-----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, CPvnE2xe9ebvHR32DPshvtwj0XijL1pUz2L4fHSFJTh6z4+wBwKg22LKwH7/mof7 Nbr2EwkLXLs4YN3hmSpbmQ== 0001209191-04-005137.txt : 20040128 0001209191-04-005137.hdr.sgml : 20040128 20040128165525 ACCESSION NUMBER: 0001209191-04-005137 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040126 FILED AS OF DATE: 20040128 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SMITH DALTON F III CENTRAL INDEX KEY: 0001158723 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19020 FILM NUMBER: 04549773 BUSINESS ADDRESS: STREET 1: 400 E KALISTE SALOOM ROAD STREET 2: SUITE 3000 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3372327028 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PETROQUEST ENERGY INC CENTRAL INDEX KEY: 0000872248 STANDARD INDUSTRIAL CLASSIFICATION: CRUDE PETROLEUM & NATURAL GAS [1311] IRS NUMBER: 721440714 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 400 E KALISTE SALOOM RD SUITE 6000 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3372327028 MAIL ADDRESS: STREET 1: 400 E KALISTE SALOOM RD SUITE 6000 CITY: LAFAYETTE STATE: LA ZIP: 70508 FORMER COMPANY: FORMER CONFORMED NAME: OPTIMA PETROLEUM CORP DATE OF NAME CHANGE: 19950726 4 1 h12226_7dfs.xml MAIN DOCUMENT DESCRIPTION X0201 4 2004-01-26 0 0000872248 PETROQUEST ENERGY INC PQUE 0001158723 SMITH DALTON F III 400 E. KALISTE SALOOM RD. SUITE 6000 LAFAYETTE LA 70508 0 1 0 0 Senior VP - Bus. Dev. and Land Incentive stock option (right to buy) 3.17 2004-01-26 4 A 0 55000 0 A 2004-01-26 2014-01-25 Common stock 55000 55000 D 36,667 shares vested on January 26, 2004; 13,333 shares will vest on April 3, 2004 /s/ Dalton F. Smith III 2004-01-28 -----END PRIVACY-ENHANCED MESSAGE-----