-----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, RyFXwZrUfJzJ+DDwHUoUKG2skGSl29L+Zp1IqOu9ftG82cguI9VPnC7EYYCOf4kl 3lHbYo9kUVa9FBBRcbOaKQ== 0000950129-02-004556.txt : 20020911 0000950129-02-004556.hdr.sgml : 20020911 20020911125411 ACCESSION NUMBER: 0000950129-02-004556 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020802 FILED AS OF DATE: 20020911 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: 02761435 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 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: NORDBERG E WAYNE CENTRAL INDEX KEY: 0001111624 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2 WORLD TRADE CENTER 85TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10048 BUSINESS PHONE: 2124324506 MAIL ADDRESS: STREET 1: 2 WORLD TRDE CENTER 85TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10048 4 1 h99726e4.htm NORDBERG, E. WAYNE FOR PETROQUEST ENERGY, INC. e4
 

OMB APPROVAL
OMB Number: 3235-0287
Expires: January 31, 2005
Estimated average burden
hours per response...0.5


UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 4

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(h) of the Investment Company Act of 1940

o Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).

1. Name and Address of Reporting
Person*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Nordberg, E. Wayne
  PetroQuest Energy, Inc. - PQUE
 
  (Last) (First) (Middle)        
  61 Broadway, 31st Floor
4. Statement for Month/Day/Year 5. If Amendment, Date of Original (Month/Day/Year)
    August 2002
 
  (Street)        
    6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Filing
(Check Applicable Line)
  New York, New York 10006
(City)        (State)        (Zip)
  x  Director o  10% Owner   x Form Filed by One Reporting Person
    o  Officer (give title below)   o Form Filed by More than One Reporting Person
    o  Other (specify below)  
     
     

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).
 


 

                                               

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)
2. Transaction
Date

(Month/Day/Year)
2A. Deemed Exe-
cution Date,
if any

(Month/Day/Year)
3. Transaction
Code

(Instr. 8)
4. Securities Acquired (A) or
Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Sec-
urities Beneficially
Owned Following
Reported Trans-
action(s)

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

              Code V   Amount (A)
or
(D)
Price            

  Common Stock                   295,000     D  

  Common Stock                   72,160(1)     I   By wife

  Common Stock                   70,000     I   (2)

  Common Stock                   80,000     I   (3)

  Common Stock   8/2/02     P   10,000   A     $3.79     10,000     I   (4)

                         

                         

                         

                         

                         

1. 160 of these shares are held in a custodial account (of which Janet Mavec is the custodian) for the benefit of Akasha Mavec
2. By Olivia S. Nordberg Trust
3. By Anna & Samuel Nordberg Trust
4. By Hollow Brook Associates, LLC Defined Benefit Pension Plan

2


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security

(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction
Date

(Month/Day/Year)
3A.  Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction
Code

(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                      Code V   (A) (D)

               

               

               

               

               

               

               

               

               

               

3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount
of Underlying Securities

(Instr. 3 and 4)
8. Price of Derivative
Security

(Instr. 5)
9. Number of Derivative Securities
Beneficially Owned Following
Reported Transaction(s)

(Instr. 4)
10. Ownership Form of
Derivative Security:
Direct (D) or
Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

                   

                   

                   

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

/s/ E. Wayne Nordberg   9/11/02

**Signature of Reporting Person
 
Date


**   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.
 

-----END PRIVACY-ENHANCED MESSAGE-----