0000950129-01-503417.txt : 20011018
0000950129-01-503417.hdr.sgml : 20011018
ACCESSION NUMBER: 0000950129-01-503417
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20010930
FILED AS OF DATE: 20011010
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
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: 1934 Act
SEC FILE NUMBER: 000-19020
FILM NUMBER: 1755536
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
4
1
h91229be4.txt
RALPH J. DAIGLE FOR PETROQUEST ENERGY, INC.
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FORM 4 OMB APPROVAL
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[ ] 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)
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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. I.R.S. 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 SEPTEMBER 2001 --- title --- below)
--------------------------------------------- (voluntary) ------------------- below)
(Street) 5. If Amendment,
LAFAYETTE LOUISIANA 70508 Date of Original EXECUTIVE VICE PRESIDENT
--------------------------------------------- -------------------- (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
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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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)
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COMMON STOCK 9/21/01 P 20,000 A $5.0175 2,669,595 D
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COMMON STOCK 26,000 I BY DAUGHTER
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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)
FORM 4 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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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)
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Date Expira- Amount or
-------------------------- Exer- tion Title Number of
Code V (A) (D) cisable Date Shares
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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)
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Explanation of Responses:
/s/ RALPH J. DAIGLE 10/9/01
**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. SEC 1474 (7-96)
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.