 0000950129-01-502973.hdr.sgml : 20010913 ACCESSION NUMBER: 0000950129-01-502973 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010904 FILED AS OF DATE: 20010912 COMPANY DATA: COMPANY CONFORMED NAME: SMITH DALTON F III CENTRAL INDEX KEY: 0001158723 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 400 E KALISTE SALOOM ROAD STREET 2: SUITE 3000 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3372327028 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: 1934 Act SEC FILE NUMBER: 000-19020 FILM NUMBER: 1735630 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 3 1 h90605e3.txt SMITH DALTON F III 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 SMITH, III DALTON F. (Month/Day/Year) (Month/Day/Year) - ---------------------------------------- PETROQUEST ENERGY, INC. (PQUE) (Last) (First) (Middle) 9/4/01 ---------------------------------- ---------------------------- 5. Relationship of Reporting ------------------------ 400 E. KALISTE SALOOM ROAD, SUITE 3000 3. IRS or Social Security Person(s) to Issuer 7. Individual or Joint/ - ---------------------------------------- Number Reporting (Check all applicable) Group Filing (Check (Street) Person (Voluntary) Director 10% Owner Applicable Line) ----- ----- LAFAYETTE LOUISIANA 70508 X Officer Other (specify X Form filed by - -------------------------------------- ---------------------------- ----- ----- below) --- One Reporting (City) (State) (Zip) (give title below) Person Form filed by SENIOR VICE PRESIDENT-BUSINESS --- More than One DEVELOPMENT & LAND 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 700 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)
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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 2. Date Exercisable 3. Title and Amount of 4. Conversion 5. Ownership 6. Nature of Indirect Security (Instr. 4) and Expiration Securities Underlying or Exercise Form of Beneficial Ownership Date Derivative Security Price of Derivative (Instr. 5) (Month/Day/Year) (Instr. 4) Derivative Security: ------------------------------------------------- Security Direct (D) or Amount or Indirect (I) Date Expiration Number (Instr. 5) Exercisable Date Title of Shares - ------------------------------------------------------------------------------------------------------------------------------------ INCENTIVE STOCK OPTIONS PURSUANT TO 1998 INCENTIVE PLAN (1) 4/2/11 COMMON STOCK 40,000 $4.5312 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) OPTIONS WILL VEST IN 1/3 INSTALLMENTS ON EACH OF 4/3/02, 4/3/03 AND 4/3/04. /s/ DALTON F. SMITH, III 9/11/01 ---------------------------------- ------------ **Signature of Reporting Person Date Page 2 SEC 1473 (7-96
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. 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. -----END PRIVACY-ENHANCED MESSAGE-----