-----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, K9LNh0anK74iYgvxs5PlTWDjAY+FxKCvnuUJs1CeWbtSClMvCtihimSaj4MsBA0P 59iAC8PrB9ZHmnTKTnLe1w== 0000914121-00-000022.txt : 20000107 0000914121-00-000022.hdr.sgml : 20000107 ACCESSION NUMBER: 0000914121-00-000022 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000106 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LODGIAN INC CENTRAL INDEX KEY: 0001066138 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] IRS NUMBER: 522093696 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-14537 FILM NUMBER: 502298 BUSINESS ADDRESS: STREET 1: 3445 PEACHTREE ROAD N E SUITE 700 CITY: ATLANTA STATE: CA ZIP: 30326 BUSINESS PHONE: 4043649400 MAIL ADDRESS: STREET 1: 3445 PEACHTREE ROAD N E SUITE 700 CITY: ATLANTA STATE: CA ZIP: 30326 COMPANY DATA: COMPANY CONFORMED NAME: LANG JOHN M CENTRAL INDEX KEY: 0001074125 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 3399 PEACHTREE ROAD N E SUITE 2050 CITY: ATLANTA STATE: GA ZIP: 30326 BUSINESS PHONE: 4048129003 MAIL ADDRESS: STREET 1: 3399 PEACHTREE ROAD N E SUITE 2050 CITY: ATLANTA STATE: GA ZIP: 30326 4 1 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP - ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 Washington, D.C. 20549 OMB Approval - ------------------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------------ [ ] Check this box if no OMB Number: 3235-0287 longer subject to Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires: December 31, 2001 Section 16. Form 4 Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden or Form 5 obligations Section 30(f) of the Investment Company Act of 1940 hours per response.......0.5 may continue. See ------------------------------ Instruction 1(b).
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker 4. Statement for 6. Relationship of Reporting Person(s) or Trading Symbol Month/Year to Issuer (Check all applicable) Lang John M. Lodgian, Inc. 12/99 [X] Director [ ] 10% Owner ------------------------------------ LOD [ ] Officer (give [ ] Other (Last) (First) (Middle) title below) (specify below) 3399 Peachtree Road, N.E., Suite 2050 --------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------- (Street) 3. I.R.S. Identification 5. If Amendment, 7. Individual or Joint/Group Filing Number of Reporting Date of (Check Applicable Line) Person, if an entity Original [X] Form Filed by One Reporting Person Atlanta GA 30326 (Voluntary) (Month/Year) [ ] Form Filed by More than One ------------------------------------ Reporting Person (City) (State) (Zip) - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Code (Instr. or Disposed of (D) Securities Form: Indirect Date 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Month/ Owned at End or Indirect Ownership Day/ of Month (I) (Instr. 4) Year) (Instr. 3 (Instr. 4) and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V Amount (A) or (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 1/1/99 (1) A V 1,231 A 4.875 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 4/1/99 (1) A V 1,231 A 4.4375 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 7/1/99 (1) A V 1,231 A 6.5625 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 10/1/99 (1) A V 1,231 A 3.75 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 12/1/99 (2) J (3) 992 A 6.125 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 12/1/99 (2) J (3) 6,124 A 6.125 353,950 (4) D,I By joint $.01 per share title with Spouse - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 12/1/99 (2) J (3) 15,794 A 6.125 353,950 (4) I By P.T. $.01 per share Partners, LLC, of which the Reporting Person is Manager. - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 12/29/99 G 8,040 D 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 12/29/99 G 8,040 A 353,950 (4) I By Trust for $.01 per share benefit of children - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 1/6/2000 G V 8,142 D 353,950 (4) D $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 1/6/2000 G V 8,142 A 353,950 (4) I By Trust for $.01 per share benefit of children - ------------------------------------------------------------------------------------------------------------------------------------ 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). Page 1 of 2 SEC 1475 (3-99)
FORM 4 (continued)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of of sion or action action Derivative Exer- and of of ship Indirect Deri- Exercise Date Code Securities cisable Amount Deri- Deri- Form Beneficial vative Price of (Instr. Acquired (A) and Expi- of vative vative of Deri- Ownership Secu- Deri- (Month/ 8) or Disposed ration Under- Secu- Secu- vative (Instr. 4) rity vative Day/ of (D) Date lying rity rities Security: (Instr. Security Year) (Instr. 3, (Month/ Securi- (Instr. Benefi- Direct 3) 4, and 5) Day/ ties 5) cially (D) or Year) (Instr. Owned Indirect 3 and 4) at End (I) of (Instr. Month 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) Date Expir- Title Amount Exerci- ation or sable Date Number of Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) Date represents the date of grant by the issuer. The certificates for these shares were received December 17, 1999. The Reporting Person voluntarily reports the acquisition of these shares earlier than required pursuant to Rule 16a-4(g)(2) under the Securities Exchange Act of 1934, as amended. (2) Date represents the average date of receipt for all shares issued out of escrow to the Reporting Person or his affiliates, including P.T. Partners, LLC, of which the Reporting Person is sole member and manager. These shares were mailed April 12, 1999 via first class United States mail. (3) Shares acquired represent the portion of shares issued, but held in escrow, pursuant to the merger of Impac Hotel Group, LLC and Servico, Inc. on December 11, 1998 (the "Merger"), and which were released from escrow after the completion of certain hotels. The certificates representing these shares are dated October 28, 1999, but were received by the Reporting Person and his affiliates on or about December 1, 1999 and are therefore reported currently. (4) 117,842 shares are owned directly. This figure includes 7,116 shares released from escrow, 4,924 shares received from the issuer pursuant to director compensation, and total distributions to trusts for the benefit of the Reporting Person's children of 16,182 shares, all of which are reported on this Form. 236,108 shares are owned indirectly, including 15,794 shares released from escrow and 16,182 shares contributed to trusts for the benefit of the Reporting Person's children. According to the relationship previously reported on the Reporting Person's Form 3 Initial Statement of Beneficial Ownership of Securities, the Reporting Person may be deemed to be the beneficial owner of 15,794 shares received from escrow by P.T. Partners LLC. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. and 15 U.S.C. 78ff(a). By: /S/ John M. Lang January 6, 2000 -------------------------------------- --------------------------- ** Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless form displays a currently valid OMB number. Page 2 of 2 SEC 1475 (3-99)
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