-----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, T8/4kbONFo8rlS4TmKz5Y+/vQWn46OmZ1LbjA89kEdJUqzToP2o+laR7kRf3Vij5 FodG08zamsGiy06QaQ/AEQ== 0000950129-02-004489.txt : 20020905 0000950129-02-004489.hdr.sgml : 20020905 20020905122134 ACCESSION NUMBER: 0000950129-02-004489 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020802 FILED AS OF DATE: 20020905 COMPANY DATA: COMPANY CONFORMED NAME: DAIGLE RALPH J CENTRAL INDEX KEY: 0001070221 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: 02757219 BUSINESS ADDRESS: STREET 1: 400 E KALISTE SALOOM RD SUITE 6000 CITY: LAFAYETTE STATE: LA ZIP: 70508 BUSINESS PHONE: 3372327028 MAIL ADDRESS: STREET 1: 600 595 HOWE ST CITY: VANCOUVER BC CANADA STATE: A1 ZIP: V6C 2T5 FORMER COMPANY: FORMER CONFORMED NAME: OPTIMA PETROLEUM CORP DATE OF NAME CHANGE: 19950726 4 1 h99645ae4.txt RALPH J. DAIGLE FOR PETROQUEST ENERGY, INC. - ------ -------------------------- FORM 4 OMB APPROVAL - ------ -------------------------- [ ] CHECK THIS BOX IF NO OMB Number: 3235-0287 LONGER SUBJECT TO Expires: January 31, 2005 SECTION 16. FORM 4 Estimated average burden OR FORM 5 OBLIGATIONS hours per response.... 0.5 MAY CONTINUE. SEE -------------------------- INSTRUCTION 1(b). U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 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 - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* |2. Issuer Name and Ticker or Trading Symbol |6. Relationship of Reporting Person(s) | | to Issuer (Check all applicable) Daigle Ralph J. |PetroQuest Energy, Inc. -- PQUE | X Director 10% Owner - -------------------------------------------------------------------------------------------| ----- ----- (Last) (First) (Middle)|3. I.R.S. Identification | 4. Statement for | X Officer (give title below) | Number of | Month/Day/Year | ----- | Reporting Person, | | Other (specify below) | if an entity | | ----- 400 E. Kaliste Saloom Rd., Suite 6000 | (voluntary) | August 2002 |Executive Vice President - -----------------------------------------| |----------------------|-------------------------------------- (Street) | | 5. If Amendment, |7. Individual or Joint/Group Filing | | Date of Original | (Check Applicable Line) | | (Month/Day/Year) | X Form filed by One Reporting Person Lafayette Louisiana 70508 | | | -- - -----------------------------------------| | | Form filed by More than One (City) (State) (Zip) | | | -- Reporting Person | | | - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of |2. Transaction| 2A. Deemed | 3. Transaction|4. Securities Acquired (A)| 5. Amount of |6. Owner- |7. Nature Security | Date | Execution | Code | or Disposed of (D) | Securities | ship | of (Instr. 3) | | Date, if | (Instr. 8) | (Instr. 3, 4 and 5) | Beneficially | Form: | Indirect | | any | | | Owned | Direct | Bene- | | |---------------|--------------------------| Following | (D) or | ficial | | | | | | (A) | | Reported | Indirect | Owner- | (Month/Day/ | (Month/Day/ | | | | or | | Transactions(s) | (I) | ship | Year) | Year | Code | V | Amount | (D) | Price | (Instr. 3 and 4)|(Instr. 4)|(Instr. 4) - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- | | | | | | | | | | | | | | | | | | | | Common Stock | 8/2/02 | | G(1) | V | 5,200 | D | | | | - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- Common Stock | 8/2/02 | | G(1) | V | 5,200 | D | | | | - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- Common Stock | 8/2/02 | | G(2) | V | 5,200 | D | | 2,878,995 | D | - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- | | | | | | | | | |By Common Stock | 8/2/02 | | G(2) | V | 5,200 | A | | 31,200 | I |Daughter - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- | | | | | | | | | | - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- | | | | | | | | | | - ---------------|--------------|------------------|-------|-------|---------|-------|--------|-----------------|----------|---------- | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ 1. The reporting person gifted these shares to two of his children. 2. The reporting person gifted these shares to his daughter who is a member of the reporting person's household.
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-|3A. Deemed |4. Trans- |5. Number of |6. Date Exer- |7. Title and Amount | Security | sion or | action| Execu- | action | Derivative | cisable and | of Underlying | (Instr. 3) | Exercise | Date | tion | Code | Securities Ac- | Expiration | Securities | | Price of | (Month/| Date, if| (Instr. 8)| quired (A) or | Date | (Instr. 3 and 4) | | Deriv- | Day/ | any | | Disposed of (D)| (Month/Day/ | | | ative | Year) | (Month/ | | (Instr. 3, 4 | Year) | | | Security | | Day/ | | and 5) | | | | | | Year) | | |-------------------------------------| | | | | | |Date |Expira- | | Amount or | | | | |-------------------------------|Exer- |tion | Title | Number of | | | | | Code |V | (A) |(D) |cisable|Date | | Shares | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------|-------------|---------|------------|-------|----|--------|---------|-------|--------|--------|-----------| | | | | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ - ------------|---------------------------------------------------------------------------- 8. Price |9. Number of | 10. Ownership Form | 11. Nature of of | Derivative | of Derivative | Indirect Deriv- | Securities | Securities | Beneficial ative | Beneficially | Beneficially | Ownership Secur- | Owned Following| Owned at End | (Instr. 4) ity | Reported | of Month | (Instr. 5)| Transaction(s) | (Instr. 4) | | (Inst. 4) | | - ------------|------------------|------------------------|-------------------------------- | | | - ------------|------------------|------------------------|-------------------------------- | | | - ------------|------------------|------------------------|-------------------------------- | | | - ------------|------------------|------------------------|-------------------------------- | | | - ------------|------------------|------------------------|-------------------------------- | | | - ------------|------------------|------------------------|-------------------------------- | | | - ----------------------------------------------------------------------------------------- Explanation of Responses: /s/ Ralph J. Daigle 8/29/02 -------------------------------- -------- Signature of Reporting Person** Date Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). ** 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. Page 2
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