5 1 h94852be5.txt ALFRED J THOMAS II FOR PETROQUEST ENERGY INC -------------------------- OMB APPROVAL -------------------------- ------ OMB Number: 3235-0362 FORM 5 Expires: January 31, 2005 ------ Estimated average burden hours per response.... 1.0 -------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 20549 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP [ ] CHECK BOX IF NO LONGER SUBJECT TO SECTION 16. FORM 4 OR FORM 5 OBLIGATIONS MAY CONTINUE. SEE Filed pursuant to Section 16(a) of the Securities INSTRUCTION 1(b). Exchange Act of 1934, [ ] FORM 3 HOLDINGS Section 17(a) of the Public Utility REPORTED Holding Company Act of 1935 or Section 30(f) of [ ] FORM 4 the Investment Company Act TRANSACTIONS of 1940 REPORTED ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to THOMAS, II ALFRED J. PETROQUEST ENERGY, INC. -- PQUE Issuer (Check all applicable) ------------------------------------------- --------------------------------------------- X Director 10% Owner (Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- --- Number of Reporting Month/Year X Officer (give Other (specify 400 E. KALISTE SALOOM RD., SUITE 3000 Person (Voluntary) 12/31/01 ---- title --- below) ------------------------------------------- ------------------- below) (Street) -------------------- 5. If Amendment, PRESIDENT AND CHIEF OPERATING Date of Original OFFICER LAFAYETTE LOUISIANA 70508 (Month/Year) ------------------------------- ------------------------------------------- 7. Individual or Joint/Group Reporting (City) (State) (Zip) ------------------ (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 (Month/ (Instr. end of Issuer's Direct Benefi- Day/ 8) Fiscal Year (D) or cial Year) ---------------------------- (Instr. 3 and 4) Indirect Owner- Amount (A) or Price (I) ship (D) (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ *If the form is filed by more than one reporting person, see Instruction 4(b)(v). (Over) SEC 2270 (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 CONTROL NUMBER.
FORM 5 (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 Number of (A) (D) cisable Date Title Shares ------------------------------------------------------------------------------------------------------------------------------------ INCENTIVE STOCK OPTION COMMON (RIGHT TO BUY) $4.95 9/21/01 A 5,000 (1) 9/20/11 STOCK 5,000 ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 9. Number of 10. Ownership 11. Nature of Derivative of Derivative Indirect Securities Security: Beneficial Beneficially Direct (D) Ownership Owned at End or Indirect (I) (Instr. 4) of Year (Instr. 4) (Instr. 4) ------------------------------------------------------------------------------------------------------ 5,000 D ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) OPTIONS WILL VEST IN 1/3 INSTALLMENTS ON EACH OF 9/21/02, 9/21/03, AND 9/21/04. **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ ALFRED J. THOMAS, II 3/7/02 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 2270 (7-06)
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